A Parent Playbook Resource

Live Q & A with Alyson Martinez

Recorded September 29, 2021

Parent Playbook with Dr Dina Kulik  - Author Alyson Martinez

Alyson Martinez, RD

Registered Dietitian

Alyson is a Registered Dietitian with over a decade of experience, working with infants and children to overcome all types of nutrition issues. She has gained her skills working in the paediatric department of an academic acute care hospital, and also maintains a private nutrition counselling practice.

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Full Transcript

Recorded September 29, 2021


If you’re just joining now welcome.

I’m Alison. I’m a pediatric dietician with the parent playbook. And we were just speaking before you came in about starting to talk a little bit about ultra-processed foods.

So what I’m going to do is I’ll just talk for five minutes or so. And of course, if you have questions, throw them in the chat. And then after that,

I can start taking some of the questions that you have. So in terms of ultra-processed foods, like I think a lot of people get confused because there seem to be so many layers of foods. There’s like what’s processed foods versus what’s ultra-processed foods. So when you think about it, like a lot of foods are processed. If you buy, I’m trying to think of an example.

Like I’m trying to, coffee’s not a great one for kids, but you know what I mean? You’re not buying like a raw coffee bean. It’s going to be roasted and then maybe ground, if you buy it, bought it that way. And there’s nothing wrong with that. Even though it’s a process food and that’s no different than if you buy something like olives or olive oil or cheese or pasta that’s dried,

or, you know, all of these things are like natural processing methods that there’s nothing inherently harmful. And it’s all things that are either, you know, oh, yogurt. Yeah. Yogurt is the perfect example. Even though theoretically it’s processed using your bacterial culture and then milk, it’s a really healthy food, but it’s more so ultra processed brings it to the next level.

So ultra processed brings it to a level where you start using ingredients where you think about it, that the average home cook wouldn’t have. So if you’re using yogurt as a really good example, what you would say is, you know, plain yogurt that you buy is fine. But then when you start buying these like crazy sweetened kids yogurts that have extra thickeners and extra emulsifiers,

that’s when you get into that ultra processed level. So ultra processed foods are going to be foods that have like industrial ingredients and industrial additives that your average home cook wouldn’t have. And a lot of times, the way that you can tell a food is an ultra processed food is because when you read the label again, there are terms that you may not necessarily be familiar with.

Not that that’s a foolproof way to tell, but you know, things that, again, you wouldn’t necessarily have at home or the other thing to think about it in terms of ultra processed food, is if it’s like a packaged food, that’s easy to eat, it’s probably ultra processed. And the reason that we care so much about ultra processed foods is because we’re starting to eat more and more ultra processed foods and getting more calories from ultra processed foods.

And that in and of itself has negative impacts on our health. But the other thing is, as we replace other nutritious foods with ultra processed foods, it starts to turn into issues. So let’s maybe start with that first example, say you used to eat, you know, fruit and maybe some trail mix and yogurt for breakfast, right? And you start replacing that with something like pop tarts while you’re losing the fiber from the oatmeal,

you’re losing the healthy fats from the trail nuts. You’re losing the potassium, the magnesium, the fiber from the fruit, the oatmeal, et cetera. And you’re replacing it with something that’s higher in sugar, higher in refined fats, higher in calories, and then lower in fiber protein, vitamins, minerals, et cetera. So you start seeing this like shift happen.

The other problem about ultra processed foods is that we know that they have a number of impacts on the body, which I think that they’re probably just really starting to figure out the challenges for our health. So one example is we know that all of these industrial ingredients, so one classic example could be like modified Palm oil, right? We know that it causes low grade inflammation in the body,

and this can be measured through real things, like say for example, measurements like CRP. If someone is familiar with this, which is a measure of inflammation in the body, and that can lead to a number of health issues that have to do with things like risk for diabetes, heart disease, cholesterol, high blood pressure, cancer, et cetera. So again,

these are all associations, but we know that they’re more likely to be. You’re more likely to have these associations with the more ultra processed foods that you have. It’s also important for weight as well. Again, because often ultra processed foods are designed to like, be craveable. You want to eat a lot of them. The classic example is Doritos, right?

Like the number one favorite snack food in the world. But the problem three does is you have no idea how much you’re eating and you just keep eating more. So again, it’s much easier to eat more calories and put on more weight when you have more ultra processed foods. And then the other thing is the way that they’re packaged, we know that there are actually some weird health implications that come along with the packaging,

right? Whether some of these things, like the classic example would be BPA, which was in a lot of tins, for example, or some of the plastics that are used for packaging. So there’s like a few different ways that we know that they’re impacting our health. So it’s not that we’re aiming for zero ultra processed foods. We’re just aiming for less ultra processed foods.

So if you look at kids, about half of kids in Canada are getting more than 50% of their calories from ultra processed foods. And this gets worse and worse and worse with time, right? But like, you understand why you don’t really have time to cook. You need something convenient. Again, these foods are really marketed to kids, so they’re meant to love them and want to eat them.

So again, you’re put in a difficult situation, but it’s not that we’re aiming for zero ultra processed foods. The ultimate goal is to have less than a third of your calories as ultra processed foods. And you don’t need to do the math. That’s not the point of this. The point is just trying to find simple places that you could swap ultra processed foods for less processed foods more often.

Right? So say for example, we were talking about breakfast. Something like pop tarts. Another thing for breakfast is like cereals, right? A lot of cereals, especially if you think of things like fruit loops, frosted flakes, these are considered ultra processed. Versus if you had a really simple breakfast, that was like a slice of whole wheat toast,

for example, with maybe some nut butter on it, or some cheese that’s a swap or yogurt, instead of again, those like really sweetened kids yogurts just doing a plain yogurt without all the additives in it, and then adding your own fruit to it. Other examples could be things like chicken nuggets. And again, I know it’s harder to make them yourself,

but that could always be an option, right. Just doing like grilled or roasted chicken more often instead of chicken nuggets, for example, other things are like soup mixes. I wrote a list of some other things, cause I wanted to make sure I had them. And then a lot of the snacks goldfish are probably like the most classic example. And then interestingly,

a lot of baby food as well, especially now that you’re starting to see more baby food, that’s like toddler entrees, which you may see in the store as well. So again, it’s just trying to focus on these simpler or less processed foods. So you, they don’t have as much focus on I’m sorry, less processed foods. So that way we know that they’re going to be less calories or less nutrients coming from the ultra processed foods.

