Foodsmart Pediatrics Program
ITEMS COMING SOON:
Macro/Micro Nutrient recommendations by age
Growth chart information (understanding data parents might share)
Scope/personal/organizational scope (highlighting talking points for RDs)
Infants (0-6 months):
Breast milk and/or infant formula should be the sole source of nutrition for the first 6 months of life.
Infants should consume about 2.5 ounces of formula per pound of body weight per day, divided into several feedings.
Vitamin D supplementation is recommended, as breast milk and infant formula may not provide enough.
Solid foods should not be introduced until around 6 months of age.
Infants (6-12 months):
Breast milk or infant formula should still be the main source of nutrition, with the introduction of solid foods.
Iron-rich foods should be introduced, such as pureed meats, fortified cereals, and legumes.
Cow's milk should not be given as a main drink until after 12 months of age.
Finger foods and self-feeding can be introduced around 8-10 months of age.
Toddlers (1-3 years):
Toddlers should be consuming a variety of foods from all food groups, including fruits, vegetables, grains, protein foods, and dairy.
Portion sizes should be appropriate for their age and activity level.
Whole milk or 2% milk is recommended, as they provide needed fat and calories for growth and development.
Limit sugary drinks and foods, as they can displace nutrient-dense foods in the diet.
Preschoolers (3-5 years):
Preschoolers should be encouraged to consume a variety of foods from all food groups, with emphasis on whole grains, fruits, and vegetables.
Limit sugary drinks and foods, and encourage water as the main beverage.
Encourage physical activity and limit screen time to 1-2 hours per day.
Consider supplementing with a multivitamin if the child's diet is lacking in certain nutrients.
School-age children (6-12 years):
Encourage a balanced diet with plenty of fruits, vegetables, whole grains, lean protein, and low-fat dairy.
Limit processed and fast foods, and encourage home-cooked meals.
Encourage physical activity and limit sedentary activities.
Involve children in meal planning and preparation to promote healthy eating habits.
Overall, it is important to individualize nutrition guidance based on the child's age, growth and development, and any underlying health conditions or nutritional needs. Consulting with a registered dietitian can be helpful in developing a personalized nutrition plan for children.
Adolescents (13-18 years):
Encourage a balanced diet with plenty of fruits, vegetables, whole grains, lean protein, and low-fat dairy.
Encourage consumption of nutrient-dense foods and limit intake of high-calorie, low-nutrient foods and drinks.
Encourage drinking plenty of water and avoiding sugary drinks and energy drinks.
Adolescents need more iron and calcium, so make sure to include foods like red meat, poultry, fish, beans, dairy products, and leafy greens in their diet.
Encourage physical activity for at least 60 minutes per day.
Be aware of the risk of disordered eating behaviors and promote a positive body image and healthy attitudes towards food and weight.
Limit intake of caffeine to less than 100 mg per day (the amount in one cup of coffee).
Talk to your adolescent about the risks of smoking, vaping, and other substance use, which can have negative effects on nutrition status.
It is important to note that individual nutrition needs can vary based on factors such as gender, growth and development, activity level, and any underlying health conditions.
Pediatric 12-Module Care Pathway:
Module 1: Introduction to Pediatric Nutrition Care
Overview of the importance of nutrition for children's growth and development
Key nutritional considerations for infants, toddlers, and school-aged children
Nutrient recommendations for children at different stages of development
Pediatric nutrition care is an essential aspect of children's growth and development. Proper nutrition during infancy, childhood, and adolescence helps support normal growth and development, cognitive function, and immune function. It is essential for registered dietitians working with children to have a strong foundation in pediatric nutrition to provide appropriate guidance to parents and caregivers.
Infancy is a critical period for nutrition because it sets the stage for future growth and development. Breastfeeding is recommended as the optimal source of nutrition for infants as it provides optimal nutrition and immune protection. Infants who are unable to breastfeed should be provided with an iron-fortified infant formula that is appropriate for their age.
During early childhood, it is important to promote a variety of foods and nutrients to support growth and development. The Dietary Guidelines for Americans recommends that children between the ages of 2 and 5 consume a variety of nutrient-dense foods from all food groups, including fruits, vegetables, whole grains, lean protein, and low-fat dairy. Additionally, parents should be encouraged to limit intake of sugar-sweetened beverages, high-fat foods, and foods with added sugars.
