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Fantastic Foods for Babies (and Moms, too!)
Or… “Babies, Boobies, Bottles, and Beikost”
Gerry Kasten, RD, MSc, FDC
March 13th, 2014
Building the FNHA
Healthy, self-determining and vibrant, BC First Nations children, families and communities
www.fnha.ca
Our Values Respect, Discipline,
Relationships, Culture,
Excellence & Fairness
Our Directives 1. Community Driven, Nation
Based
2. Increase First Nations
Decision-Making
3. Improve Services
4. Foster Meaningful
Collaboration and Partnerships
5. Develop Human and Economic
Capacity
6. Be without Prejudice to First
Nations Interests
7. Function at a High Operational
Standard
Our Vision
www.fnha.ca
First Nations Perspective of Wellness A visual expression
to the First Nations
Perspective on
Wellness – the way
it has always been.
Passed down from
our Elders and
traditional healers.
Wellness belongs to
every human being
and their reflection
of this Perspective
will be unique.
What the heck do I know about Nutrition, anyways??
• A Registered Dietitian
• Practicing Community Nutrition for 23 years.
• First Nations Health for past three years (…and transferred to the FNHA on October 1st)
• Primary Care Dietitian at Spectrum Health and the Catherine White Holman Wellness Clinic.
• A former (and current) farm hand.
• A former chef (H Dip in Comm Cooking from NAIT)
• M.Sc. (Human Nutrition) from UBC
• Chair of HC Expert Advisory Panel on Infant Nutrition
Some Food For Thought…
Key Determinants of Health 1. Income and Social Status
2. Social Support Networks
3. Education and Literacy
4. Employment/Working Conditions
5. Social Environments
6. Physical Environments
7. Personal Health Practices and Coping Skills
8. Healthy Child Development
9. Biology and Genetic Endowment
10. Health Services
11. Gender
12. Culture
BC has had the highest rate of child poverty in Canada for six years running.
94,002 people in BC used food banks in March, 2013. Almost 28,000 were children.
HungerCount 2013 Foodbanks Canada
Sound Nutrition Practices
Sound Nutrition Practices
Menu planning
• more likely to meet Canada’s Food Guide
• more likely to shop for food
• lower food costs
• less likely to consume higher fat foods
Sound Nutrition Practices
Eating Breakfast
• more likely to meet CFG recommendations
• consume fewer calories through-out the day
• better school /work performance
Sound Nutrition Practices
Sound Nutrition Practices
•People who eat together
• eat more fruits and vegetables
• eat lower fat meals
• choose less fried foods & soft drinks away from home
• are more likely to meet the recommendations for vitamins and minerals
So How Do You Choose Food?
Eating Well with Canada’s Food
Guide
What Amount of Food do You Need?
Start eating when you’re hungry.
Stop eating when you’re full.
Canada’s Food Guide
•Enjoy a variety of foods from each group every day
Canada’s Food Guide
Choose lower fat foods more often… (…?)
Canada’s Food Guide
Canada’s Food Guide
Anti-Oxidants, Phytonutrients and Fibre Choose dark green and orange vegetables and orange fruit more often (and lots of other colours, too!!)
Canada’s Food Guide
Canada’s Food Guide
Antioxidants, Vitamin E and Fibre
Choose whole grain and enriched products more often
Canada’s Food Guide
Canada’s Food Guide
Calcium Foods
Choose lower fat milk products more often.
For lactose intolerance, try cheese and yoghurt to see if you tolerate them
HealthLinkBC File 68c
Canada’s Food Guide
Canada’s Food Guide
Meat, Fish, Poultry, Beans, Soy, Nuts and Seeds (not to mention Iron…)
Choose leaner meats, poultry and fish, as well as dried peas beans and lentils more often
Barriers to Consuming Traditional Foods The nutritional quality of food intake by BC First Nations is improved when traditional food is eaten.
91% of BC FN participants would like to eat more traditional food.