I’m just going to answer Betsy’s question cause she has a food. She has a question. Is it too sweet to add honey to plain yogurt? I really don’t think so. The only caveat is, especially for children who are less than 12 months. So babies know you honey, for them because of the risk of botulism. But I would personally rather you do like plain yogurt with a little bit of honey in it than something like a yogurt that you buy that has high fructose corn syrup.

Which again, I think is really well known, especially because it’s in pop and there’s a lot of more like media buzz about high fructose corn syrup. So that’s personally in my opinion, a much better solution. So that’s something that you could do. So it’s trying to find these really small things that you can do. So in terms of other swaps that I could say,

so we talked about yogurt, oh, instead of goldfish, just doing things like Triscuits with cheese. And I know it’s not like as exciting as goldfish, but they’re still really good. It’s still a nice snack. And then something like tomato sauces or Kraft dinner, if you buy a lot of tomato sauces, this is actually a really interesting fact. What do you think has more sugar in it?

Tomato sauce, like a Prego style, tomato sauce or lucky charms. So of course I set that up where you’re going to say, oh, it’s the tomato sauce, but it’s true. A lot of tomato sauces are considered ultra processed because the amount of additives they have in it. So instead what I would say is just getting something simple, like the string tomatoes,

and then putting like a little bit of pesto in it, for example, or you know, other these small things that you could do, or instead of doing Kraft dinner, there are some really easy sauces that you can make that are just made of cream cheese, right? So while your pasta is boiling, it’s just melting some cream cheese with a little bit of milk.

You could throw a little bit of extra like Parmesan in if you wanted. And it makes a nice sauce that tastes in my opinion, better than Kraft dinner, right? So it’s all these small things that you can do. So anyway, I would say, you know, if you can try to find any ways that you can substitute, it’s going to be a positive thing.

We’re not aiming for zero ultra processed foods. We’re just aiming for less. So anyway, if anyone has questions about ultra processed foods, I’d love to answer them. If you want to know if a food is ultra processed or not, we can even walk through an example if you want, but whatever works you guys, cause it’s, it’s all about you.

I’m just here to answer your questions. So if you do have any questions about ultra processed foods, feel free to write them in the chat. Or if you just want to go ahead straight to the actual nutrition questions, that’s okay with me as well. I’m just going to have a sip of water. The other thing is I tend to talk really fast.

So I apologize in advance, especially when I start getting like on a roll. So if I’m talking too fast, please tell me and I will slow down. So just let me have a sip of water while I give you a chance to answer any questions. So I see Angela had a question, but just because Erica has a question about ultra processed foods,

I’m going to go ahead and answer Erika’s question instead. So Erica has a question, are multi-grain Cheerios considered ultra processed foods. So you know what I’m going to actually do. I’m just going to open up the food label for multi-grain Cheerios and I can read it to you and I can actually walk you through it, which is one of the things that I really like to do.

So multi-grain Cheerios food label. So here we go. I’m on the Cheerio’s website for the Cheerios multigrain cereal, and let’s go through the label. So the ingredients, whole grain oats, whole grain, corn, sugar, and golden sugar. I actually don’t know what golden sugar is, but cornstarch brown, rice flour, whole millet flour, whole sorghum,

flour, golden syrup, salt, calcium carbonate, trisodium, phosphate, monoglycerides caramel and nano colors and took off for ALS. So some of the things in there that do stand out as ultra processed ingredients are going to be things like the trisodium. Phosphate is one preservative. The monoglycerides is, are preservative, but on the whole, a lot of other ingredients are ones that are recognizable.

So I think if we compare this to another cereal, like fruit loops, for example, you would see a big difference in terms of the types of ingredients. So this, even though the multi-grain Cheerios are ultra processed, it’s not to the same degree as some other cereals. So this is actually a good option to use. So I think that that could be one that you could think of.

Another one is Shreddies. Shreddies is a really good one that I think is underrated. That is a bit less ultra processed. Okay. Erica, I hope that answered your question. If anyone has questions about other foods, let me know. So Katrina is asking, am I able to give any less processed, packaged food suggestions for on the go? Actually,

I wrote a long list for one of my patients yesterday. So let me open it up. I have it in my Canva app. I’m glad I have my phone charged. Otherwise I’d be in trouble right now. Oh, and of course I got a new phone, so I have to log in. Okay. Just give me one second. I’ll try to be fast.

I wish I knew how to share my screen on Demio or else I would do that. Okay. My, I don’t know if anyone else is like a canvas addict, but I absolutely love Canva and I use it for everything. So let me go to my designs. And then here, some of the school snacks that are going to be less processed.

So some of the things like the Armstrong, cheese sticks, cheese sticks, some of the popcorn, like the Boomchickapop sea salt, popcorn, not all the flavors are, but a lot are something like some of the Cloverleaf, tuna snacks. They’re really good options. Some of the things like the dried apples. So like Ilan cinnamon apples are a really good option.

Some of the chips that are vegetable chips, so like hard bite vegetable chips, other cheese packs, like your Carlsberg cheese packs. Oh, Martin’s apple chips. Those are one of my personal favorites. There are some crackers. Like I mentioned, the Triscuits the Mary’s gluten-free herb organic crackers. I know I have another, the RW Garcia, three seed crackers,

cottage cheese, another underrated snack that I think is so good for kids. There are some like beef jerkies that have really simple ingredient lists. So that’s another thing that you could do. I don’t have a lot of granola bars on this list because I find that granola bars are often like highly processed and have a lot of calories. So honestly I’m not a huge fan of them.

So I didn’t write any on the list. Other types of crunchy snacks are going to be like the, you pick toasted coconut chips. Those are really good. The summer fresh snack and go hummus. The three farmer’s Pete pops, Sesame snaps, dried mango, dried pineapple, the roasted seaweed hope that’s enough. But yeah, there’s a long list that you can,

you can use. So anyway, I hope that answered your question Katrina. Okay. Now Liz has said for snacks, we often do Babybel cheese, PC, organic cereal bars puffs, baby, or may machines. How bad are these from an ultra processed food perspective? So some of them I think are better options, the baby bell cheese, for sure.

