Postpartum Body Image

Postpartum Body Image
By Jennifer McGurk, RDN, CDN, CDE, CEDRD

Photo Credit: Adrian Dreßler via Compfight cc

I had a very easy pregnancy and felt great almost the entire time.  What I didn’t expect was the shock and roller-coaster ride of emotions and body image after giving birth.  Not a lot of people tell you about the intense ups and downs during the postpartum period, especially when it comes to your body.  Everyone says, “Enjoy every minute!!” and “They are only this small once!!”  I remember feeling guilty thinking I wasn’t a fan of the newborn stage and felt so uncomfortable in this new body post-baby.  I would ask myself, “Why do I feel so ‘blah’?”  All I’m supposed to be doing is sitting on the couch and breastfeeding.  The only expectation is to bond with baby Connor, how hard can that be?”

Throughout my pregnancy I told myself I would get back to my normal self as soon as possible.  I didn’t care much about my weight but just wanted to feel good about my body.  I’m a very active person who loves yoga and exercise.  It felt amazing to participate in those activities while I was pregnant.  I also enjoyed gaining weight, knowing that the baby was growing and I was eating to support a healthy pregnancy.  I went back to the doctor a week after giving birth and had lost twenty pounds right away.  “Well that was pretty easy,” I thought to myself as I walked out the door… “I bet I’ll have my ‘normal’ body back in no time.”  So five more weeks pass by, and I walk in for my six-week postpartum checkup.  Those five weeks were probably the hardest weeks of my life, as the initial “high” of giving birth wore off, and life with a newborn started to actually sink in: no sleep, no activity, and increased anxiety.  I get on the scale at my six-week checkup, and the nurse weighs me and says, “Well, we don’t see that too often!  You actually went up!”  I kept on telling myself that weight wasn’t important to me, but in that moment all I could think about was the annoying negative body image voice winning over my healthy self.

Life went on, but something shifted in me around the three-to-four-month mark. I went back to work and felt fulfilled in my career, Connor started sleeping more, and I started to introduce formula and wasn’t exclusively breastfeeding (which honestly took away a lot of stress).  I also asked for help with babysitting so I could get out of the house more often.  I started to not care as much about my postpartum weight loss and started to focus more on doing something each day for myself and self-care for a healthy body.  I felt myself change both mentally and physically as more self-care happened.  I am now feeling so blessed and happy, and my anxiety has decreased.  I am walking more with my mom friends and babies, going to weekly “Mommy and Me” yoga classes, and am training for a five-mile race on Thanksgiving Day.  I am also slowing down each day, cutting back on my “to-do lists,” and just taking it one day at a time with my son with no expectations.  My body feels strong as it has now fully recovered from childbirth, and I feel almost “back to normal.”  But guess what?  I weighed myself the other day out of pure curiosity and wouldn’t you know—my weight was the exact same number it was at my six-week postpartum checkup.  Thanks to a healthier attitude and lots of self-care, I feel incredible both physically and mentally.  I also feel blessed that I can teach my son what it means to love your body no matter what the scale says.

Food Cravings: Consuming Peanuts and Soy During Pregnancy

Originally published on NY Metro

Are you craving a peanut butter and jelly sandwich during your pregnancy? Did you religiously consume soy products like yogurt and milk before your pregnancy, but aren’t sure if you should continue to do so? Manhattan nutritionist and mother of two says it’s OK!

Photo Credit: Jack Fussell via Compfight cc

My friends used to glare at me when I ate peanut butter and soy yogurt while pregnant. They, like many other moms, believed in the notions that parents should not introduce nuts or soy to children younger than 2, solid food to infants younger than 6 months, and food like nuts, nut butters, and anything with soy while pregnant.

I loved these foods too much though; peanut butter and soy yogurt remained a primary means for me to consume protein, fat, and calcium for the duration of my pregnancies. To my content, after giving birth, I received my Food Allergy and Anaphylaxis Network newsletter, confirming that there was no such relationship between these ingredients, food products, and allergies. Since then, neither of my boys has developed any type of severe food allergy either.

But enough about me. Let’s talk about you, your babies, and what the latest research says on consuming allergenic products while pregnant, breastfeeding, and in the first years of life.

Food Exposure While Pregnant

If you’re the kind of mom who, like me, relied on peanut butter sandwiches for simple grab-and-go lunches while pregnant, don’t feel guilty if your child has developed a food allergy. There is plenty of proof that ensures that this is not your fault.

Eliminating specific foods during pregnancy and/or while breast-feeding, prolonged breastfeeding, and delayed weaning have not been proven to prevent the development of food allergies. New research actually suggests the opposite—that this may be the ideal time to expose children to sensitive ingredients in order to induce a natural tolerance to such items.

Rather than obsessing over which foods to limit, focus on eating a variety of items on a daily basis. Identify your cravings, and be sure to consume enough calcium and omega 3 fatty acids in a moderate manner. Craving chocolate and peanuts? Don’t eat them in excess every day. Instead, rotate the foods you love and incorporate a variety of ingredients from one meal to the next.

If you are still afraid of what ingredients like nuts and soy may trigger, try using a four-day rotation that’s known to help individuals with food intolerances. For example, if you have eggs on Monday, don’t eat them again until Friday. While this may require extra thinking and work, the four-day rotation can help to calm even the most cautious mom’s fears.

Photo Credit: Ann@74 via Compfight cc

When to Introduce Food to Infants

Back in the 90s, when I studying nutrition and was pursuing my RD certifications, I learned that it was appropriate to introduce solid foods to babies between 4 and 6 months. By the time I had given birth to my first child in 2006, the word on the mommy block was to delay the introduction of solids until at least 6 months or older in order to prevent the development of allergies.