Participants said that these are the 5 main barriers that prevent them from using more traditional food: 1) Lack of equipment or transportation 2) Lack of availability 3) Lack of time 4) Difficult to access 5) Government/firearms certificate regulations
Contaminants in Traditional Food A total of 429 food samples representing 158 different types of traditional food were collected for contaminant analyses.
Levels of contaminants in traditional food are within levels that are typically found in this region.
Intake of contaminants (except cadmium) from traditional food is below the guideline levels and is not a cause for concern.
To decrease exposure to cadmium (which can cause kidney problems and weak bones), limit intake of the following foods:
- moose kidney and liver: not more than 1/2 a cup per month
- seaweed: not more than 1/2 a cup per day It is recommended to replace lead shot with steel shot. Lead contamination of traditional foods can cause toxic effects to the brain, especially in children.
Fukushima and Radioactivity
“That was a surprise,” said Juan Jose Alava, an adjunct professor in the school of resource and environmental management at Simon Fraser University, in an interview on Tuesday.
The results raise concerns for aboriginal people who maintain a diet heavy in fish.
“We might expect similar results because the diet of First Nation communities is based on seafood,” Alava said. “Humans at the top of the food web can perhaps see increasing levels in the future.”
“So far the levels are safe,” Alava said. “We shouldn’t be worried now, but we need to keep monitoring in the long term to see whether these levels are building up in the food web.”
Fukushima and Radioactivity
Canada’s Food Guide also
Recommends:
– Satisfying your thirst with water
Canada’s Food Guide also Recommends:
Energy Intake from “Other Foods”
Adult Men
71.30%
28.70%
4 Food Groups Other Foods
Adult Women
73.20%
26.80%
4 Food Groups Other Foods
For More Information Visit Canada’s Food Guide Online:
www.healthcanada.gc.ca/foodguide
Canada’s Food Guide also Recommends:
Canada’s Physical Activity Guidelines
Canada’s Sedentary Behaviour Guidelines
Enjoy eating well, being active and feeling good about yourself.
That’s
Babies…
Advice for Pregnant and Breastfeeding Women
• Pregnant and breastfeeding women need extra calories:
– Include an extra 2-3 Food Guide Servings from any of the food groups
Weight Gain during Pregnancy
Weight Gain during Pregnancy
“Ills from the Womb”??
My journey started…
Weight Gain during Pregnancy
SOGC Guidelines:
Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD. Prenatal care.
In: William’s Obstetrics. 21st ed. New York: Appleton and Lange;2001:232.
Weight Gain during Pregnancy
Institute of Medicine: Nutrition During Pregnancy,
I Weight Gain;
II Nutrient Supplements.
Washington, DC, National Academy Press, 1990
Weight Gain during Pregnancy
Except…
Weight Gain during Pregnancy
(5 - 9 kg)
Weight Gain during Pregnancy
There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy
Cochane Review, Jan. 2012
Weight Gain during Pregnancy
Provision of regular input on planned nutritional intake… has the potential to improve outcomes…
Current research focuses mainly on mixed interventions with both diet and physical activity components. But interventions predominantly based on diet seemed to be more effective for weight related and clinical outcomes.
With lack of individual data on important factors such as age, ethnicity, socioeconomic status, compliance, and other risk factors, we are limited in our explanation for the benefit observed with diet compared with other methods.
Thangaratinam, S et al. BMJ 2012
Weight Gain during Pregnancy
…the understanding that low SEP is not only
independently associated with various adverse out-
comes but also with their simultaneous occurrence
suggests that greater health gains may be achieved if
investments focus on reducing the social inequities
behind the health disparities rather than on tackling
proximate risk factors that may hopefully prevent
one but not all negative consequences of low social
position.