As children enter school-age, the focus shifts to promoting healthy habits and supporting their growing bodies. It is important to emphasize the importance of a balanced and varied diet that meets the nutrient needs of growing children. Encouraging family meals and involving children in meal planning and preparation can promote healthy eating habits and positive relationships with food.
Module 2: Picky Eating - building a food profile for your child
Strategies for dealing with picky eaters
Encouraging children to try new foods
Balancing nutrient needs with food preferences
Picky eating is a common issue that many parents and caregivers face when feeding children. It is important for registered dietitians to understand the causes and consequences of picky eating to provide appropriate guidance to parents and caregivers. Picky eating can have a negative impact on children's growth and development if it leads to limited food variety and inadequate nutrient intake.
Picky eating can stem from a variety of factors, including genetics, sensory processing difficulties, and environmental factors. While some children may appear to be picky eaters due to behavioral issues or stubbornness, for many children, picky eating is a genuine struggle that can impact their overall health and well-being.
One reason why picky eating isn't just "bad behavior" is that it can be rooted in sensory processing issues. Some children may be highly sensitive to certain textures, tastes, or smells, which can make certain foods unappealing or even intolerable. For example, a child with sensory processing difficulties may be unable to tolerate the texture of certain fruits or vegetables, making it challenging for them to consume a balanced and varied diet. When you are meeting with the parent of a picky eater, asking questions similar to the following can be helpful:
Does your child have sensitivities to other things like:
Fabrics
Temperature
Volume or certain sounds
Moisture
Colors
General overstimulation
If so, what don’t they like?
What about it bothers them?
Identifying some triggers could be helpful and correlate to food aversions. Even if there isn’t a correlation between rough fabrics and food, having this discussion with a parent can still help to provide insight into how their child navigates through the world around them. Insight and knowledge is power, especially for parents, and even more so when children are unable to clearly express themselves! If they only have food-focused sensitivities, it may be helpful to bring the child into the conversation in a more tangible way and allow them to “play with” certain foods and describe them. Those descriptive words can be illuminating for the RD and parent alike.
When they are describing food items, here are some ways to be a detective and find out how to help them:
RD: You said broccoli is yucky - I hear you! Why is that?
Child: It just is, it’s gross!
RD: Well I want to hear all about it. How does it look on your plate? What does it look like?
Child: It looks like a tree.
RD: I see. Trees can be beautiful, don’t you think? What’s wrong with this tree.
Child: It’s yucky! It’s too big for me.
RD: Ah, does it take up too much space on your plate? Or in your mouth when you take a bite?
Child: Both! It’s scratchy and tastes funny.
RD: What about other things on your plate, do you like those? No?! Why not?
Child: Because they taste like broccoli and that’s yucky!
In the above example, I’ve now learned a few things:
The color and shape don’t seem to be an issue
The child doesn’t like other foods when broccoli is on the same plate
Food touching/mixing could be a challenge
It’s scratchy and tastes funny
“Scratchy” tells me that the texture is off
Tastes “funny” could mean that they aren’t sure quite how they feel about it yet because everything else is overstimulating them, reducing their ability to decide if they “like” it
In this case, we want to reintroduce the food in not just one, but several different ways to normalize the items. Examples could include:
Letting them “play” with their food - literally. Give them fruits and veggies to play with (safety and appropriateness first though!). Let them put stickers on them, touch and learn how they feel, make it fun!
Adding the item to a food you know they already like - broccoli cheddar soup for example. If they turn their nose up or don’t like it, just allow it to sit there and tell them to inspect it - encourage them to be a detective. If their behavior is negative, react as minimally as possible while acknowledging their feelings.
Serve the item in a separate bowl
Add toppings and dips
And just keep trying. Don’t make a spectacle if they do try something - just continue on and ask questions in a normal tone of voice.