Current research conflicts with this proposal. Jonathan M. Spergel, MD, Ph.D., and chief of the Allergy Sector at the Children’s Hospital of Philadelphia says, “Delaying food introduction after 6 months could be even more detrimental in regards to developing a food allergy.” One study, reported in Pediatrics, supports this theory, suggesting that introducing solid foods at a later age was associated with an increased risk for allergic sensitization to food and inhalant allergens by the age of 5. Another proved that introducing cow’s milk, chicken, eggs, peanuts, tree nuts, soy, and gluten before 6 months was not significantly associated with eczema or wheezing at any age.

So remember, while there are always exceptions, the general consensus is that introducing solid foods between 4 and 6 months of age is actually associated with the lowest allergy risk. In other words, it’s during this time, before the 6-month-old mark, that it may be best to incorporate solid foods during mealtime.

How to Introduce Peanuts and Tree Nuts to Toddlers

Based on current research, parents do not need to delay the introduction of peanut butter or nut butters until their toddler is 2 or older. However, you should wait to introduce foods that may put your child at risk for choking, such as the actual nut itself.

Also take note that nut butters are highly sticky and can get stuck on the roof of your child’s mouth. If you do choose to feed them nut butter, be sure that they have developed sufficient tongue strength and motor skills to swallow the spread. Serving these sticky products in between two soft pieces of bread may help prevent choking or difficulty chewing as well.

If there is a family history of food allergies to peanuts, nuts, or any other food, a medical physician and registered dietitian should always be consulted. Many times, the pediatrician will try exposing the child in a medical setting if anaphylaxis is of concern.  Another option to consider, of course under the recommendation or supervision of your child’s pediatrician, is to test the potential allergenic food at home with an antihistamine available in case there is an allergic reaction.

Feeding your pregnant body and your growing baby can be a joyful and exciting, not to mention delicious, period of your life. Relax knowing that you can dine on your favorite foods while sporting your bump, introduce solid foods to your bundles of joy between 4 and 6 months old, and even let your little ones nibble on some nutritious nut butter at some point before age 2.

To Breastfeed or Not To Breastfeed?

In honor of World Breastfeeding Week, we wanted to share a previous post from a guest blogger, Allison:

 

Guest Blog: Breastfeeding versus Bottle-feeding
By Allison Brooks

Photo Credit: nettsu via Compfight cc

Moms may differ in their opinions and or choice to breastfeed or bottle-feed. I personally think it should be the woman’s right to choose. Breastfeeding and bottle-feeding both have pros and cons. We hear the many pros of breastfeeding such as less illness, possible greater intelligence of the child and so on. Many organizations including the Academy of Nutrition and Dietetics (formerly known as the American Dietetic Association) promote breast-feeding here in the USA and abroad. However, I question whether this is always appropriate especially if the mother is deficient in micronutrients, deficient in essentially fatty acids, malnourished, stressed, had multiple births in a short period of time or perhaps is not the right choice for the mother. I was breast fed for 3 months and choose to bottle feed my children.

Below, guest blogger Allison Brooks shares her point of view at an international level. Allison studies biomedicalization in Bolivia. Here she presents an example of biomedicalization on breastfeeding versus bottle-feeding in third world countries. Allison shared with me that she too was bottle-fed.  Feel free to comment and share your opinions as well. All are welcome.

Biomedicalization of BreastFeeding: What is healthy here, might not be healthy for all

Biomedicalization is a term used to describe the way in which natural life processes, human conditions and problems are defined and treated as medical conditions. Aging, childbirth and breastfeeding are good examples of normal life processes which have come under the authority of doctors. Biomedicalization may bring benefits, but there are also costs. Philosopher Ivan Illich was one of the first to use the term “medicalization,” which he argued actually caused an increase in social and medical problems as a result of medical intervention. One example is the drive by manufacturers of baby formulas to supplant breastfeeding with formula.

When a mother dies in childbirth or cannot breastfeed for some reason, infant formula may be the only choice. However, in the underdeveloped nations of the world, breastfeeding serves a number of critical purposes. Breastfeeding protects babies from infection, provides them with near-perfect nutrition and acts as a natural birth control for the breastfeeding mother. Breastfed babies are less likely to develop diarrhea, bacterial meningitis, ear infections and respiratory infections than infants who are fed formula. Breastfeeding also triggers beneficial hormone secretion in the mother, and the milk changes in amount and constituents to meet the needs of the individual infant.

The Nestle baby formula promotion of the 1970s urged mothers in less-developed countries to forgo breastfeeding in favor of formula, stressing convenience and nutrition. Nestle used strategies such as sending a new mother home with free samples; once the samples ran out, the child was habituated to formula and the mother’s milk had dried up, so the family had to buy formula.

Problems with this sort of infant nutrition quickly became apparent. Formula must be mixed with water and water in poor countries is often contaminated. Mothers could not read the instructions on water sterilization, or did not have the means to boil the water. Formula-fed babies were much more likely to die of diarrhea or pneumonia as a result of infections. Poor mothers would often mix inadequate amounts of formula for each feeding to make the expensive formula last longer, resulting in malnourished babies.