O’Campo & Urquia. Matern Child Health J (2012)
16:1870–1878
Weight Gain during Pregnancy
Weight Gain during Pregnancy
And at the end of it all… Ills from the womb? A critical examination of clinical guidelines for obesity in pregnancy
Shannon Jette and
ve Rail
Health (London)
The online version of this article can be found at:
http://hea.sagepub.com/content/early/2012/10/15/1363459312460702
Folic Acid
Take a daily multivitamin containing 400 μg folic acid
ALL people who could have a baby or become pregnant
Healthy Eating for Pregnancy
• Nausea
• Heartburn
• Constipation
Three-Ginger Bar Cookies
3/4 cup (175 mL) butter, at room temperature
1 cup (250 mL) packed brown sugar
¼ cup (50 mL) blackstrap molasses
1 large egg
4 teaspoons (20 mL) finely chopped fresh ginger
2 ¼ cups (550 mL) all-purpose flour
2 teaspoons (10 mL) ground ginger
1 teaspoon (5 mL) baking soda
½ teaspoon (2 mL) salt
½ cup (125 mL) finely chopped crystallized ginger
In large bowl, beat together butter and brown sugar until fluffy. Beat in molasses, then egg and fresh ginger.
Combine flour, ground ginger,. baking soda and salt. Using a wooden spoon, stir flour mixture into butter mixture until blended. Add crystallized ginger and stir until well mixed.
Drop mounds of dough over entire surface of greased 15 ½ x 10 ½ inch (39 x 26 cm) jelly roll pan. Press dough evenly into pan and smooth surface with metal spatula.
Bake at 350 F (180 C) for 13 to 15 minutes or until lightly browned. Let cool in pan on wire rack for 15 minutes. Cut into bars and remove to wire rack; let cool completely.
Makes 40 bar cookies.
Approximate nutritional analysis for each serving:
93 calories, 1 g protein, 3.6 g fat, 14.5 g carbohydrate.
BC HealthFile 68h
Lemon Bran Loaf
•1 ½ cups all purpose flour 375 ml
•1 ¼ tsp baking powder 6 ml
•¼ tsp salt 2 ml
•½ cup wheat bran 125 ml
•½ cup butter or margarine 125 ml
•1 cup sugar 250 ml
•2 eggs 2
•1 tbsp lemon juice 15 ml
•1 tbsp lemon rind 15 ml
•2/3 cup milk 125 ml
•Glaze:
•2 tbsp lemon juice 30 ml
•2 tbsp sugar 30 ml
•Preheat over to 375°
•Sift flour, baking powder and salt together
•Stir in wheat bran
•Cream butter in a bowl, beating in sugar gradually
•Add eggs one at a time
•Stir in lemon juice and rind
•Blend in dry ingredients alternately with milk
•Pour into a greased loaf pan
•Bake for 55 – 65 minutes or until an inserted toothpick comes out clean
•Remove from oven and immediately paint on glaze
•Cool before slicing.
•
Healthy Eating for Pregnancy
• Nausea
• Heartburn
• Constipation
• Food Safety
BC HealthFile 76
No unpasteurized milk or juices
No raw or undercooked eggs
Deli meats and hot dogs: cook well
Soft cheeses: Brie, camembert, feta, queso fresco, queso blanco
No uncooked sprouts
No uncooked shellfish
No liver paté
Motherisk If food is properly handled and stored, the risk of
being infected with L monocytogenes appears to be
low. Therefore, pregnant women need not avoid
soft-ripened cheeses or deli meats, so long as they
are consumed in moderation and obtained from
reputable stores.
Cooking is the most effective method for
inactivation of parasites, although flash-freezing is
also effective and is often used for sushi-grade fish.
Pregnant women need not avoid raw fish if it is
obtained from a reputable establishment, stored
properly, and consumed soon after purchase.
Women should limit their consumption of high
mercury fish and shellfish, including fresh tuna and
yellowtail
BC HealthFile 68m BC-Caught Tuna – No Limits
Pregnant or breastfeeding women: two – four ½ cup servings per week
Canned tuna for 6 – 24 month olds: Max two ½ cup servings per month
Canned tuna for 2 – 12 year olds: Max three ½ cup servings per month
Healthy Eating for Pregnancy and Breastfeeding
• Most women take a supplement:
– including vitamin B12
– including 16 to 20 mg of iron. Some women may need more iron.
