Nutrition 2016

Session 5

November 28, 2016

Purvi Manek, RECE

Nutrition

Mothercraft College

Agenda

• Attendance

• Due Assignment # 2

• Infant Nutrition

• Breast feeding

• Bottle feeding & Formula

• Introducing Solid Foods

• Feeding Toddlers

• Choking Hazards

• Food Additives

• Scenarios – Group Work

(Mothercraft Foundational Theories)

• Reading Labels

• Test Review

Infant NutritionPRINCIPLES:

• Healthy nutrition begins at birth.

http://www.healthybabyhealthybrain.ca/start-early.htm

• Infants double their weight in 6 months.

• Healthy development dependent upon nutritious

food.

• A baby’s brain continues to develop. Healthy brain

development requires specific nutrients.

• Semi-solid food not usually introduced before 6

months of age.

• Babies can’t digest the solid food and their bodies

don’t need it.

Breast FeedingBREAST-FEEDING for the first 6 months is ideal

because:

• A mother’s milk is specific to her child

• It contains the right mix of protein, carbs and fat.

• The content of breast milk adjusts to the needs of

the baby in both the short and the long term.

• It has essential fatty acids that promote brain and

nerve development.

http://www.healthybabyhealthybrain.ca/health-builds-

brains.htm

Breast Feeding

• Babies need the lactose (sugar) in breast milk to

help the development of the central nervous system

• It contains the right balance of essential nutrients

(except?)

• Breast milk protein is more easily digested than

other protein (high whey protein)

Breast Feeding

• Breast milk contains antibodies that provide babies

with some immunity during the time they are breast-

fed

• Babies who are breast fed exclusively are less

likely to be victims of SIDS

• Babies are less likely to develop allergies

• Breastfeeding is less expensive

Feeding at Day Care

BREAST OR BOTTLE FEEDING AT DAY CARE:

• All infants MUST have their own labelled bottles.

• Parents may bring bottles of expressed breast milk

or may come in and breast feed the infant

• Bottle feeding is an opportunity for ECE’s to bond

with the infants.

Bottle Feeding

DO’S AND DON’TS OF BOTTLE FEEDING:

• Older Infants should always sit down if they still

have a bottle rather than wandering around

• Do not put babies/toddlers to bed with a bottle;

there a risk of choking

• AND the sugar in the milk/formula increases the

risk of cavities developing.

Breast Feeding

Statistics• Breastfeeding initiation rates in Canada have

increased considerably in recent decades

• Less than 25% in 1965

• 88.4% in 2011

• However, of the mothers who initiate breastfeeding,

some stop after less than one week and close to 25%

stop before their infant is one month old

• The percentage of Canadian mothers exclusively

breastfeeding their infants to six months remains low,

at 27.8%

• (Statistics Canada, 2012)

Formula

• Formula provides essential nutrients so long as it is

prepared properly and not overly diluted

• Babies can bond with their parents and their

caregivers through bottle feeding

• Babies under 9 months should not be given cows’

milk, but should drink formula/breast milk.

What is Enough?

HOW TO TELL IF THE BABY IS GETTING

ENOUGH?

• Does the baby seem reasonably content?

• Does the baby wet 6 to 8 diapers a day?

• Is the baby gaining weight on a fairly steady basis?

(Approximately an ounce a day)

Supporting Breastfeeding

Mothers at Daycare:• Provide a comfortable space.

• Make sure that Mothers know that they are welcome to

drop in and feed their babies.

• Think about your schedule. Be respectful of Mothers who

breastfeed when planning walks.

• Recognize that not all Mothers will be able to drop in

during the day but that they want to continue

breastfeeding. They may express milk and may breastfeed

at drop-off and pick-up time.

• Be respectful of everyone’s feeding choices.

When to Begin Solid FoodsINTRODUCING SOLID FOODS:

• Around six months is usually the ideal time

• Watch for signs of readiness:

– Does the baby drink breast milk or formula eagerly?

– Does the baby seem to want more even when the bottle is

empty?

– Does the baby want to eat more often?

– Has the baby doubled her/his birth weight?

– Is the baby interested in other people’s food?

– Can the baby hold a spoon (even if she/he can’t actually

use it?)

– Can the baby sit up and does she/he have good control of

her neck muscles?

Introducing Solid Foods• Introduce one food at a time and leave two to three days in

between to provide an opportunity to watch for allergy

development.

• Breast milk or formula remains the baby’s primary food

until at least 9 months so the baby should drink first and

then have the semi-solid food.