Picky eating can also be influenced by genetic factors. Some children may have a heightened sensitivity to bitterness, which can make it difficult for them to consume certain types of food, such as leafy greens or cruciferous vegetables. Additionally, children who are genetically predisposed to obesity may be more likely to be picky eaters, as they may have a reduced appetite and an aversion to certain types of food.
Finally, picky eating can be influenced by environmental factors, such as feeding practices and cultural influences. For example, children who are pressured to eat or who are rewarded for eating certain foods may develop negative associations with those foods, making it difficult for them to eat them in the future. Additionally, children who live in households where certain foods are not readily available may be more likely to be picky eaters, as they may not have the opportunity to develop a taste for those foods.
Here are some suggestions for helping picky eaters:
Involve them in meal planning and preparation: Let your child help choose recipes or ingredients for meals, and involve them in preparing the meal. This can help them feel more invested in the food and more likely to try new things.
Offer a variety of foods: Offer a variety of fruits, vegetables, whole grains, lean proteins, and low-fat dairy at meals and snacks. This can expose your child to new flavors and textures and help them develop a more diverse palate.
Let them explore with all their senses: Encourage your child to explore their food with all of their senses, including sight, smell, touch, and taste. This can help them become more comfortable with new foods and flavors.
Try different cooking methods: Experiment with different cooking methods, such as roasting, grilling, steaming, or baking, to see which ones your child prefers. For example, your child may prefer steamed broccoli to raw broccoli.
Don't force them to eat: Forcing your child to eat or using food as a reward or punishment can create negative associations with food and lead to picky eating. Instead, offer a variety of foods and let your child choose what they want to eat.
Offer dips and sauces: Kids often enjoy dipping their food into sauces or dressings, which can make new foods more appealing. Try offering hummus, salsa, yogurt dip, or a favorite salad dressing as a dip for vegetables or whole-grain crackers.
Be a role model: Show your child that you enjoy a variety of foods and make healthy choices yourself. Kids are more likely to try new foods if they see their parents and caregivers eating them.
One approach to managing picky eating is to offer a variety of foods and allow children to decide how much to eat. Repeated exposure to new foods can also help children become more accepting of them over time. It is important for parents and caregivers to model healthy eating behaviors and avoid pressuring children to eat.
Registered dietitians can also provide guidance on appropriate meal and snack patterns for picky eaters. Encouraging small, frequent meals and snacks throughout the day can help ensure adequate nutrient intake. Additionally, incorporating favorite foods into meals and providing a variety of textures can help make mealtime more enjoyable for picky eaters.
Module 3: Food Allergies
Identifying food allergies and sensitivities
Strategies for managing food allergies in children
Nutritional considerations for children with food allergies
Food allergies affect an estimated 5% of children in the United States, and can have significant impacts on their growth, development, and overall health. It is important for registered dietitians to have a strong understanding of food allergies and how to provide appropriate nutrition care for affected children.
But what is an allergy? In short terms, a food allergy is an immune system reaction to a particular food, where even a small amount of exposure can trigger a severe and potentially life-threatening reaction. A food sensitivity (or food intolerance) is a non-immune system reaction to a particular food, where the body has difficulty digesting or processing certain components of the food. Symptoms of food sensitivity can range from mild to severe and may include gastrointestinal symptoms, skin irritation, or respiratory problems. Food intolerance does not involve the immune system and is generally less severe than a food allergy.
The most common types of food allergies are allergies to peanuts, tree nuts (such as walnuts and almonds), shellfish, fish, milk, eggs, soy, and wheat. Sesame is another allergy type that is on the rise in children and young adults.
Food sensitivities or intolerances can vary widely depending on the individual and their digestive system, but some of the most common types include lactose intolerance, gluten intolerance or celiac disease, and sensitivity to food additives such as MSG, sulfites, or artificial sweeteners. Other common food sensitivities may include reactions to specific types of food such as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) found in certain fruits, vegetables, and grains, as well as histamine intolerance which can be caused by foods that contain high levels of histamine such as fermented foods, aged cheese, and cured meats.
The first step in managing food allergies is to identify the allergen(s) and eliminate them from the child's diet. It is important to work with a healthcare team to develop a plan for managing allergic reactions, and to ensure that the child's diet remains nutritionally adequate. Registered dietitians can work with families to provide guidance on appropriate substitutions for allergenic foods, as well as strategies for avoiding cross-contamination in food preparation.