Nestlé’s marketing activities were considered so unethical that a boycott was launched by a group called the Infant Formula Action Coalition. In 1981 the World health assembly adopted Resolution WHA34.22, which bans the promotions of breast milk substitutes. Although Nestle agreed to accept the code, in 1988, formula companies were accused of repeating the unethical tactics and the boycott, which was still in force as of 2011, was launched. Other companies such as BordenSimilac and Wyeth have come under similar criticism for marketing methods that imply formula and breast milk are nutritionally equal. Most physicians and international organizations such as WHO and UNICEF recommend now breast milk exclusively for the first six months of life.

But the effects of biomedicalization do go way beyond the idea of breastfeeding. Pharmaceutical companies push new rules on societies regardless of their cultures, everyday. This is easy to see in America, because we are the only country that allows pharmaceutical companies to run ads and develop an image for people to follow. Without regards to the culture, the environment and so on, sometimes these “better” medications/therapies can actually be harmful for the people. With new drugs entering the system to promote beauty or health, or a better life-expectancy for cancer, traditional practices are be dropped by the wayside, and people and cultures are being negatively affected.

 

About Guest Blogger Allison Brooks:

Allison says “I was bottle-fed too, that’s why I say what is healthy to you might not be healthy to others (cultural relativism). Thats why I don’t push my beliefs onto people, I state what I know and allow you to do what you please, with no judgment.”

Allie went to the University of Mississippi. She earned her degree in biomedical anthropology and  is now studying in the field to finish an ethnography on the effects of biomedicalization on Bolivian cultures, but as it relates on other societies as well. She loves to guest blog on her time off to past time and spread the word. When she is not at her computer, Allie enjoys riding her  horse, Lilly and playing with her ducks, Alvin and Shirley.

One Mom's Story on Breastfeeding

In honor of World Breastfeeding Week, we wanted to share a post from a guest blogger, Rachel:

Breastfeeding May Be “Natural,” but That Doesn’t Make It Easy
By Rachel Lipson

Like so many other pregnant woman, I spent the months leading up to my son’s arrival planning, reading, decorating the nursery, and educating myself about childbirth, breastfeeding, and raising a newborn. I took classes, read books, talked to lots of moms and moms to be to get more tips. Everyone told me that breastfeeding would be difficult, but I couldn’t believe it would be difficult for me. I couldn’t imagine that a practice passed down over so many generations, a practice that nourished newborns since the beginning of time, could be all that challenging. The pain of unmedicated childbirth should have given me a clue that just because something has been done countless times before doesn’t mean it’s easy. I took breastfeeding classes, read books, talked to anyone who would give me tips, and prepared myself for any issue that could come up with nursing.

 

When my son came out last November, rooting and ready to latch, it still seemed like the most natural, carefree experience a mom and baby could share. How amazing that he came out knowing just what to do! Then he latched on and I was in excruciating pain! I was breathing through every suckle like it was another contraction. The nurse told me to toughen up (ironic since this was following a thirty-hour labor, an unmedicated birth, and two very severe post-partum hemorrhages that led to massive medical interventions and two blood transfusions). I had just been through quite a lot but was feeling stronger and more capable than ever. So, I persevered. The nurses at the hospital fancied themselves lactation consultants but dished out the worst advice. It turned out, following a visit to the pediatrician after we got home, that my son was tongue-tied. I thought that sounded like a figure of speech and not a diagnosis, but as it turned out, his tongue was too attached to the bottom of his mouth and that’s what caused the painful latch. We were referred to an ENT and had it corrected when Max was five days old. We were told he would cry for a moment and then nurse painlessly immediately after. He did only cry for a few moments, but when he tried to latch, he couldn’t figure out what to do with his tongue! After two visits with a lactation consultant, we were partially able to nurse with a nipple shield. Then, at the next doctor’s visit, it turned out Max was losing too much weight. We were advised to supplement with formula, but instead I supplemented with my own pumped milk in bottles after every feed.  Max’s latch was still incorrect, and it turned out he wasn’t efficiently nursing. I continued to nurse and pump and bottle feed…I was exhausted!

 

All of that pumping helped him to return to his birth weight but led to a massive oversupply of breast milk. Max would drink for a few moments and pop off screaming as milk squirted into his mouth. This was just getting harder and harder. I should say here that I’m the type of person who is extra motivated and somewhat of a perfectionist. It’s harder for me to give up than it is to persevere. Still, I thought about giving up, and when Max became colicky at three weeks old, I was ready to throw in the towel. I was exhausted, the latch problems were still there, and the nursing, pumping, and bottle-feeding took up way too much time and energy. That’s when things really got tricky. Max’s colic got worse and worse. He would cry and fuss from 7:00 p.m. or so until 2:00 a.m. every single night. My husband and I were losing our minds. The doctor suggested giving up dairy in my diet to see if it helped his colic. She gave us a can of hypoallergenic formula to try as well in case we wanted to see results even faster. Within just a few days, Max was a different baby. He no longer seemed to be in such intense discomfort, and the crying at night subsided. It turned out that Max had a milk protein intolerance. Problem solved!  But wait! A few days later, his reflux started. He was spitting up left and right and crying out in discomfort. The doctor suggested giving up soy as well. I gave up soy, and his reflux started to improve to some extent. The hypoallergenic formula made his reflux much worse. We tried multiple other hypoallergenic formulas (to supplement), and every single one made him absolutely miserable and unable to keep any food down.