• Start with the food least likely to cause an allergic reaction:

CEREAL. Rice cereal is ideal. It takes about 3 weeks to

introduce cereal.

• Special cereals designed for babies are best as they

include iron and a combination of nutrients best suited to

the needs of a growing baby.

Introducing Solid Foods• New foods are ideally introduced at home rather

than at day care.

• Babies don’t actually eat very much

• Never force the baby to eat; if the baby indicates

that she/he is finished (i.e. turning head away,

shaking head ‘no’, spitting food out), then stop

feeding.

• What non-verbal cues would a baby use to indicate

he/she is full??

What to Introduce First• Recommend meat, meat alternatives, and iron-fortified

cereal as an infant's first complementary foods.

• Most healthy term infants are born with sufficient stores

of iron to meet their iron needs until they are about six

months.

• At about six months of age, iron stores are depleted

and breast milk alone can no longer meet all of the

infant's nutrient requirements.

• At this stage, iron-rich foods, such as meat, meat

alternatives (e.g., eggs ‘Health Canada 2015’, tofu, and

legumes), and iron-fortified infant cereals, are important

to help meet the nutrient needs of the rapidly growing

infant.

The Infant Feeding Joint Working Group

(2014)• A collaboration between Health Canada and

national organizations. Members of the working

group came from the following organizations:

• Canadian Pediatric Society's Nutrition and

Gastroenterology Committee (CPS)

• Dietitians of Canada (DC)

• Breastfeeding Committee for Canada (BCC)

• Public Health Agency of Canada (PHAC)

• Health Canada (HC)

http://www.hc-sc.gc.ca/fn-an/nutrition/infant-

nourisson/index-eng.php

IFJWG

The mandate of the Infant Feeding Joint

Working Group was to:

• Review and update evidence-informed

infant feeding recommendations for

health professionals in Canada

(Nutrition for Healthy Term Infants).

Recommendations of the IFJWG• Breastfeeding is the normal and unequalled method of feeding

infants

• Breastfeeding initiation and duration rates increase with active

protection, support, and promotion

• Supplemental vitamin D is recommended for breastfed infants

• First complementary foods should be iron-rich

• Routine growth monitoring is important to assess infant health and

nutrition

• Feeding changes are unnecessary for most common health

conditions in infancy

• Breastfeeding is rarely contraindicated – However, an acceptable

alternative to breastfeeding for mothers who are HIV-infected is

recommended

• Most medications are compatible with breastfeeding – use a caseby-

case approach when a mother is using medications or drugs

• Recommendations made on the use of breast milk substitutes

Toddler Feeding• By the time children become toddlers they should

be eating “regular” food.

• Toddler development and food are very closely

connected; growing independence applies to food

too.

• Feed toddlers small amounts frequently. They are

more likely to eat and less likely to get so hungry

and tired that they can’t concentrate on food.

• Growth rates slows from infancy.

• Most toddlers will eat when they are hungry and it

will be a battle to get them to eat if they are not.

Toddler Feeding• This is the time that lifetime eating habits are set;

provide healthy food choices and avoid getting into a

power struggle over food.

• Toddlers can be overwhelmed by large servings; it is

more effective to offer little servings and then provide

“seconds”.

• Toddlers can be afraid to try new foods. Don’t worry

and keep offering them. Pair a new food with

something familiar.

• Food jags are common with toddlers. Just ride the

wave and recognize that at some point the child will

increase the range of food that he/she is willing to

eat.

Toddler Feeding

• Juice should not be fed by bottle. Why?

• Toddlers control the amount of food that

they eat and grown-ups control what food is

offered!

• Toddlers are not growing as rapidly as

infants and sometimes they eat less; this is

normal.

Toddler FeedingHELPFUL HINTS

• Use unbreakable child sized equipment

• Don’t expect toddlers to always use cutlery; provide lots of

finger foods

• Small serving sizes are important (about a ¼ of an adult

serving)

• Cut food into bite-size pieces

• Avoid foods that are a choking hazard

• Try to avoid very chewy foods

• All children must sit down to eat.

Reducing the Risk of Choking

• The following foods should never be served to

children under 4:

– Popcorn, hard candy; gum; raisins; food on toothpicks or

skewers; fish with bones; round, smooth or slippery foods

• Remember:

– Cut grapes, cherries and olives into 1/4s and remove any

seeds. If serving wieners, cut them in half length-wise and

then into bite size pieces.

– Grate, chop or parboil hard fruits and vegetables such as

carrots and apples.