– fish is an excellent source of omega-3 fats and other nutrients. Women
who like fish can eat at least 150 grams of fish each week. Choose fish
that is low in mercury most often.
Boobies…
Breastfeeding
Exclusive breastfeeding is recommended for the first six months. . . .
. . . with continued breastfeeding for up to two years and beyond.
BBC page 98 – 109 – for more BF info. A HealthLinkBC File on breastfeeding is also available.
BREASTFEEDING
“You Won’t Regret It!”
http://www.youtube.com/watch?v=CDQ8wOvNXIE
Benefits of Breastfeeding
Enhanced cognitive development
Protects against: • gastrointestinal infections
• acute otitis media
• respiratory tract infection
• sudden infant death syndrome
Enhanced bonding
Lower costs
Ease of delivery
Breastfeeding
Duration of breastfeeding is
equally important to promote
as is initiation!
Breastfeeding
• Breastfeeding Committee of Canada’s Baby Friendly Initiative
• A goal - have all of BC become Baby Friendly; managerial and director support
is needed.
• Many sample guidelines have been developed;
• All Health Centres should have designated areas for breastfeeding for clients, staff, et
cetera, as well as ensuring that people feel welcome to breastfeed a baby anywhere in
their facility.
Breastfeeding - What is practically needed?
Mothers need space to nurse.
I have mixed feelings about little rooms set aside for this purpose. On the one hand it can
be beneficial for the child to have decreased stimulation; usually not an issue for the older
child. Done well, they can be a little haven for a quiet break. Done poorly, these rooms
smack of broom closet and your knees hit against the diaper genie pail when you try to
rock the glider rocker!
I would rather see less segregation and a space right in the waiting room. Maybe a boppy
pillow with removable cover and a stack of clean receiving blankets (if it's clinic where
linens must be laundered anyway), a tub of wipes to clean up spit-ups and a poster or fun
fact/ quote about nursing on the wall might be all that's needed to communicate the non-
verbal support.
Sure, maybe the pillow / blankets wouldn't get much use because people bring their own,
but it's the atmosphere that counts.
Mothers need time to nurse. Generally I have been pleasantly surprised by doctors and
nurses who, upon seeing that my child is nursing, went out of their way to let the child
finish before continuing with an exam or procedure. Likewise, after an intervention I have
been told to take all the time I need before freeing up the exam room. That being said, I
am not sure that all HCPs are sensitive to this.
Mothers need flexibility. Every mother-child dyad is different; some crave the privacy of a
separate space, others would far rather you offer them a glass of water than usher them
to another room as if they have to hide. The same flexibility encouraged in training the
staff that serves the nursing mother and child will go a long way toward accepting
different nursing styles and more to the point, different nursing ages.
Breastfeeding - What is practically needed?
Mothers need to hear, again and again, it's normal. I am always a little shocked to receive
the free samples of formula (undermining!) but no breast pads. Literature and
magazines provided for the pregnant or new mom advertise maternity wear (good for
part of 9 months) but nursing wear (which could serve for years) is a hard to find
specialty item.
Breastfeeding - What is practically needed?
Vitamin D Supplementation
. . . all breastfed, healthy term infants in Canada
receive a daily vitamin D supplement of 400 IU.
Supplementation should begin at birth and
continue until the infant's diet includes at least 400
IU per day of vitamin D from other dietary sources
or until the breastfed infant reaches one year of
age.
All Infants beyond one year should get 600 IU of
Vitamin D from food and/or supplements.
Vit D is from the sun
Few foods have vitamin D.
Good sources:
fortified milk,
fortified soy drinks
fortified margarine
Fish, liver, and egg yolk are the only foods
that naturally contain vitamin D.
Vitamin D – not just rickets
Lots of ongoing research with Vitamin D
Possible links between Vitamin D status in adults and some cancers, multiple sclerosis
and other diseases
Adult recommendations do vary from agency to agency but at this time HC
recommendation is 600 IUs from age 1 – 70 years of age.