 

From that moment on, I knew that all I had done to continue to breastfeed my son had been worth it. I had a child who couldn’t tolerate any food other than my breast milk (as long as it was milk and soy free). We had all sorts of other ups and downs, Reynaud’s phenomenon, mastitis, etc. I constantly wished I could stop, but I knew that this wasn’t an issue of what I felt was best for my son…there was nothing else for him to eat! What would we have done if I hadn’t kept it up all those weeks before? By six months, he was thriving and loving life. The reflux started to subside, and with the help of the amazing Brooke from Sleepy on Hudson, Max started sleeping through the night. I tried every hypoallergenic formula out there once again and found that there was one ready-to-feed version (one that had failed us miserably early on) that he was able to drink and keep down. When he was seven months old, he had given up nursing (his choice) for the most part and was exclusively bottle-fed (still mostly breast milk). I knew I had given him what he really needed…food and sustenance during a time when he couldn’t tolerate anything else. I was ready to eat dairy and soy again, ready to stop pumping 4–6 times a day, and completely weaned him by the time he was eight months old. Now he’s nine months old and as happy and healthy as can be.

 

Pregnancy was challenging at times, childbirth was excruciatingly painful beyond words, but breastfeeding was hands down the hardest thing I’d ever done in my life. It wasn’t always the amazing bonding experience I had envisioned, but I am grateful that I had the willpower and perseverance to stick with it when my son really needed me the most. I can’t believe I thought it would be easy! Of course, I’m sure it couldn’t be that hard the second time around…right?

 

About Guest Blogger Rachel Lipson:

Rachel Lipson is the founder and director of Blue Balloon Songwriting for Small People in Brooklyn, NY.

Breastmilk or Bust

Does the Rocking Chair Look Good Next to the Deep Freezer?
By Amanda Mellowspring, MS, RD, CEDRD, LD/N

Eat from the Earth Nutrition Counseling, LLC
www.eatfromtheearth.com

We all hear stories about “the crazy things” that mothers will do to care for and protect their children. I, along with many of you, also thought I was immune to such craziness despite my big heart…until I actually became a mom myself! Oh yes!

First, I will declare that “crazy” is not the right word for what I will share below, nor for most of the decisions we make as parents. While others may have their own views on our choices, the decisions that feel right in your family do not require approval from others. So, here’s a portion of my story…

In 2012, my husband and I welcomed a baby boy into our lives through adoption. What a powerful experience (which is an entirely separate story)!

As with any parents, our discussions had thoroughly covered a million topics on how we would care for this child. We reached out to only a few family and friends before his birth to avoid spreading the word in such a delicate situation (again another story altogether). One topic that arose as we spoke with another family that had recently adopted a child was feeding. Now, I certainly think most families have some discussion about feeding, so I don’t think being a dietitian really impacted me all that much. My friend shared with me the idea of breastmilk donation. I was immediately in LOVE and curiously asked a million questions about safety, quantity, storage, resources, and networks and then we were off! We eagerly met with pediatricians in our area to find a good fit before the big day and asked for their feelings about our decision to pursue breastmilk donation, at least as much as possible. We purchased a deep freezer for our milk storage & pre-purchased breastmilk bags to trade these amazing mommas who would offer us milk. We nervously contacted our local midwife to explain our situation and ask if she knew any mothers who may like to donate. Interestingly, this was the only thing, aside from one sweet handmade teddy bear that my husband made, that we allowed ourselves to do to prepare for his birth. Again, side story, adoption is amazing and amazingly scary. Everyone approaches this in their own right way.

The dietitian in me did step in the picture at times. We had an open adoption process, and knew that our birthmother was a beautiful gift in our life, but she also refused anything aside from soda and pizza throughout the pregnancy. Now I am not out to bash a good pizza and soda now and again, but talk about checking my work at the door! And, don’t worry I hold onto my own mom/RD guilt about not trying to induce lactation (yes, you can do this & yes, it is super cool), but there were a million reasons that it wasn’t possible in my life at that time. I have always been a strong advocate for breastfeeding, but prior to hearing about breastmilk donation, I had already adjusted my personal feelings about using formula as I had anticipated it to be my only reasonable option. Yes, formula is formulated to resemble breastmilk and provides adequate nutrition, and bonding really comes from love and not from boobs, so I was okaying myself with this. In learning more about milk donation, I also knew that I would most likely supplement with breastmilk donations and primarily feed formula and it would be fine, more than fine. I mean, how would I actually get enough breastmilk from other women to feed him only that!?! So, my dietitian part obviously loved the idea of the nutrition that breastmilk would provide, but I was most excited surprisingly about two other aspects of this endeavor – introducing milk would allow for flavor variation which would assist with food introduction and the development of his flavor palate & I would meet other moms! When you adopt, you don’t generally build the community that you may get from birthing classes etc, so meeting mommas was on my radar!

Beautifully and perfectly, our little guy was born on 9/12/12 and came home with us just a few days later. Over the next 9 months, I fully engaged in my “crazy” & my amazing husband went there with me! I linked up to every milk sharing network that I could find and began driving all over the state (& even other states when we travelled) to meet moms to trade breastmilk for milk bags and fresh foods from our garden. (The Friday evening car rides that took 3-4hrs round trip to pick up donations, the parking lot meetings at Babies R Us, & the coolers that constantly resided in the back of our car may be the “crazy” that I speak of!) Most of the moms didn’t want anything in trade (although milk bags are expensive and I would have bought a million of them if someone had wanted). Just the joy of knowing that they were offering a priceless gift satisfied these amazing women. (It is illegal to pay for breastmilk in the US just so you know, & I never met a mother that would have ever considered it either.) Amazingly, we were able to provide him with ONLY breastmilk from donation for 9 months – and talk about flavor profile with cultural influences from all over Latin America, Asia, Australia, France, & throughout the US! I will just take a moment here to say that the amount of breastmilk that a woman can produce is AMAZING! Seeing all of the milk that my son took in just by standing over a deep freezer packed, labeled, and organized always left me in awe (& usually tears again…a theme in motherhood I am pretty sure.) We pulled back from the search a bit as he started to eat more solids, because we knew that there were more new little ones out there that could benefit from this precious gift. Our little guy had never even had a diaper rash in this time period, so we wanted other babies to benefit from this nutritional gold mine too.