For infants with food allergies, it is important to ensure that they are receiving appropriate nutrition to support growth and development. Specialized infant formulas are available for infants with certain food allergies. For older children, it may be necessary to supplement the diet with certain nutrients to ensure adequate intake.
Helping children with food allergies at school or outside the home requires a collaborative effort between parents, school staff, and healthcare providers. Here are some tips for supporting children with food allergies at school:
Educate school staff: It's important to ensure that school staff, including teachers, cafeteria workers, and bus drivers, are aware of the child's food allergies, the symptoms of an allergic reaction, and what to do in case of an emergency. This can be done through training sessions or written information provided to school staff.
Develop an allergy action plan: An allergy action plan outlines the child's specific food allergies, symptoms of a reaction, and steps to take in case of an emergency. This plan should be developed with input from the child's healthcare provider and shared with school staff, parents, and the child.
Communicate with other parents: It's important to communicate with other parents of children in the same class or on the same bus about the child's food allergies, and to ask for their cooperation in avoiding allergenic foods when sending snacks or treats to school.
Encourage hand washing: Encourage children to wash their hands before and after eating to reduce the risk of cross-contamination.
Pack safe snacks and meals: Parents can provide their child with safe snacks and meals to bring to school to ensure that they have access to food that is free from allergens.
Consider accommodations: In some cases, accommodations may need to be made, such as providing a designated allergen-free lunch table or allowing the child to carry an epinephrine auto-injector with them at all times. Unique accommodations can also help, like adding a label or tag to their lunchbox, a button to wear during lunchtime, or a reminder card for children who can read their own labels.
Module 4: Healthy Body Image and Habits
Teaching children about body positivity and self-esteem
Strategies for promoting healthy eating habits and a positive relationship with food
Tips for preventing disordered eating in children and adolescents
As registered dietitians, it is important to promote healthy body image and habits while encouraging healthy food choices in children. This includes emphasizing the importance of a balanced diet, rather than focusing solely on weight or body size. It is important to encourage physical activity and healthy habits, such as getting enough sleep and managing stress, in addition to making healthy food choices.
To promote healthy body image, registered dietitians can encourage parents and caregivers to avoid making negative comments about their own or their child's body, and to focus on positive aspects such as strength and health. It is important to emphasize that every body is unique and to avoid comparing children to others. It is important for parents, guardians, teachers, and healthcare professionals alike to be aware of the signs and symptoms of disordered eating in children of any age, as these patterns can develop early and worsen if undetected.
Examples of some signs and symptoms include:
Skipping meals or avoiding certain food groups
Extreme concern with body weight or shape
Talking about what size they are, only wanting to try on certain sizes when they are clothes shopping, avoiding shopping in person or online, comparing their looks/size with other people they know
Listening to the way their peers discuss body weight, size, and shape is also important to note
Obsessive counting of calories, fat grams, or carbohydrates
Being overly aware of calories or very specific with measuring food items at a young age is a red flag
Preoccupation with food, weight, and body shape
Talking about food in terms of substance vs. taste/flavor/enjoyment
Avoiding social situations that involve food
Not eating lunch in the cafeteria, not wanting to eat at the table at home, not attending food-focused outings or events
Feeling guilty or ashamed after eating
This can be very clearly related to food or come out in other ways - tears after dinner when attempting homework, change in mood around showertime after dinner, look for distinct changes in behavior that may have no noticeable trigger or something new
Exercising excessively or engaging in high-intensity exercise despite pain or injury
Look at reasons for exercise, where and when they choose to exercise, if they exercise alone or with others, what they wear to exercise, and their mood and level of energy before and after
Using laxatives, diet pills, or other weight-loss products
Binge eating or purging behaviors, such as vomiting or using diuretics
Withdrawing from friends and family or becoming socially isolated.