BREASTFEEDING
“Teach Me How To Breastfeed”
http://www.youtube.com/watch?v=SZ3QO-7h4YA&list=FLaAleJiMzzA6cPShHjA4DhQ
Bottles…
Formula Feeding
Breastfeeding should at all times be actively encouraged and
supported. Provision of formula info to health professionals
is not intended to encourage the substitution of commercial
breastmilk substitutes for breastmilk.
Formula Feeding
Formula is not the “Next Best Thing” to breastfeeding –
at best, it is the FOURTH choice in a hierarchy:
1. Breastfeeding
2. Feeding Expressed Breastmilk
3. Feeding pasteurized human donor milk
4. Feeding commercial breastmilk substitutes
General Issues: Powdered Formula
Healthfile 69b states:
“If your baby is formula fed,
you must be careful to
safely prepare and store
the formula.
If not, your baby can get
sick.”
46 cases world-wide between 1958 and 2005
Other outbreaks have been associated with Citrobacter freundii and multiple Salmonella serotypes
General Issues: Powdered Formula
General Issues: Types of formulas
Price/brand not a indicator of quality.
Composition of formula is tightly regulated by Health Canada.
Some infants may tolerate some formulas better than others.
General Issues: DHA (omega-3) and ARA (omega-6)
Found in breastmilk and some formulas.
Amount in breastmilk depends on how much omega 3 fat (fish) mom consumed
Important for brain development and vision.
General Issues: DHA (ω-3) and ARA (ω-6)
DHA/ARA supplementation may be advantageous for full term infants.
Premature infants should be fed a formula with DHA/ARA until 9 months corrected age.
General Issues: Probiotics
General Issues: Follow-On Formulas
After 6 months, follow-on formulas are acceptable, but not necessary.
After 12 months, infants should be fed cows’ milk (or other mammals’ milk) or follow-on formulas, to meet higher calcium needs.
BC HealthFile 69b
If formula has been warmed up or partly used for a feed, throw it out after 1 hour. Do not put in the fridge to re-use again.
General Issues: First Nations Health Benefits
When a doctor/health practitioner
confirms a medically defined need
for specialized formula, it is available
through Social Assistance or First
Nations Health Benefits (formerly
NIHB)
BC HealthFile 69a
Milk-based commercial infant formula unless advised otherwise by your doctor or health care provider.
“Follow-up” formulas not needed under 12 months.
BC HealthFile 69a
Let’s talk about “Iron-fortified”…
–All formulae contain iron
–Iron is added at differing levels: •Lowest is about 0.7 mg/100 ml
•Highest is about 1.3 mg/100 ml
–All formula contain enough iron to meet infants’
needs until they can get iron from other foods.
–Introduction of solids should have a focus on high
iron foods.
Follow-On Formulas
Starter formula or follow-on formula are appropriate from 6 – 12 months.
Parents who feed formula beyond 12 months must switch to follow-on formula to ensure infants meet their calcium needs.
Constipation
There is no evidence that higher iron formula causes constipation.
Thickened formula
Added rice starch thickens on contact with stomach acid.
Limited research available to support prevention of reflux and regurgitation.
Soy and Phytoestrogens
Soy formula is only appropriate/recommended for vegan infants or infants with galactosaemia.
No human studies confirming harm from soy formula.
Long term effects remain controversial.
More research pending…?
Post-Discharge Formula (PDF)
Marketed for the nutrition needs of premature infants post-discharge from hospital.
Higher in calories, fat, protein, iron, calcium, vitamin D.
Contain DHA & ARA.
AAP recommends use of PDF after discharge until 9 months corrected age: CPS currently has no recommendation on the use of PDF.
Post-Discharge Formula
Similac Advance Neosure.
Enfamil Enfacare A+.
Both available only in powder format (i.e. may be recommended for premature or ill infants or infants less than 1 month of age, against the advice of Health File 69b)
Enfagrow
Beverages marketed for toddlers or
‘picky eaters’ are
not recommended
as meal replacements.