The idea of breastmilk donation dates back, way back, all the way back! Historically women have always been known to wet-nurse or nurse babies that were not their own. It’s just a love thing. But, even still, my protective mom self and my RD part considered what questions to ask women about their lifestyle, their diet, their health, etc. ‘To each her own’ on this topic, I say. I think everyone should be responsible for asking the questions that fit for them. We did not use formal hospital-based milk banks (which do exist) because those generally are reserved for sick children or children with special nutritional needs & there was not one in our area. For me, I can say that I have hugged every woman that provided for my child in this way & that, amongst a few questions here and there, felt right for me. Mind you, that almost all of these women came to me to offer to donate via midwives, other mommas, & friends. I went to their homes, met their babies, and even shared tears for babies that made the gift possible but didn’t live to see the gifts of their mothers in this way. Many women consider the birth children of their milky moms’ to be “milk brothers/sisters”. All of the sudden, I wasn’t just making momma connections; our family was literally growing with every milky mom we met! Thankfully, somewhere in the craziness of the adoption process and becoming a mother, I had the clarity to ask each woman to pose for a photo with our little one. In total, over 30 heart-touching, heart-wrenching photos of love and gratitude have compiled my little guy’s “Moms Book”. His book includes photos of his birthmother, several women (& a man) who were integral to his adoption, over 30 milky moms, & me. Quite a book. And, we are really loving picture books right now anyhow. We look at it together, and I suppose that one day he will ask why I always cry when we do.

Tips For Feeding Children With Special Needs

By Guest Blogger, Virginia Cunningham

The science of parenting has reached dizzying heights of understanding, but even in the 21st century we are still butting heads with children who refuse to eat their broccoli. Getting children acclimated to various foods and basic eating etiquette will probably always be one of the most demanding arenas of raising kids, but in the case of special needs children, there may be deeper issues at stake. Here are the major hurdles you may face when introducing your son or daughter to the dinner table, as well as some hints to ameliorate the situation.
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Food Attachment and Aversion
Parents of every stripe may be familiar with this stumbling block to ensuring your children consume the full range of nutrients needed for healthy development: stubbornly finicky taste. However, what might simply be old-fashioned childish obstinacy can take on an all but obsessive quality among special needs children.

Even adults can get stuck in a rut of eating comforting, familiar foods, but a special needs child may develop attachments to particular items based on their texture, color, or even temperature.

To expand your child’s monolithic diet, experiment with what behavioral psychologists call shaping and chaining. The method is simple enough. First, try to identify the particular quality of the food that has your child in its spell. A child might like a pasta dish for its bright orange color or for its squiggly shape. Identify what it is by the process of elimination, and then gradually mix in portions of another, potentially more desirable food. If a child only has eyes for cheddar cheese, for example, lead him or her toward similarly hued steamed squash.

“Purely Psychological” Factors
While food aversion is rooted in children’s relationship to the physicality of what they put into their mouths (or refuse to), children can also veto meals as a way of sending a message when they feel unable to communicate any other way. When a child is feeling particularly vulnerable, he or she may go on a mini hunger strike to vie for attention.

The worst thing to do in such a situation is the threat of punishment. Instead, use positive reinforcement in incremental steps (so as to avoid over indulging the child and enabling continued problem behavior). For instance, promise an additional few minutes of story time for every bite of spinach, peas, or whatever the target dish may be.

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Oral-Motor Skills

So far we’ve looked at eating problems that amount to a child’s not wanting to eat. Among children with various physical impediments, the issue may be that they are simply unable to. When a young person’s jaws, tongue, and labial muscles are weak, uncoordinated, or both, the act of eating is itself difficult. (The attendant emotional frustration threatens to make matters even worse, so be sure not to register your frustration.

Here, good intentions alone will not set things right, as your child most likely needs a consultation with a specialist and a regimen of exercises to bolster the muscle groups involved in biting, chewing, and swallowing.

Medical Conditions

On top of physical impediments linked to muscle control and coordination, children with some afflictions may have other innate problems with ingesting and even digesting foods. Certain birth defects can lead to chronic gastrointestinal woes, for example; children with visual impairment may not trust foods they can’t see.

The most widely reported medically-related eating problem is gastroesophageal reflux disease, or GERD. Affecting a ring of muscle between the stomach and esophagus, this condition can manifest a variety of symptoms, but the most frequent is spasmodic vomiting. After the child grows to associate eating with unpleasantness, he or she may begin to be wary of food in general, sometimes making it difficult to discern whether the issue is behavioral. If parents have strong suspicions that the problem is a medical one, a specialist should be consulted immediately.

Given that “special needs” is hardly a unified category, not all of these difficulties will apply to all children included within it. Some concerns are consistent, however. Always take great care to discover whether the issue is a physical or psychological one, as the symptoms can often be similar. And whatever the corrective path, be sure to take a course that is positive, calming, and paced with your child’s comfort level.

 

About the Writer

Virginia Cunningham is a freelance writer. Her work with Northwest Pharmacy helps all individuals get the care that they need. As a mother of a special needs child, she has written extensively on nutrition, alternative therapy, and inclusion of special needs children.