And then things like the cereal bars, like this is where Pinterest is really great, because there are a lot of cereal bar recipes that are just made from like oats and fruits. And not that you have to make everything right, like maybe sometimes buy them sometimes make them try to find the balance that works for you. Because again, we’re not aiming for perfection.

We’re just aiming for small changes. So I would say maybe relying on some of these other things that you could make instead, but a lot of like the kids’ snacks that are, these meltable snacks are really processed. And I would say, if you can replace them with like fruits, veggies, cheese, those are probably going to be a better route to go toast,

cutting to fingers. Those are personally, I’m more of a fan of the food manufacturer. Companies know how to get kids hooked early, right? Like you see the kids who are still in school and love bringing a baby. My mom’s to school, even though you really only need them between like age 12 months of life. So anyway, that’s just my personal rant as a dietician.

Okay. So Maria has asked how to identify ultra processed foods. So in terms of identifying ultra processed foods, and you’re going to look at the label for ingredients that the average cook wouldn’t have at home. And I know that that is a little bit deceiving in some ways, because you know, things like calcium carbonate is just like calcium. That’s fine.

Even though the average cook wouldn’t have it at home. But the other thing you could think of is if you look at the food, does it look like there’s any real food items in it? So if you think about it, like you think something like guacamole, right? You see chunks of avocado in it, you see chunks of tomato. You’re like,

oh, I know what’s in this food. Versus if you look at something like, I’m trying to think of an example, like Kraft dinner, you don’t see any cheese in it. You don’t see any wheat in it. There’s no like discernible food content. So sometimes you can look to see if there are those foods. I might Instagram, I made a post.

This was a while ago. The post was maybe back in January or so. And on Instagram, I’m at kids dot digestive dot dietician. And I actually included a list of all the different ingredients that are considered to be ultra processed. So you could just screenshot it and then you could take it to the grocery store with you. And it can give you something to look at.

I think if the food is ultra processed, so maybe look at that, that should help you. Okay. Jane has a question. How bad are hot dogs? What if they’re made by a butcher, can you please post this list or send after Jane? I’ll answer your question about the hot dogs. But my question for you is, is the list of the snacks that you’re looking for.

Just clarify if you want that list of snacks and if so, we’ll figure out a way to get it to you. I’m not sure how, if you could DM me on Instagram, that would actually be the best way, because I don’t have access to your email list just for privacy issues, but I can talk to Keith who’s our admin guy to figure it out.

But yes, if anyone wants anything like the resources, just get in touch with me and I can figure it out for you. Okay. Hotdogs. So I would consider hotdogs ultra process. But the nice thing is when you go to a butcher, that’s a bit more like natural, then there’s more control over. What’s put in it. And the things that I think I’m particularly like what I pay when I’m more mindful too,

is the types of preservatives used in them because we know that a lot of these preservatives and FA there’s considered like salts, phosphate, salts. They’re not great for health for kids or for adults. And we know that, especially in adults, kids, sorry, we know that an adults, adults who have more processed meats are more likely to again, have higher rates of inflammation in the body and then higher rates of cancer.

So, you know, hot dogs every once in a while are not a problem. But if you guys like to have sausages for breakfast, or it’s a bit more frequent thing, like more than once a week, then I would try to go to a butcher and get ones who are going to list what additives are in it, where the salts are going to be not as harmful.

So anyway, that’s just an option for you. I also have a list of some of the salts that are added to foods that are considered ultra processed on that post. Okay. Jane? I hope, I hope that helped. Okay. Katrina. Oh, thank you. Katrina. And then Celia has a question her 26 month old, who still eats baby gourmet purees every day as a snack hooked.

I promise you they are not the only one. The other thing that they’re doing now is like, you know, the baby core mate purees. Like if you have kids who are too young for school, but now they have like the kid versions to send in lunch bags, which is pretty much the exact same thing, just marketed for kids. And I always think like,

you know, there’s a time and a place for the purees are great, but we definitely want kids to develop their chewing skills. And I think that sometimes if they eat a lot of things that are still pureed, they don’t get that opportunity to really practice. So I would say, you know, don’t feel badly. Not all the time. I promise you.

They’re not the only one and just keep mixing it up. Like sometimes the baby may purees. And then other times like pieces of cut-up fruits are going to be a good opportunity. And then Liz has, baby gourmet is delicious. Mama is hooked to, you know, sometimes when I’ve been baking and I’ve been desperate and like, I couldn’t get mangoes in season.

I’ve actually bought the baby food mango and use that as like a mango puree and what I was baking. So anyway, you’re not the only one who buys it sometimes they’re still helpful. Okay. And then Celia is laughing at my comments. Betsy is asking about my Instagram. I’m just going to put it in the comments, kids dot digestive dot dietician.

Okay. There you go. Okay. And then I know that I did miss one question, Angela. I’m so sorry. Cause I’m scrolling back up and I know that you answered it, but I was on a roll about ultra processed foods. So I am going to get maybe to the nutrition questions now. So again, if you have nutrition questions,

pop them in the comments. I’m going to start off with Angeles. I’m just going to have some water first. Okay. So Angela has a question. What if a child is underweight and an extreme picky eater, what are good ways to ensure nutrition and calories? So this is a challenge because if you look at kids like the majority of them are picky eaters,

right? We say over 90% of toddlers are picky eaters. And then in adults only like two to 3% are picky eaters. So it is a natural phase of development, but it’s one that we grow out of because of the foods that kids really generally like to have when they’re picky eaters, even though it’s not a wide variety, they will eat enough to get enough calories,

but this is for the most part. And there are a subset of children who aren’t able to get enough calories and they’re small. And these are the ones that I think really need an extra degree of caution or support. So in terms of a child who’s underweight and an extreme picky eater, I definitely want to make sure you have the support of your pediatrician.