• Mealtimes should be calm and quiet

• Children should be sitting when eating

• Do not leave children alone at meal or snack times

Food Additives

What are food additives?

• Chemicals added to food for a specific purpose (to

change appearance or to preserve)

• Substances that are used in food to maintain its

nutritive quality, enhance its shelf life, and make it

attractive or to aid in its processing, packaging or

storage are all considered to be food additives. http://www.hc-sc.gc.ca/fn-an/index-eng.php

• Ex. of food additives – colouring agents, anticaking

agents, preservatives, some sweeteners

• Ex. That are not additives – salt, sugar, vitamins,

minerals, spices.

Food Additives• 1964 - rigorous testing on food additives began

• Before a new food is approved by Canada’s Health

Protection Branch it must go through testing of food

additives

• There are more than 2800 additives approved for use in

Canada

Under the Food and Drug Regulations, food additives do

not include:

• Food ingredients such as salt, sugar, starch

• Vitamins, minerals, amino acids

• Spices, seasonings, flavouring preparations

• Agricultural chemicals

• Veterinary drugs

• Or food packaging materials

Food Additives

Are Natural Food Additives safer than

Synthetic?

• Human body can’t tell the difference.

• All foods contain chemicals – natural as well

• Food additives - listed at the end of product

“ingredient” list – usually present in low

quantities

• Most additives do not pose a health threat

• Some (i.e. nitrates) may cause health risks if

consumed regularly for long periods

Food Additives – Food Colouring

• Not essential

• Increases attractiveness of food - “Eye appeal”

• Replace natural colours destroyed through processing

• To ensure conformity

• Colour is a big part of food; almost as much as taste or

smell

• Consumer demand will change levels of food colouring

used

• Can be a trigger of hyperactivity along with benzoates,

rather than sugar (sugar actually makes us sleepy)

https://www.youtube.com/watch?v=c2NVi2qZR2c

(Excellence in Paediatrics)

BABY FOOD?

• Very few additives allowed

• Most occur naturally

Food Additives – Nitrates• Used in processed meats as a preservative (hot dogs, ham,

bacon, bologna, salami, other luncheon meats)

• Assists in preventing botulism, potentially deadly form of food

poisoning

• After we ingest nitrates, our body converts them to nitrites,

then to nitrosamines: in strongly acidic conditions such as the

human stomach, can be carcinogenic

• Can cause cancer in large quantities

• Avoid by limiting or not eating processed meats

• Children better off not being introduced to processed meats

early in life - easier to chew, have a salty flavour, which

children enjoy

• Food additives are not new and they save lives; the challenge

is to increase the amount of natural or whole foods that we

eat that do not require food additives• https://www.youtube.com/watch?v=KSOIY9V-hC8

Sweetners

• Found in many foods - beverages, snack products

• Nutritive sweeteners – sugars including honey and

sugar alcohols

• Non-nutritive or non-caloric sweeteners –

aspartame, agave, sucralose

• Use of non-nutritive sweeteners does not prevent

of combat obesity

• Still encourage a sweet tooth or habitual desire for

sweets

• Avoid by providing healthier foods that don’t

require sweetening and are naturally sweet fruits

and vegetables

Pesticides

• Unintentional additive – some chemicals

remain in or on the food after harvesting

• Used to kill pests on vegetables, fruits, grains

• Concern about potential effects of pesticides

on children, termed neurotoxins – have effect

on developing nervous system

• How to reduce pesticides ingested?

– Wash all produce thoroughly before eating

– Peel fruits and vegetables

– Buy organic produce

Mothercraft’s Foundational Theories

Developmental Theory• Nature + Nurture - neurobiological and psychosocial

impacts of the pre- and postnatal environments.

Attachment Theory• Child’s attachment to caregiver based on day-to-day

interactions with caregiver;

• Depends on caregiver’s response when the child’s

attachment system is activated;

Relational Theory• People, institutions and systems grow through relationships

with others (Jordan et al. 2004; Walker et al. 2004).

Group ScenariosScenario #1

• Marie is an 8 month old girl, in your Infant room at the

Mothercraft child care centre. Marie has not yet been

introduced to semisolid foods, not even infant cereal.

Marie’s only source of nutrition is her mother’s milk. Marie is

showing signs of readiness, she is interested in other

children’s foods, sits and seems to want to drink very

frequently. However, when you mention this to her mother,

she assures you that she will be starting Marie on infant

cereal. That was three weeks ago, and Marie’s mother has

not followed through.

• What are the issues and concerns for the educators caring

for Marie?

• How should you proceed keeping in mind Mothercraft’s three

foundational theories?