MDIO's Easy Peas-y Tips for First Solid Foods

This blog is for all the new mommies and daddies out there. My good friend is about to transition her baby twins to solid foods and asked for my advice. So, here is the latest dish on feeding babies their first foods.

Well, I remember the excitement as well as the apprehension I felt when starting my little boys on solid foods. I still have their food diaries, as thick as a novel sitting on my bookshelf. While I was old fashioned, meaning I only gave my boys bitter or less sweet veggies for the first few feedings (of course this was after rice cereal), no longer is it standard to feed veggies first. Research shows that there is no correlation between fruits or veggies, sweet or bitter, with picky palates or anything else we may be concerned about. So, follow MDIO’s Easy Peas-y Six First Foods Tips.

  1. First, I read Child Of Mine–well part of it–by Ellyn Satter. I also recommend this book to all my clients getting ready to give birth. Actually, I think it makes an amazing baby shower gift. So if you haven’t read it, download it or borrow it from your local library.
  2. Next, take a stroll through the baby food aisle at your local grocery store. You will note, that there are now organic jarred baby foods, frozen baby foods, purees in a handheld squeezable form and everything else under the sun, literally!! They all read nutritionist approved, earth friendly, and healthy. Write down some of the brand names, flavors and maybe even purchase one or two jars and frozen purees. Give them a quick taste test for a point of reference.  Start asking your friends what they like, what their kids liked and what was easiest. You may opt for homemade, jarred, and/or frozen depending on where you are feeding the baby (or babies if you have twins).
  3. Of course, you’ll want to make eating and feeding enjoyable for you and your little one early on. Mom Dishes It Out’s feeding expert and speech therapist, Robin Goldberg, shares the Top Ten Tips for Pre-Feeding Warm Ups. Before introducing food to your bundle of joy, read her wisdom. And then when the day finally comes, have fun! Get your rubber baby spoons and sit with baby in a calm place. Remember, like Robin says “The goal is to establish positive experiences with eating from an early age!” *Note: KidsHealth.org shares this quick guide on their website.
    Is My Baby Ready to Eat Solids?
    How can you tell if your baby is ready for solids? Here are a few hints:Is your baby’s tongue-thrust reflex gone or diminished?
    This reflex, which prevents infants from choking on foreign objects, also causes them to push food out of their mouths.

    Can your baby support his or her own head?
    To eat solid food, an infant needs good head and neck control and should be able to sit up.

    Is your baby interested in food?
    A 6-month-old baby who stares and grabs at your food at dinnertime is clearly ready for some variety in the food department.

  4. Then determine with your doctor, registered dietitian or perhaps your intuition whether to start feeding solids at 4 months, 5 months or 6 months.The latest of this ever-changing recommendation is to solely feed your baby breast milk for the first 6 months based on the World Health Organization. However, this recommendation is not universally accepted. In countries, like the USA where the infant’s energy expenditure/output is likely greater, many children are formula fed, and solid foods are more readily available than in a third world country, it remains to be determined if it is appropriate to wait until 6 months1.The American Academy of Pediatrics says “Generally, when infants double their birth weight (typically at about 4 months) and weigh about 13 pounds or more, they may be ready for solid foods2.” Yet the AAP goes on to recommend “breastfeeding as the sole source of nutrition for about 6 months.” Parents, talk with your doctor, your personal registered dietitian and assess your baby. I know my mom started me on solids at 4 months and I too started my boys between 4 and 5 months. Please know the current recommendation for 6 months has nothing to do with food allergies. It was established years ago that earlier age of introduction does not have a causal affect on food allergies in babies and children (see Is It OK to Eat Peanut and Soy Products While Pregnant)
  5. Refer to this quick Bottom-line of Feeding Baby:

    Birth to 6 Months
    : Babies get the nutrients they need from breast milk and formula during the first six months. You should NOT give your baby cow’s milk until after age 1.By 4 to 6 Months: While most babies are ready to eat solid foods now, they will continue to get most of their calories, protein, vitamins and minerals from breast milk or infant formula. Introduce iron-fortified infant or pureed meats to help replenish iron reserves, while continuing breastfeeding and or formula feeding.By 6 to 8 Months: This is an appropriate time to begin pureed or mashed fruits and vegetables. Introduce one new food at a time giving 3 day windows between each new type of food. Be cautious and observe for signs of allergic reactions. The three to five day window helps you to be sure which food your child may have an intolerance too. Look for rashes, vomiting, breathing difficulties, and or mood swings.By 7 to 10 Months: Think Finger foods. Babies are usually ready to start feeding themselves dry cereals like Cheerios or teething biscuits.  The Academy of Nutrition and Dietetics states, “[Babies] can begin to use a cup for water.” If they are not ready for the cup, or perhaps you are not ready, start to introduce the sippy cups with straws.By 8 to 12 Months: At this stage, most babies are ready for soft or cooked table foods. Think about having baby eat at some of the same times as the rest of the family. Family member role modeling and making food times pleasurable will help to create an overall positive food experience, which is the ultimate goal.From 1 to 2 Years: Babies continue developing eating skills. They feed themselves and enjoy the same foods as the rest of the family. Choking on firm, round foods is a risk, so cut these foods into smaller, ¼-inch squares. Adapted from Eat Right.
  6. Adhere to Baby Beware: What not to give Baby.Cows milk until after age 1 – before this they need breast milk or formula. Yogurt, pasteurized cheese and cooked eggs are okay as long as breast milk and or formula are the main form of liquid nutrition.Avoid potential choking hazards like nuts, seeds, popcorn, whole grapes, candy, gummy candy, anything with pits or have a round shape.. like cherry tomatoes or whole grapes.Avoid candy and sometimes foods. Babies need to focus on fuel for growth. Babies, need not have cupcakes. We just get enjoyment watching them get their first taste of pure sugar!