That’s going to be the most important thing because they are going to have to have that extra degree of caution of seeing, is there anything we can do about their appetite? Are there any contributing factors that are happening either from like a chewing, a swallowing, a digestive point of view, are they constipated, which is another really common reason why children will have a low appetite.

So a really thorough medical workup is going to be important, but separate from that, what you need to look at are the different food groups that your child is eating. Are they having meats and alternatives? Are they having some fruits and vegetables? And if it’s just fruit, that’s fine. Believe me, are they having some kind of grains? And then are they having some kind of dairy alternative?

Because say, for example, if they are missing an entire category, like if they are missing all fruits and vegetables, for example, it just means that again, they need a little bit of extra support in terms of making sure that they’re getting the vitamins and the minerals that they need. What I would say is there’s always ways to optimize more calories or to get more calories in.

So say for example, they really loved yogurt drinks. Well, maybe we’ll work on yogurt smoothies instead that are going to made with a high-fat yogurt, right? So most yogurt drinks are going to be like 1.5% fat, but maybe we could use it with a high-fat yogurt that has like five or 10% fact. Maybe we could put some protein powder in it,

right? Maybe say, for example, if they do like spreads, we could really go wild with using nut butter, seed, butters, butter, cheese, all these ways to add a little bit of extra calories. But I think with that combination of both being underweight and an extremely picky eater, it’s just making sure you have the medical care that you need.

And I do think you probably would need to see a dietician if not an occupational therapist as well, just to try to make sure that your child is supported. So if they need a little bit of extra TLC, so Angela, I hope that answered your question and then I’m just gonna scroll down. Cause I think I have some more questions coming up.

Okay. Oh, Wendy. Wendy has a question. So I’m going to read Wendy’s question in full. So when do you says eight, eight and a half month old doing baby led weaning eats well by himself except vegetables, exception being sweet potatoes, unless they are well folded into other foods. So for example, the vegetable that into the meatballs, I serve vegetables repeatedly in various farms and with seasonings and we modeled eating them.

I don’t understand why he would love sour plum, but not eat roasted sweet pepper. He ate the vegetables quite well for a few times at first and then decided not to eat them anymore. Sometimes he would eat small pieces. If I feed it to him, there’s a very small proportion of vegetables in his diet. He also doesn’t drink much water. I tried different bottles cups.

What’s your advice? When can I expect him to grow out of the dislike? In the meantime, can I offer more fruits in breast milk to compensate? Okay. When do you thank you so much for the detail. I’m a really type a person. So I love the detail that you put into that question. First off, I want to say it sounds like you’re doing an exceptional job with feeding your little guy.

This is really great. I’m happy to hear that he’s doing well with the baby led weaning. It seems like he’s got a lot of really nice foods going on. I do have to say everything is doing is very age appropriate, especially in terms of not being into vegetables. So the interesting thing about vegetables and babies is that they often don’t like them and it does take time.

So if you think about it, babies are hardwired to like sweet foods and to dislike bitter foods like vegetables. Because if you think about it from like an evolutionary point of view, babies had to like sweet foods because you know, we’re talking about like over 10,000 years ago, at least something sweet would be an immediate source of energy and calories, which is what you needed when you didn’t have a good food supply versus something like vegetables tasted bitter.

So it could be a sign of having toxins. So again, babies are hardwired to not like vegetables. So at this point, the most important thing you can do is a, be a good role model with eating vegetables, which I think you’re doing a really good job of the second thing that you can do is just keep offering them to him. Because again,

it often does take time. And the third thing, and I know this is really hard is just, don’t get discouraged. If you look at children who eat vegetables with time, the most, the number one predictor of that are having parents who eat vegetables. So as long as you guys are role modeling that, and you can, he has the opportunity to see you guys eating them.

You’re talking about them once he starts getting a bit older and his toddler years getting him involved at any age appropriate activities in the kitchen, gardening, if you, if it’s possible for you, all of these kinds of things, it will happen with time, right? I think you’re doing everything you can to set him up. In the meantime, the fruits are great.

They’re giving him the vitamin a they’re giving him the vitamin C the B vitamins, the fiber. So definitely offer both fruits and vegetables and it will come with time. It may not be next week. It may take a few months, but I always think too, in terms of like, when kids are learning to read, you don’t expect them to start off with like Russian literature.

And sometimes it’s sorta like that with eating, right? We want them to eat everything, but sometimes they need a little bit of time to learn and then to develop an appreciation. So give him the time. But everything you’re doing is setting him up for success. So in terms of the water, yeah, it takes some water. It takes some time for the babies to get used to water,

healthy babies. As long as you know, they have functioning heart functioning, kidneys, which 99% of babies do, their bodies will tell them when they need to drink more. So oftentimes if it’s warmer out, if you’re weaning, breastfeeding, sorry, I’ve got to turn this off my phone. If you’re weaning breastfeeding, then their body is going to tell them you need to drink more.

So that’s going to be a natural time when he’s going to drink a little bit more. In the meantime, I would continue to have the opportunity to offer whether a sippy cup, a straw cup. I personally am a big fan of straw cups. I think that they’re great for kids to learn. And even at eight and a half months, it will take him some time,

but he will learn to use the straw cup. And then once he gets the hang of it, you’ll be good. So I don’t think have to do anything special in terms of giving extra breast milk, I would continue to follow the feeding plan you’re on. Cause it sounds great to me and give him the time to get used to starting to drink water in a straw cup because I promise you it will come with time.

Okay. When do I hope that answered your question? If there was anything you need clarification about, then just let me know and I can clarify for you. Okay. Oh Angela. You’re welcome. Thank you for asking a question. So I’m going to answer Celia’s question. Celia says, I feel better that you said, if it’s just fruit, then it’s fine because my son doesn’t eat any vegetables at home,

but he’s a fruit monster. He eats veggies at school though. So that keeps me sane again, Celia, I promise you. You’re not the only one here. So it’s so funny. You know, the kids, they refuse to eat the food at home. They go to daycare, they eat everything there and they just won’t eat it at home.