Module 5: Nutrition and Behavior Connections
Understanding the connection between nutrition and behavior
Strategies for managing behavior through diet and lifestyle changes
Tips for promoting positive behavior through healthy eating habits
Nutrition and behavioral health are closely connected in humans, but it’s importable to note especially in children as they grow. Research indicates that a child's diet can affect their mental health, behavior, and cognitive function presently and over time and into adulthood. Here are some examples of the scientific evidence linking nutrition and behavioral health in children:
Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in fatty fish, nuts, and seeds. Research has shown that children with behavioral disorders, such as ADHD, may have lower levels of omega-3 fatty acids in their diet. Studies have also suggested that supplementing with omega-3 fatty acids may improve symptoms of ADHD in children.
Sugar: Sugar is a tricky one. There are some studies that have shown a correlation between high sugar intake and behavioral problems, including hyperactivity and inattention in children (2011, Journal of Child Psychology and Psychiatry). However, other studies since that time have disproven the impact of sugar on behavior, stating that it is overtimes the circumstance more than the sugar itself that impacts behavior. Consider; when do most children have sugar? The answer - holidays, parties, events, special occasions, with other friends/peers present, to keep them distracted, etc.
Micronutrients: Micronutrients such as iron, zinc, and vitamin B12 are important for brain function and cognitive development in children. Research has shown that children with deficiencies in these nutrients may have an increased risk of behavioral problems, including anxiety and depression.
Gut microbiome: The gut microbiome plays a crucial role in the development of the brain and the regulation of mood and behavior. Research has shown that a healthy and diverse gut microbiome may be beneficial for mental health in children.
Diet quality: A healthy diet that includes a variety of fruits, vegetables, whole grains, and lean proteins is associated with better mental health outcomes in children. A 2017 study published in the Journal of the Academy of Nutrition and Dietetics found that children who consumed a diet high in fruits, vegetables, and whole grains had lower levels of anxiety and depression.
Like the example provided in the sugar section above, it is challenging to say “what came first, the diet or the environment?” Another example is gut microbiome and diet quality - is it the specific items themselves leading to improved behavior, or that children with access to those foods and who are surrounded guardians/professionals who can provide education, support, and encouragement to eat those foods are generally receiving care unique to those without poverty, exclusion, etc.
Module 6: Promoting Healthy Eating Habits
Encouraging families to eat together
Teaching children about balanced meals and portion sizes
Strategies for incorporating fruits and vegetables into meals and snacks
There is a strong connection between nutrition and behavior in children. As registered dietitians, it is important to understand how diet can impact behavior and to provide guidance on how to promote healthy behavior through nutrition.
One important factor is the role of sugar and other additives in behavior. Excess sugar and artificial additives can lead to hyperactivity and other negative behaviors in some children. Encouraging parents and caregivers to limit these substances in their child's diet can help promote healthy behavior.
Registered dietitians can also provide guidance on the role of nutrient deficiencies in behavior. For example, inadequate intake of certain nutrients, such as iron or omega-3 fatty acids, can lead to behavioral issues such as poor concentration or irritability. Encouraging parents and caregivers to provide a balanced and varied diet can help ensure that children are getting the nutrients they need for healthy behavior.
Module 7: Meal Planning and Preparation
Strategies for meal planning and preparation
Tips for making healthy meals on a budget
Encouraging families to cook at home and avoid fast food and processed foods
Infancy and early childhood are critical periods for growth and development, and nutrition plays a key role in ensuring optimal outcomes. As registered dietitians, it is important to provide guidance on appropriate nutrition for infants and toddlers, including recommendations for breastfeeding and introduction of solid foods.
For infants, breast milk is the optimal source of nutrition, providing all the nutrients they need for healthy growth and development. Registered dietitians can provide education and support for mothers who are breastfeeding, as well as guidance on appropriate formula selection for those who are not.
As infants transition to solid foods, registered dietitians can provide guidance on appropriate timing and selection of foods. This includes introducing a variety of nutrient-dense foods, such as fruits, vegetables, whole grains, and lean proteins. It is also important to avoid foods that pose choking hazards, such as nuts, popcorn, and hard candy.
Module 8: Sports Nutrition for Children and Adolescents
Nutritional considerations for children and adolescents who participate in sports
Strategies for fueling children's bodies before and after exercise
Tips for staying hydrated during exercise
Food allergies and intolerances can have a significant impact on a child's nutrition and overall health. As registered dietitians, it is important to understand the difference between these conditions and to provide appropriate guidance for managing them.