 

Let us know if this helps you or what has helped you at this precious and impressionable time. Remember it is of utmost importance to create a positive experience with eating and a neutral relationship with foods (Healthy Habits, 2013).

 

References

  1. Fewtrell MS, Morgan JB, Duggan C, et al. Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations? Am J Clin Nutr 2007;85:Suppl:635S-638S
  2. Hansen-Petrik, Melissa. “Nutrition: What Every Parent Needs to Know.” Journal of Nutrition Education and Behavior 44.2 (2012): 194-e3.

Top Ten Tips for Pre-Feeding Warm Ups

By MDIO’s Feeding Expert and Speech Therapist, Robin Goldberg,  MA, CCC-SLP, TSSLD


Tips to support your baby as he transitions to solid foods:

1. Make sure your child has adequate head, neck, and trunk control before transitioning to solids. He should be able to hold his head upright and steady for feeding, and should be able to sit up independently for 3-5 seconds. Providing supportive whole-body positioning, with the head and trunk upright and feet firmly grounded on a stable surface, allows for the stability needed to isolate and coordinate the smaller muscles of the mouth for feeding.

2. Use a soft, rubber spoon when feeding. Begin with a very small amount of food (1 tsp) on the tip of the spoon. Wait for your child to open his mouth independently. If he doesn’t do this, you can gently touch the spoon to his cheek to initiate a rooting reflex and help prepare him for feeding. Bring the spoon straight to the front of your baby’s mouth, stopping just inside the lips, with the spoon tip just approaching the tip of the tongue. When your child closes his lips around the spoon, draw the spoon straight out. Avoid scraping food up and off the spoon onto the roof of your child’s mouth. The goal is to teach your child to use his upper lip to clean food off of the spoon and his tongue to transport food to the back of his mouth for swallowing.

3. Your child should be able to move food from the front of his tongue to the back of his mouth for adequate swallowing. If he is pushing food forward and out of his mouth, his oral motor system may not be ready for solids. That is okay! Just wait a few weeks and try again. He will let you know when he is ready!

4. Only introduce one new food at a time. When your baby is first transitioning to solids, stick with one food per feeding (e.g., infant cereal OR pureed vegetables). It is important to give your child’s oral motor and oral sensory systems time to explore new flavors, textures, temperatures, and consistencies.

5. Begin feeding sessions when your child is alert. It is helpful to start with breast or bottle feeding so he is not too hungry. Learning to accept and manipulate solid foods (removing food from a spoon, transporting food from the front to back of the mouth, and tolerating new tastes and textures) takes time and effort (both for you and baby!). The goal is to keep this experience fun and positive. Allow him to explore the food on his lips, chin, cheek, and hands. When he begins to fuss or seems tired, stop feeding. The goal is to establish positive experiences with eating from an early age!


Tips to support your child with sensory processing challenges:

*Note: Every child with sensory processing challenges is unique. Children may be hypersensitive (overly reactive to sensory stimulation), hyposensitive (under-reactive), or demonstrate mixed sensitivities to different colors, textures, temperatures, smells, and sounds. If you are concerned about your child’s feeding skills, please consult a speech language pathologist or occupational therapist for an evaluation.

1. Many children with sensory processing challenges benefit from a pre-feeding sensory warm up. Exercises to help prepare your child’s sensory system for the intake of food can include massage or vibration around or inside the mouth. Always begin with massage or vibration (either with your fingers, a wash cloth, oral motor toy, or sensory bean bag) on the hands and arms, then from the outer cheeks towards and around the mouth. This input helps to alert or “wake up” the oral musculature (cheeks, jaw, lips) and sensory system for feeding.

2. Children with sensory processing disorders may demonstrate food aversion or present as “picky eaters.” Remember that food can be explored and experienced using all 5 senses, long before your child may be ready to actually chew and swallow something new. Consider incorporating multi-sensory experiences to increase your child’s tolerance and comfort around new foods. Activities can include visually observing and describing foods (e.g., sorting red vs. green foods onto different plates), touching foods (e.g., cutting, mixing, poking holes, food stamping, “finger painting” with pudding or peanut butter), or conducting smell tests.

3. Be aware that changing too many foods too quickly can be quite triggering for a child with sensory challenges. Take note of what foods he or she currently eats and look for patterns in color, texture, consistency, and temperature. Let your child’s natural food preferences and patterns inform your decisions about what foods to introduce next!

4. Creating a sensory-friendly feeding environment can make mealtime much more successful. If your child struggles to organize and process sensory information, he may become overwhelmed by auditory, visual, and olfactory information that you may easily be able to tune out. Strong cooking odors from the kitchen, a visually crowded table (many different serving dishes or containers), or even brightly colored or patterned dishes can be distracting for some children.

5. Be mindful of the length of mealtime. If your child has sensory processing challenges, sitting for long periods of time may be particularly difficult. Depending on your child’s age and developmental level, he may only be able to sit for 10-15 minutes per feeding session. If this is the case for your child, don’t be discouraged. As his oral sensory system develops and new foods are introduced gradually, you can expect meal times to lengthen.