So that’s fine. Leave them be, you know, there’s no better peer pressure than being at daycare at a table with all the other kids, seeing the meat. And we know that that’s like a big motivator for kids. So I wouldn’t be concerned about it again, nothing wrong with just having fruit. It sounds like you guys have veggies at home,

which is the best thing to do. It will happen with time. You know, like I said, trying to get him involved in the kitchen, trying to get involved with gardening, trying different flavors. I remember as a child, I never liked vegetables. And it was because my parents just cooked like the bland as vegetables with no seasoning. And then when I realized that you could see it in them,

I realized like how delicious they were. So maybe try different flavors as well for him. But I think with time it will happen. It’s just so hard to keep the patients, but feel comfortable. If he’s having fruit, he’s getting all the nutrition that he needs from fruit. So I hope that helps Celia. Okay. So Erica is asking a question,

is it okay to give a two and a half year old picky eater? The vitamin poly by Saul and Polyface all is, are really popular multivitamin and it’s the liquid multivitamin, sorry, my dog is making so much noise right now. I hope you can’t hear that in the background. So poly buy-sell is the liquid multivitamin that has vitamin a, it has vitamin C has vitamin B or multiple B vitamins.

So it is good for children. Now, I think in term it always, the thing to think about is what kind of picky eater they are. Cause say, for example, if they’re a picky eater who will eat fruits, eat vegetables, but just won’t have meat. Then the problem is poly by salt. Doesn’t have things like iron, like zinc,

which are things that you would need. So it may just be that it may not be the right fit for your child versus you have a child who’s like a carnivore loves meats, but isn’t as enthused about fruits or vegetables, then poly by polyvinyl can be a good option. So it’s really thinking about what food groups your child’s not having. And then what we do is we try to choose the right vitamins to make up for the nutrients that they’re not getting from that food.

So it would be something you could talk to your pediatrician or if you have a dietician about, and they could give you some more recommendations. This is all just sort of general stuff, but yeah, poly buy-sell is a very common multivitamin for toddlers. Yeah. Okay. I’m just going to take a break and have a sip of water. I have to say I’m really thrilled to see all the questions that you guys have.

I hope this is helpful for you because I do love answering them. And it’s nice to have a group of people who are like so enthusiastic. So okay. Now that I’ve had my water break, so Louisa has a question. When do you start to give vitamins to kids and how to choose a good vitamin for a four year old? So I would say in terms of giving vitamins to kids,

the first one is always going to be vitamin D. And because you know, you’re really supposed to use it from birth. And I would argue throughout childhood as well, especially right now. Like it’s so dark now we’re not getting enough vitamin D from the sun, especially if you are using proper sun protection for your kids in the summer. So anyway,

vitamin D is the one that’s sort of the exception to the rule and that the majority of children will need a vitamin D supplement. But apart from that, vitamin C aren’t necessary, right? For all kids. I think, you know, if you have a child who eats from all four food groups and your doctor is happy with how they’re doing, they may not necessarily need a vitamin at all.

I personally am not a huge, I don’t want to say I’m not a huge fan of vitamins, but I’d like to use them in the right circumstances. And if a child is eating a balance again from the four food groups, they may not necessarily need one, but if they’re missing a food group, that’s when we think about really targeting the right vitamin to the right child.

So I would say it’s just that reflection piece of is my child eating from all four food groups. And if you’re missing one food group talking to your doctor or your dietician about that, and then they can give you a suitable vitamin recommendation for your child. Okay. It’s sort of a general answer Louisa, but I hope that that was helpful for you.

Okay. Liz has a question. My daughter is 18 months and really only likes to eat broccoli and peas straight up. Any other veggies need to be folded into egg bites or Kesha, et cetera. She eats a lot of fruit. So I guess it’s fine. Should I just keep offering other veggies to try to expose her Liz? You’re doing a great job.

This is really great. The fact that she likes to eat broccoli and peas and then all types of fruit. That’s fantastic. So I would say, I think you’re doing fantastic. I would, again, just keep offering other veggies, trying to find different ways that you can offer them. So like an example is zucchini, right? In the sense that you can have a zucchini cut into coins,

you can have zucchini grilled, you can have, so can you roast it shredded spiralized. So just trying to like go through the different ways that you can offer different foods, different types of seasoning is also going to be appropriate. So I would continue to do what you’re doing and just give her time to adjust. But to me, she sounds like she’s doing great for an 18 month old and getting some nice variety in the food she’s having.

So I think that that’s good. Okay. So I’m going to go on to Wendy’s question. So Wendy’s asking what is the right proportion of different food groups for babies and toddlers? Is it the same as the adults? Do kids need proportionately more meat than adults because of their iron needs? Okay, Wendy, that’s a great question. And I think you bring up a good point too,

about the importance of balance and foods balance with kids is always tricky because especially in toddlers, you know, what they’re known for is one day eating a lot, one day, deciding they want to have nothing one day loving a food the next day, hating it, you know, all common stuff. So what I would say is thinking of the balance in terms of the new Canada’s food guide,

I’ll use that as an example. So when you’re thinking of a meal, there should be three categories on your plate. And again, this isn’t true for every child. I know some children who are picky eaters, this can be really challenging, but we’re all talking about the goal to work towards. So the goal to work towards is to have something that’s from the fruit and vegetable category,

something that’s from the grains or like the starch category and something that’s from the meat category, right? So that’s really what you’re working towards. Of course not every meal is going to be a success, but that’s what we’re aiming for at mealtimes is a little bit from each of those foods. And generally I find, you know, if you have kids who are agreeable to eating from those different categories,

then it’s going to be okay, in terms of nutrients like iron, you bring up a good point in that babies do need a lot of iron. So if you think about high times of life where you need a lot of iron it’s infancy, it’s tarred through years. And then if you have a daughter, it’s when she’s a teenager. So those are the three highest risk times for iron,

for children. So, you know, at those times, if they’re willing to eat high iron foods, so if they eat meats, things like beef poultry, even like fish and shellfish have some iron. If you eat pork, if you eat some organ meats like liver and then some of the vegetable sources of iron. So especially that would be things like beans and lentils is trying to offer them on a regular basis.

Another thing you could still do is infant cereal, even as they get a bit older and then some of the iron fortified grains otherwise, so cream of wheat is another option, right? So making sure that there’s the opportunity to get those in, but in terms of, you know, do they need more than adults? They, they definitely do need nutrients.