Group ScenariosScenario #2

• Your program’s goal is to encourage infant and toddler

independence. You encourage Jerome (10 month old) to

hold a spoon while you have a second spoon for feeding.

You also encourage Jerome to pick up finger foods for self-

feeding. Jerome’s parents emphasize the importance of

interdependence and seem quite concerned when they see

Jerome “playing with his food”. They value the connection to

the family as a priority and self-sufficiency as less important.

• How would you proceed with this scenario keeping in mind

Mothercraft’s three foundational theories?

Group ScenariosScenario #3

• Josie has enrolled her five month old in childcare. Josie is

still breastfeeding her baby and wants to continue this, even

after going back to work. Mom has a flexible job and since

she works down the street from the childcare centre she is

coming into the childcare to breastfeed her infant. Josie is

breastfeeding when she drops off her baby, she is coming in

at 12:00, 3:00 and she is breastfeeding the infant at pick-up

at the end of the day. The staff are concerned how the

infant will attach to the staff and how this may interrupt the

program.

• How would you proceed with this keeping in mind

Mothercraft’s three foundational theories?

Group ScenariosScenario #4

• Rosa has been breastfeeding her infant for the last 12

months and has not introduced a bottle or Sippy cup to her

baby, Maci. Maci is starting childcare and Rosa is

apprehensive on how her baby will drink since she has not

introduced a bottle or Sippy cup. The staff encourage Rosa

to start introducing Maci to a bottle or Sippy cup but mom

has not yet done this. The staff are also apprehensive about

Maci’s transition into the program.

• How would you proceed with this scenario keeping in mind

Mothercraft’s three foundational theories?

Group ScenariosScenario #5

• At the end of the day, you overhear two parents talking

about their evening routine with their infants. The two

parents are talking about how they don’t give their 14 and 15

month old dinner because they get enough food in childcare.

You are concerned because you know that at childcare they

are not getting enough nutrition to sustain them through the

night. What would you do?

• How would you proceed with this keeping in mind

Mothercraft’s three foundational theories?

Nutrition Labels• 2007 Nutrition Labeling Policy introduced by Health

Canada

• Standardized Nutrition Facts table – mandatory on all

prepackaged foods.

• Indicates calories, core nutrients, vitamins, minerals

• Amount of each is based on serving size indicated

• Nutrients given in weights such as grams and milligrams,

then translated to percentage of recommended daily

value

• Vitamins and minerals are given as percentages of daily

value

• Saturated and trans-fats are listed separately

• Carbohydrates - divided into fibre and sugar

Nutrition LabelsAlso found on package/can:

• Expiry date and ingredient list-from highest quantity to least quantity

Read the Label:

• Limit the amount of salt- everything with the word SODIUM.

• Compare amount of sugar with the amount of fibre; choose higher

fibre.

• Look at amount of sugar. Anything ending in “ose” is a type of sugar.

• Glucose, corn syrup, molasses, sucrose, lactose, dextrose and

fructose are all types of sugar

• Choose foods that are lower in fat (especially saturated and trans fats)

• Look for the amount of total fat, saturated fat, and trans fat. The lower

the number, the less fat the food contains.

• Should not exceed 20 grams of fat per day (or approximately 10% of

our daily caloric intake)

Potato Chips

Peanut Butter

Canned Crushed Tomatoes

Nutrition Labels - WorkREADING NUTRITION LABELS – SMALL GROUP WORK In groups of 4

look at the labels that each group member brought:

• What is the highest quantity ingredient in the food?

• What food groups are represented by this food?

• Does this food fit into the Canada Food Guide? In which category?

• List the additives in this food.

• Would you eat this food?

• Would you feed it to children?

• Could this food be made more naturally?

• What colour do you think this food would be without food dye

additives?

• Of each label in your group, which food do you feel is healthiest?

Why?

SummaryToday we talked about

1. Infant Nutrition

2. Introducing Solid foods

3. Feeding toddlers

4. Labels

5. Review for test

6. Today after lunch – Presentations

7. Next week – Test December 5, 2016

• You will have full 3 hours to write the test: 1 – 4 pm

• Closed book

• Test will be

– True/False

– Multiple choice

– Short Answer

– Long Answer

References• Healthcanada.gc.ca (2016). Food and Nutrition:

Health Canada. Retrieved from http://www.hc-

sc.gc.ca/fn-an/index-eng.php

• Healthybabyhealthbrain.ca (2016). Healthy Baby,

Healthy Brain,

http://www.healthybabyhealthybrain.ca/