About the Author:

Robin Goldberg, MA, CCC-SLP, TSSLD is a speech language pathologist specializing in the assessment and treatment of developmental disabilities, autism spectrum disorders, speech and language delays, and feeding challenges (food aversion and selective eaters). She currently serves as Co-Chair of the Speech and Language Department at The Parkside School, an independent elementary school for children with language-based learning challenges. Additionally, Robin treats children privately through her practice Leaps and Sounds NYC. Robin uses a fun and highly interactive child-centered approach to therapy, incorporating both structured and play-based techniques that support the whole child and ensure that new skills are carried over from therapy into the child’s daily life at home, school, playdates, and extracurricular activities. She has specific training to support her work with oral motor deficits and articulation disorders, sensory and behavioral feeding disorders, and autism spectrum disorders, including: PROMPT, Nancy Kaufman’s Speech to Language Protocol, The DIR-Floortime Method, Applied Behavior Analysis (ABA), The Social Thinking Curriculum by Michelle Garcia Winner, Food Chaining, and Lori Overland’s Motor-Sensory Approach to Feeding.

Walking with Purpose

By Guest Blogger: Rebecca Weiss

For the past ten years I have been invisible. I’m not a superhero, and I’m not joking. Since the early 2000s, I, as an overweight, middle-aged woman in New York City, have been completely invisible.

This has played out like a humorous montage in a sitcom. I climb up a flight of stairs from the subway, and the people coming down the steps run right into me. I walk out of a coffee shop with a cup in each hand and the person in front of me drops the door in my face. I walk down the street with my husband—no small fellow himself—and people part ways and let him through while I am swallowed by the crowd. Back when George Bush was president, I posted political stickers all over lower Manhattan and no one noticed my acts of vandalism. I really was invisible.

I got used to it. People didn’t see me, and I didn’t make an effort to be seen. I stopped getting my hair cut, stopped wearing makeup, stopped buying new clothes. By the time I was up to 230 pounds, I was wearing my husband’s old khakis and baggy t-shirts everyday and always had my hair piled up on my head.

I often laughed to myself when someone from my neighborhood, or one of my kids’ schools, or just the grocery store, would acknowledge my husband but not me. It got to be quite comical at times. I stopped to help someone whose car had broken down and she waved me away, not realizing that I have ridden the same train with her to and from the city every workday for the past six years.

Since beginning a fitness program about a year ago, and eating more mindfully, I’ve noticed many changes in myself. I’ve got more energy, I sleep well, I don’t suffer from stomach-related ailments any more, and I can run, climb stairs and dance like a fool without getting out of breath. I’ve reveled in my discovery of these things. And, just recently, I’ve begun to notice something else: People are seeing me again.

It seemed like a fluke at first. One morning my train pulled into the station, and the other people waiting to board made room for me in line. Some even said hello. Next, a barista at Starbucks acknowledged my presence without me waving my hands in her face. Then, it spread: salespeople offered to help me in fitting rooms, coworkers complimented my outfits, some people actually apologized after bumping me with their bags on the street. I had forgotten how to react in these situations, so I adopted a nervous smile and tried to go with it.

I’m not saying it’s been a complete 180 and the world embraces me now. It’s certainly nothing like when I was in my 20s, sashaying down the NYC sidewalks in platform sandals and short skirts, with men coming up to ask for my number. I know those days are long gone, and I’m not sorry to see them go. But, whether they see me as a set of legs, or as a mom, or a woman on her way to work, it’s notable to me that they actually do see me. Of course, I still get the door dropped on my face at the coffee shop from time to time, and pushy people on the train are still pushy—this is New York, after all.

Now I wonder, is it just my weight loss that’s brought me back into the visible world? Could it be that I walk differently, hold myself differently, address people differently? When I was heavier, was I showing myself to anyone? Or, was I hiding in my oversized clothes and unkempt hair? Perhaps I wanted to be invisible.

Regardless, the fact is that I’m here now. I walk with purpose. My eyes are bright. I’m taking up the space I choose. No matter what I weigh, I’m here, and I’m not going to disappear again.

A Comment from MDIO:

When reading this, I expect that Rebecca is just now becoming present and comfy in her own skin. No longer does she want or feel the the need to hide. Yet– Moms and dads, despite what our kids look like, what shape or size their bodies are, lets vow to love them, and help them find self worth so that they can beam from the inside out from childhood through adulthood.

 

About Rebecca: 

Rebecca Weiss is a writer, mom of two, and director of communications for a New York City auction house. In 2012 she started a fitness and wellness journey. She is a monthly contributor to Mom Dishes It Out.

Tabbouleh

Tabbouleh is a classic Middle Eastern salad made with fresh herbs like parsley, mint & tomatoes. Serve this tart salad with a scoop of hummus and warm pita!

 INGREDIENTS ( Makes 8 servings)

1 cup bulghur wheat

1 1/2 cups boiling water

1/2 cup freshly squeezed lemon juice (4 lemons)

1/4 cup extra virgin olive oil

1 cup minced scallions, white and green parts

1 cup chopped fresh mint leaves

1 cup chopped flat-leaf parsley

1/4 cup white wine vinegar

1 hothouse cucumber, unpeeled, seeded, finely chopped

2 cups cherry tomatoes, finely chopped

1 teaspoon freshly ground black pepper

3 1/2 teaspoons kosher salt

METHOD

Bring water to a boil. Add bulgur  lemon juice, olive oil, salt and pepper to a large bowl.  Pour boiling water over bowl and allow to stand at room temperature for about 45 minutes.

In a large bowl, combine the scallions, mint, parsley, cucumber, tomatoes, vinegar, and  2 teaspoons salt. Cover and refrigerate. When bulgur has absorbed all of the liquid, add it to the bowl. Adjust seasonings and serve immediately or chilled. with whole wheat pita bread.