Food allergies involve an immune system response to certain foods, which can range from mild to severe and potentially life-threatening. Registered dietitians can work with parents and caregivers to identify and avoid foods that trigger an allergic reaction, and to provide guidance on appropriate alternative food choices to ensure adequate nutrition.
Food intolerances involve a non-immune system response to certain foods, such as lactose intolerance or gluten sensitivity. Registered dietitians can provide guidance on appropriate food choices and alternative sources of nutrients to ensure adequate nutrition while avoiding trigger foods.
Module 9: Vegetarian and Vegan Diets for Children
Nutritional considerations for children on vegetarian and vegan diets
Strategies for ensuring adequate nutrient intake on plant-based diets
Tips for incorporating a variety of plant-based foods into meals
Children with special health needs, such as those with chronic illnesses or developmental disabilities, may have unique nutrition needs and challenges. As registered dietitians, it is important to understand these needs and provide appropriate guidance for managing them.
For example, children with certain chronic illnesses may have restrictions on certain nutrients or require specialized diets. Registered dietitians can work with the child's healthcare team to develop appropriate nutrition plans and provide education and support for parents and caregivers.
Children with developmental disabilities may have challenges with feeding and may require specialized feeding techniques or assistive devices. Registered dietitians can work with the child's healthcare team and family to develop appropriate feeding plans and provide education and support on feeding techniques and nutrition needs.
In conclusion, as registered dietitians, it is important to understand and provide appropriate guidance on infant and toddler nutrition, food allergies and intolerances, and nutrition for children with special health needs. This can include providing guidance on appropriate foods and alternative sources of nutrients, developing specialized nutrition plans, and providing education and support for parents and caregivers.
Module 10: Nutritional Supplements for Children
Understanding the role of nutritional supplements in children's diets
Identifying when supplements may be necessary
Discussing the potential risks and benefits of supplements with parents
Nutrition can have a significant impact on behavior, and as registered dietitians, it is important to understand the relationship between the two and provide appropriate guidance for managing behavior through nutrition.
Research has shown that a diet high in sugar, artificial colors, and preservatives may contribute to hyperactivity and other behavioral problems in children. On the other hand, a diet high in nutrient-dense foods, such as fruits, vegetables, and whole grains, can promote positive behavior and mood.
Registered dietitians can work with parents and caregivers to develop appropriate nutrition plans that promote positive behavior, such as providing guidance on limiting sugar and processed foods and increasing intake of nutrient-dense foods. It is also important to address any underlying nutrition deficiencies that may be contributing to negative behavior.
Module 11: Encouraging Healthy Habits Outside of the Home
Strategies for promoting healthy eating habits outside of the home
Tips for navigating school lunches and social events
Encouraging physical activity and limiting screen time
As registered dietitians, it is important to promote healthy body image and habits in children, and to provide guidance on developing a healthy relationship with food and their bodies.
This includes providing education on appropriate portion sizes, encouraging a variety of nutrient-dense foods, and promoting regular physical activity. It is also important to address any negative attitudes or beliefs about food or body image and promote positive self-talk and self-esteem.
Registered dietitians can work with parents and caregivers to model positive behaviors and attitudes, and to provide education and support for developing a healthy relationship with food and their bodies.
Module 12: Supporting Families in Making Sustainable Lifestyle Changes
Encouraging families to make sustainable lifestyle changes
Identifying barriers to healthy eating and developing strategies to overcome them
Providing ongoing support and guidance to families in making healthy choices
In conclusion, as registered dietitians, it is important to provide evidence-based nutrition guidance and support for parents and caregivers to promote optimal nutrition and health outcomes for children. This includes providing education and support on a range of nutrition topics, such as picky eating, food allergies, infant and toddler nutrition, and nutrition for children with special health needs.
It is also important to promote healthy behaviors and attitudes towards food and body image, and to address any underlying nutrition deficiencies or health conditions that may impact nutrition. Finally, ongoing maintenance and follow-up is important to ensure that nutrition goals are being met and to address any challenges or changes in nutrition needs over time.