Evaporated Cow’s Milk Formula
Not recommended, especially prior to 9 months of age.
Infants receiving these formulas require iron supplementation.
Goats’ Milk
Whole Goat’s Milk (nor the milk of any other mammal) should not be introduced prior to 12 months of age.
http://www.fnha.ca/Documents/familyconnections.pdf
And Beikost…
Introducing Solids
BC HealthFile 69c
Solids at 6 months, with a focus on iron
Baby needs to try different tastes and textures.
Pureed foods are not needed. Baby can enjoy mashed foods and finger foods before teeth appear.
BC HealthFile 69c
Start with:
well-cooked finely minced meat, poultry or fish OR other high iron family foods OR
iron-fortified infant cereal
First Foods for First Nations
Solids at 6 months
Baby needs to try different tastes and textures.
Pureed foods are not needed. Baby can enjoy mashed foods and finger foods before teeth appear.
Start with:
well-cooked finely minced meat, poultry or fish OR
iron-fortified infant cereal
Infant Feeding Timeline Game
Infant Feeding Timeline Game
??
Family Meals
•
Encourage parents to serve baby same food as rest of the family, but cut up very small
Spices are okay. No extra salt.
Khichri
1 onion, chopped into small pieces 1
2 tsp vegetable oil 10 mL
½ tsp turmeric (optional) 2 mL
½ cup uncooked rice 125 mL
(e.g. brown basmati)
1/3 cup dried lentils 75 mL
1 cup chopped vegetables 250 mL
(e.g. peas, broccoli, cauliflower, carrots, squash, spinach and/or potatoes)
4 cups water 1 L
2 tbsp chopped fresh cilantro (optional) 30 mL
¼ cup plain yogurt (optional) 50 mL
• Lightly fry the onion with the turmeric in oil,
in a large cooking pot.
• Wash the rice and lentils.
• Put the rice, lentils, vegetables and water into
the onion mixture and cover.
• Bring to a boil. Boil for 3 minutes, then turn heat
to low medium and simmer for 30-40 minutes.
• Stir occasionally. Add ¼ cup (50 mL) water if
stew looks too dry.
• Sprinkle stew with cilantro if you wish.
manjuzkitchen.blogspot.ca
Dairy Products
Breastfeeding recommended till 24 months and beyond
9 months of age for cheese and yogurt
12 months for cow milk to drink
Allergy Prevention?
Delaying the introduction of potentially allergenic foods (eg. nuts, fish, soy) has not been shown to prevent allergies.
We don’t know how to prevent allergy.
A Division of Responsibility
Parents are responsible for what children are offered to eat and the manner in which it is presented.
Children are responsible for how much and even whether they eat.
How much should kids eat?
According to the Division of Responsibilities:
“Children are responsible for how much and even whether they eat.”
Without pressure, children can and will eat enough to grow.
BC HealthFile 69d Parents decide what and when
food is served
Children decide whether and how much to eat
BC HealthFile 69e
Offer 3 meals and 1 to 3 scheduled snacks.
Water in between.
Meals - 4 food groups
Snacks – 2 or more food groups
Kids and Thirst Fruit is best “Chew Your Juice” ½ cup/day or less of juice 2 – 3 cups of milk Too much milk or juice = high risk of anemia
Early On, Good Eaters Learn
When s/he is hungry, s/he will be fed
Personal food preferences will be respected
Eating is an enjoyable activity
There are ways to deal with uncomfortable feelings, besides eating
People in different cultures have different ways of eating and celebrating special occasions with food
Our food choices affect our well-being
Food is made available through the efforts of many members of the community
To eat, we use up resources, and we create waste that needs to be dealt with responsibly.
Resources
Recommended Reading
By Ellyn Satter
Also:
www.ellynsatterinstitute.org
Recommended Reading
Recommended Reading
Recommended Reading
Recommended Reading
So…
Thanks for Your Time and Attention
Any More Questions??