I don’t want to give you like anything too specific because you know, sometimes sort of tracking it in that sense is difficult, but aiming for the balance is the most important thing. So I hope that that is helpful for you. If you need anything clarified, just let me know. Okay. Liz has a question. What kind of seasoning is okay for under two years?

So I would say maybe we’ll break it into zero to 12 months and then we could go over 12 months because for zero to 12 months, the only food that’s off limits is honey, that’s it just because of the risk of botulism for honey. But apart from that, you know, you can definitely season foods for babies. And I do see those babies who really liked to have food seasoned.

So when you think about it, and this is true, if you’re breastfeeding, you know, babies get familiar with the foods that you’re having and the seasoning that you have, because all of those flavor compounds get passed through your breast milk. So, you know, if you’re using a lot of like ginger, garlic, cumin, whatever it is you’d like to cook with,

and that’s what you’re eating, those are all sort of familiar flavors to your baby. So they may actually like that food a bit more seasoned when you start going over 12 months, it’s okay to have honey. I would say, try to have pasteurized, honey. That’s probably a better choice for kids. But apart from that, every seasoning is on the table,

right? Like today, for example, I saw a nine month old who actually loved spicy food. She didn’t want to eat bland food. She just wanted to eat spicy food. So as long as they’re comfortable, as long as it’s not causing any gastrointestinal distress, then that’s fine. Let them have the season foods. The only caveat is a salt.

So we know that, you know, trying to avoid too salty foods for, for kids is a positive thing. And it’s not that it causes any like direct health issues on, in and of itself. It’s more so that our taste preferences are developed in the first five years of life. So if you’re like, you know, a toddler and you’re used to eating really salty foods,

when you’re an adult, it’s harder to get used to lower salt foods. And you would just worry that as an adult, eating higher salt foods could be associated with high blood pressure, some other medical conditions. But you know, we’re not worried about like for most kids, their blood pressure and eating the salt. So it’s more so just what they’re getting used to.

So I would say trying to limit the salt from really, really salty things. So say for example, you know, like things like fast food, a little bit less often trying to add less salt when you cook it doesn’t have to be anything too extreme, but you just want them not to have like a ton of salt, right. Just use two different flavors.

So anyway, I hope that answered your question for seasoning. So the main thing is seasoning is definitely a go, just be mindful of salt and then be mindful of honey for the infants. Okay. Oh, Louisa. You’re welcome. Thank you for asking the question. So Jane has a question. My three-year-old is very much attached to breastfeeding, but she’s not so keen on water or milk.

My concern is that she’s not getting enough milk, so calcium and vitamin D okay. Yeah. Jane, this is, this is a good question. And I think too, one of the factors that’s going to influence this is how often she breastfeeds and how hungry she is for food. So especially if you feel like she’s breastfeeding for comfort, or you don’t feel like you have a large mill or significant milk supply,

then it wouldn’t be something that I would be too concerned about. But if you feel like you do still have like a pretty significant milk supply, it would just be thinking, is she filling up when she nurses and is that influencing her appetite at other meals? So in terms of the milk, it’s true, milk is the main source. And we’re talking about cows milk.

It is the main source of calcium and vitamin D for kids, but there are many children who don’t like having milk. So my recommendations for milk are anywhere from zero to hundred milliliters per day, if your child’s on the lower end, like doesn’t want to drink milk. As long as they’re eating cheese, yogurt, tofu, soy, some of these kinds of calcium fortified products,

then you, they can make their knee, excuse me. They can meet their needs through that. The vitamin D often they still need a vitamin D supplements, but that’s something you could speak to your pediatrician about. So I would say, you know, think of the other sources of dairy or non-dairy fortified items that she does eat. And if she’s not having any of those,

then I would talk to your pediatrician about it because you could always do supplements as well to make it work. So I would encourage you to talk to your pediatrician about that and just about what her appetite is like for other foods, to make sure that she is, has a good appetite for eating regular foods, because that should be the main source of her nutrition.

And then the breastfeeding can be for comfort. So, yeah, I hope that helped Jane. And then Jane answering your second question. What were the ages for iron again? Okay. Three ages for iron that are really important. First is an infancy. Second is and toddler years. And then if you’re, if you have like a female child when she’s like a teenager,

so when she starts menstruating, she needs a lot of iron. So those are the three times that you really need a lot of iron. Yeah. Okay. That’s I don’t have any other questions right now. Does anyone else have any more questions or can I clarify anything? Oh, Maria is asking why are girls developing so fast nowadays and how to avoid it?

So there’s a lot of different factors that influence like early puberty. Some of them, you know, I’m a dietician, I can’t speak to everything, but I can speak to the nutrition piece. So one of the things that we do think about early puberty for girls is just in terms of their body size as well. So a lot of the girls who do experience early puberty tend to have a larger weight.

So oftentimes it’s seeing, you know, I’m not a fan of putting kids on diets. That’s not my approach, but sometimes it’s seeing, is there something that we could do some small little tweaks in terms of the food setup or structure at home to try to help like sort of normalize the calories that they’re eating or how much they’re eating? I think the key is doing these small things in the background that the kids don’t necessarily know that are happening because our main thing is we don’t want any child to feel like they’re deprived because that just sets them up for issues with eating later on in the future.

So anyway, I definitely think it’s either the amount of foods, the type of foods are a contributing factor. And then as I was speaking earlier about ultra processed foods, I do think there are also ones that are associated more so with gaining weight more rapidly. So maybe even getting a sense of how many ultra processed foods are in their typical diet, but I will leave it for the doctors to answer the question in terms of the other factors that are contributing to like early puberty for girls.

I hope that helped Maria. Okay. Are there any other questions that anyone else wants answered? I have a few that I was supposed to answer in the last live that I did. And then I got so sidetracked. I forgot to, so I do have them written down. So if anyone, oh, Liz, did I miss you? Oh,

I’m so sorry, Liz. I missed your question. Do dairy. And so let me just start. So Liz has a question, do dairy and eggs count as the meat food group. Okay. So let’s talk about what dairy and eggs have. So dairy is going to have calories, protein, fat, depending on what kind of dairy you use,

calcium vitamin D B12 phosphorus. So a lot of benefits to it. One of the things that it doesn’t have is iron. And then when we look at eggs, eggs also have protein, fat vitamin a B12, but they also, even though theoretically, they have iron, sometimes you’ll read eggs are a source of iron. It actually is a really poorly absorbed form of iron in the body.

So I don’t even count as eggs supporting iron. So Derrick and X have a lot of nutrition in them and they are a main contributor to protein for kids, but they don’t have iron. So I would say if you have like a vegetarian child who likes milk and they like eggs, but they don’t eat meat, it would still be worth having a chat with your pediatrician about to seeing what their,

their iron is. Yeah. Okay. Sorry about that, Liz. I missed that with the questions coming in at the same time. So I’m going to answer a Betsy’s question. So Betsy’s question is I’m still breastfeeding my 21 month old and she hasn’t been a big fan of cows milk, interior related products. Okay. So Betsy, you know, she is getting some calcium and some vitamin D from your milk,

but if she’s not a fan of cow’s milk or dairy or related products, I would encourage you to talk to your pediatrician because she may need a vitamin D supplement and she may need a calcium supplement. So she’s 21 months old. She needs about 700 milligrams of calcium a day and 600 units of vitamin D a day. So I would ask your pediatrician about what their perspective is and if she needs blood work to check her vitamin D levels.

And if they want to consider a calcium supplement. But apart from that, I would see maybe if there’s creative ways to get calcium into them or into the foods that they’re having. So like, say for example, maybe they don’t like drinking milk on their own, but maybe they’d like, like a fruit smoothie that you make that is made of yogurt and some frozen fruits,

or sometimes you can freeze it into popsicles. You know, some of the milk-based puddings can be another option that you could do. So thinking of some of those other things that you could try out, then maybe give them another source of calcium and vitamin D. Okay. And then Eric has asking until what age should children drink whole milk instead of 2%?

Okay. So if you ask public health, public health would say, serve whole milk until the age of two, and then switch over to two. But I really think it’s dependent on your child and is dependent on what you have in your fridge. If you have a child who is like lower on the growth charts or has challenges gaining weight, then I’d say,

go ahead, give them a higher fat milk. There’s absolutely nothing wrong with that. Or the other thing would be, you know, if you have like, you’re drinking whole milk, your husband’s drinking lactose free milk. You have multiple children drinking, multiple fat percents, like make life easier, just get one fat content for the milk for all the kids,

because there’s always other ways to increase the fat content for kids or to decrease it if needed. But I don’t want to go down the route of decreasing more. So if they drink, you know, 2% milk instead of whole milk, there’s always ways to add a little bit of extra cheese, extra cream, avocados, nut butter, seed butters, et cetera.

So there’s lots of other variables that we can do to change fat intake apart from just milk. So I hope that that helped. Okay. So I think Betsy’s adding onto the question that she had previously. So Betsy says she hasn’t measured how much she takes cow’s milk because I thought she’s taking some calcium from breast milk. She’s been on vitamin D since birth.

She’s going to explore more options with this lack of dairy, have negative impacts on her growth. So, you know, in terms of the impacts on growth, there are some studies that show that children who drink milk are slightly taller, but it’s one of these things that I would say there’s so many other factors going on, especially like, if you,

if you look at nutrition research with time and the past nutrition research would say like, oh, this food is associated with this, right? So say for example, they would talk about like something like shellfish and cholesterol, but now we shouldn’t be looking at these individual things. We should be looking at patterns instead. So what I mean by that is you think of things like Mediterranean diet,

right? How does Mediterranean diet impact health? How does vegetarian diet impact health? So it’s more of these things that we do on a day-to-day basis rather than specific foods. So I would say, you know, I’m not too concerned about children who don’t drink milk, being shorter, but I do know that children who don’t drink milk, she have another source of calcium and vitamin D in their diet.

I know she’s on a supplement, but I would still talk to your pediatrician about the calcium otherwise. Cause it definitely is important for bone density. So I hope that helps Betsy. I know it’s hard to be really specific on these kinds of things. It’s more general, but hopefully it’s still illuminated a little bit about, about the topic of this, so,

okay. Okay. So Maria has a question at school isn’t allowing nuts what proteins could use for lunches through her daughter. Doesn’t like hummus, oh, that’s too bad. She always ends up giving her Turkey nitrate-free sandwiches. Okay. A hummus is like my number one, standby for recommending as well as for myself, I have hummus packs for lunch, like so many days of the week.

So in terms of proteins that you could try. So maybe we’ll start with vegetarian proteins because I know that you’ve already talked about hummus. So another example is if your child doesn’t like comments, but they like other dips, you could always explore that black bean dip is like one of my favorites. And a lot of these dips are quite easy to make.

Again, you can buy them too, but if you have a food processor, there’s a lot of dips that you just throw everything in blend. It, it takes like less than five minutes. Another option is there are some dips that are made from like white beans, roasted red tomatoes, cream cheese. That’s another one favorite of mine. It’s actually a post on my Instagram.

I have some dip ideas that you could do. So some of these being day steps are a good thing. The other thing that you could do too, is I’m guessing she probably doesn’t like chickpeas or she doesn’t like hummus, but mashed chickpeas or like a chick pea salad can be a really nice filling for a sandwich or like a mini bagel for kids or for different crackers.

In the other thing is you could always explore the world of things like Tempe. A lot of people aren’t familiar with Tempe or they don’t use it, but it’s like a fermented soy that’s cut into strips that you can actually put on in a sandwich. So some kids really do like it. You can even put barbecue sauce on it and cook it for a little bit.

That’s something that sometimes I’ll do like a BLT, but instead of the bacon, I’ll do Tenpay instead. So you could do options like that. As the weather gets a bit colder. The other option are soups that are like lentil soup or soups with beans in it. So like a Tuscan bean soup. So that could be another source of getting protein.

Cheese is like the classic example. You could put cheese on everything. So that’s a good option. Another thing are including at a mommy as a snack in a school lunch, that can be a really nice thing to snack on cottage. Cheese can be a great source of protein at school. And then if you have any leftover meats from dinner the night before,

that can be an option, things like meatballs, you had like a rotisserie chicken, you could put it in a wrap, the other things are eggs. So I know it’s really old school, but like Xcel had sandwiches, they always work fried egg sandwich, hard-boiled eggs, egg bites. The other thing are like tins of tuna, right? Those mini tunas,

especially the ones that are flavored. They’re really great. That could be another good option. And then, because you can’t do nut butters, but there are a lot of great seed butters, right? So there’s like pumpkin seed butter, which is one of my favorite. That could be a really good option. And then of course, well, butter is a,

is a really common one as well. So hopefully marina answered some of your questions, lots of different options for protein that I hope help you out there. Okay. Wendy has a question for preventing baby constipation. What are your recommendations on foods when they say beans or high fiber? Is it green beans or dried beans? Okay. Constipation is so common for infants and toddlers.

Actually, a lot of kids there’s about like a third of kids are constipated. The majority of children that I see are constipated. So it is a big deal. And in terms of constipation, the reason I’m not a fan of it is one, it teaches children that it’s painful to stools, so they withhold their stool and it makes the situation worse.

And then the other thing about it is if a child is constipated, their appetite is lower. So really getting a good handle on constipation is a positive thing. It’s usually like a two-pronged approach. Sometimes your pediatrician will use a stool softener, but in addition to that, food should always be one of the main ways to help manage constipation. So the first thing to think about is fluids.

So whether that fluid is breast milk, formula, regular water, and Wendy, I know that you have an eight month old and you’re working on the water. So that’s really positive. All the fluids. The other component we look at are things like fiber. So there’s, I call it the fiber trifecta. Cause I think it’s the three ways that you can really approach infant constipation.

And that trifecta is soluble fiber, insoluble fiber, and then sorbitol. So maybe we’ll start with a sort of talk because I think it’s a great place to start. And that is things like prunes. So sorbitol is considered a sugar alcohol it’s like has no alcohol content in the sense of URI thinking of alcohol. Like it’s not like vodka, but the sugar alcohol,

it does draw water into the stool to soften stools. Prunes are the classic example of that. Excuse me, prunes are the classic example of that. Other things can be apples, pears. And another way to think about it is if the fruit starts with P it likely helps with constipation. So this is the prunes, the plums, the pears, the peaches,

that can be a good thing. So getting some serotonin, the other thing are the soluble fibers. So what a soluble fiber is, is it something that sort of acts like a gel in your intestine or a child’s and testing? So it sort of like, you know, you can imagine a gel consistency, it’s more liquidy and soft. So these fibers create that type of stool.

So one thing that you could think of are going to be oats, right? So even if you’re using like baby cereal, if you wanted, as long as your child has good sources of iron, you could start adding in, in, or like adult oats. So that could be things like steel cut oats. The other thing is barley, especially if you’re making things like baby led,

weaning style fritters, or your baby starting to work on their pincer grasp and picking up grains of rice, you could do barley instead, cooking. Barley is just like cooking pasta. It just, that it takes longer. So for Pearl barley, you bring the water to a boil. You let it cook for about 30 minutes and then it’s good. So I know barley can be an intimidating thing to bake or to cook,

but it’s one of my favorite grains. It is full of soluble fibers. And then other things are like fruits and vegetables have soluble fibers. And then the last category of the trifecta is going to be insoluble fibers. So these are fibers that they don’t act like a gel or they don’t draw water into your stool, but they move through the intestinal tract quickly.

Right? So that’s going to really help with passing stool. So these are going to be things like nut butters, right? I know obviously she’s too young to have whole nuts, but any kind of nut butter could be a really good way. The other thing, or any kind of whole grains, right? So say, for example, if you were doing bread using a whole grain bread,

if you were making some muffins, putting things like wheat bran or Oprah and into it, that is also gonna help. And I should have answered your question about the beans because beans are great dried beans, green beans, happy with it all. They’re great sources of fiber. So say for example, you could do things like using dips like chickpeas. You could make fritters like baby led weaning style fritters out of beans,

for example, or the other thing is cooking the beans and serving them as a snack. So, you know, sometimes I find the canned ones are just too hard. There’s a way that you can, if you have a slow cooker, you can make like chickpeas or beans in your slow cooker overnight, you just dump your dried beans or your chickpeas into the slow Kercher with some water and some baking soda,

cook it on low for seven to eight hours. You wake up and you have really soft beans, which is like a perfect consistency. So you could do something like that. And then as long as they’re soft enough to sort of smush, then you’re, then you could have that as a snack for your baby as well. So anyway, I hope that that is helpful.

I see too, that Liz says beans in an instant pot and broth. Absolutely. I have to admit, I am obsessed with my instant pot. I got it. Maybe three years ago as a gift. And I thought like, I’m never using this. Why did I get this as a gift? And now I use it again probably like three times a week or so I eat a lot of beans and I cook them all in my instant pot.

So anyway, if you’re trying to introduce more beans into your eating or your child’s eating instant pot is the best thing ever. So anyway, listen, I feel the same about this, Liz, if you have good instant pot bean recipes, send them my way. I always love learning new recipes in the instant pot. Okay. And then Maria said,

thanks. Thank you as well, Maria, Betsy as well. I’m hoping that this is helpful. And I think a lot of people are still on here, which is great. Does anyone else have any questions? I’d be more than happy to keep going for it. I guess it’s 8 57. That hour went really fast. I don’t know about you guys,

but that flew by for me. If anyone has like one final question, feel free to ask me before I log out. Well, thank you so much, Erica and Wendy, thank you for attending and for your questions. That was great. So I maybe we’ll just wrap it up then, but anyway, thank you so much for your time. Thanks for your engagement.

And if you have more questions for me, you can follow me on Instagram. I met kids dot digestive dot dietician, get in touch anytime and very accessible there. And, and then obviously I’m part of the parent playback as well. And I have some videos on the site, so you could find me there. Okay. I hope you all have a really good evening.

I hope you have a great rest of the week and enjoy your weekend. I’m hoping the weather is going to be nice, but I see it’s going to rain, so we’ll make the best of it anyway. Okay. Thanks. I’ll see you guys later.


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