Milk, Whole milk vs. 2 percent Current recommendations from AAP and - - PDF document

2/9/2017 1

Controversy and Issues in ECE practice, identified by states

Bonnie A. Spear, PhD, RDN, FAND

Milk, Whole milk vs. 2 percent

• Current recommendations from AAP and AHA

– Breastfeeding or formula until 1 year of age – Whole milk until 2 years of age – Beginning at 2 transition to 2 percent milk

• So why the controversy

– David S. Ludwig, an pediatric endocrinologist in Boston and Dr. Walter C. Willet, Professor of epidemiology and nutrition chair at the Harvard SOPH questioned why low‐ fat milk was given the OK over the whole milk option. – Few clinical trials that have looked at the benefits of reduced‐fat milk compared to whole milk. Most people just assume the lower‐fat milk has fewer calories and that is better

So what do we know?

• Toddlers are picky eaters:

– They have tiny tummies – Toddlers don't like to sit still for anything.

• Milk

– contains calcium, potassium and vitamin D, which helps the body balance levels of calcium and phosphorous for stronger bones. – milk and other dairy products have been known to improve bone health & reduce the risk of

• steoporosis.

– important to drink and eat dairy at a young age when bones are forming.

• Fats

– provides twice as many calories per gram as do carbohydrates and proteins. – healthy fats are a necessary component of the vital tissues—especially the brain and central nervous system—that are growing so fast in your toddler. – when you switch to two percent milk, you must add

• ther healthy fats to your baby's diet.
• Need for fat

– Until age of 5 brain myelination‐ which is essential for brain development continues. Requires saturated fat to develop. If a child does not add other forms of fat that then the brain maybe at risk

• In a 2013 JAMA article, researchers suggested

that whole milk may be the better option when giving children dairy drinks.

• A study in the Archives of Disease in

Childhood in March 2013 showed that children who drank lower‐fat milk were more likely to be overweight later in life.

Milk (per 8 oz.) Calories Fat Pro Carbs

Whole Milk 150 8g 8 g 12 g 2 Percent Milk (also known as reduced fat milk) 120 5g 8g 12 g 1 Percent Milk (also known as low‐fat milk) 100 2 g 8 g 12 g Skim Milk (also known as nonfat milk) 80 0 g 8 g 1 2 g Non‐fat Chocolate milk 120 0 g 8 g 20 g (8 g

sugar)

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So what is an ECE program to do?

• Breastfeeding or formula until 1 year of age
• Whole milk until 2 years of age
• Beginning at 2 transition to 2 percent milk
• However, research shows

– Ok to continue whole milk past 2 – For picky eaters of those who don’t eat much fat, continue with whole milk to received necessary fat or encourage other foods that provide healthy fats – Skim milk is probably not needed until after 5 years of age, even for overweight children.

Engaging child care workers in Helping Their Kids eat

It’s Not About E ating It’s About F e e ding

Mealtime Conversations

F e e ding is

WHAT (fo o d, nutritio n) HOW (a c tio ns/ a ttitude s) WHY (c hild

de ve lo pme nt/ b e ha vio r / te mpe ra me nt/ e a ting style )

2/9/2017 3 Feeding Relationship

“Parents/child providers are responsible for WHAT children are offered to eat; children are responsible for HOW MUCH they eat.”

Childre n do n’ t kno w ho w to c ho o se balanc e d me als, re g ular timing o r whe re to e at, but the y do kno w whe n the y’ ve had e no ug h to e at and ho w we ll fo o d taste s and fe e ls in the ir mo uth.

www.e llynsa tte r.c o m

R e war ding

Disre g a rds inte rna l hung e r re g ula tio n E xte rna l fa c to rs pre side (re wa rd) F

• o d pre fe re nc e s impa c te d o ve r time

De va lue he a lthy fo o d; fa vo r le ss he a lthy fo o d Ge ts kids to e a t to da y, b ut do e sn’ t g e t the m to L IK E fo o d to mo rro w

“I f yo u e at the bro c c o li yo u c an have de sse rt.” “Just two mo re bite s and yo u c an have mo re bre ad.”

F a ith e t a l, Ob e s Re s, 2004; We b b e r e t a l. J Am Die t Asso c . 2010

55% o f pare nts o f 3 ye ar o lds use re wards to g e t the m to e at he althie r

Energy Intake Regulation

(Birch, 1991)

• Meal‐to‐meal energy intake highly variable
• Day‐to‐day variability of total daily energy

intake is very low

Restricting

 Gre a te r inta ke o f limite d fo o d  E a ting in Ab se nc e o f Hung e r  Po o r se lf-re g ula tio n o f e a ting  I nc re a se d risk fo r o ve rwe ig ht  Va lue re stric te d fo o d

L imit se c o nd he lping s,

• nly lo w kc al fo o d
• ptio ns, no

swe e ts/ junk/ so da in the ho use

Birc h e t a l. Am J Clin Nutr 2003; Sa va g e e t a l. J L a w Me d E thic s 2007

Prompting/Pressure

• L
• we r a b ility to re g ula te inta ke
• De c re a se d inta ke o f fruit/ ve g g ie s
• I

nc re a se d sa tie ty re spo nsive ne ss (e a rly fullne ss)

• Slo w & fussy e a ting
• Ove re a ting

F ishe r e t a l, AJCN, 2002; We b b e r e t a l. J Am Die t Asso c . 2010

Re minding the pic ky e ate r to e at, c hasing the to ddle r with a sippy c up o f milk, le aving fo o d o ut all day to e nc o urag e mo re e ating , e xc e ssive talking abo ut fo o d and nutritio n at the dinne r table

Controlling

Unc le a r influe nc e During infa nc y, c o ntro l o ve r wha t a nd ho w muc h pro duc e s a lo we r BMI a t a g e 2 Olde r c hild: Ma y pro mo te unc o ntro lle d e a ting , o ve re a ting a nd we ig ht g a in

F a rro w e t a l, Pe dia tric s, 2008

Pare nts take o ve r kid’ s e ating ; c o ntro l whe the r and ho w muc h the y e at. Child: “I do n’ t want to e at that.” Pare nt: “T he n yo u must no t be hung ry fo r de sse rt e ithe r.”

2/9/2017 4 No Thank you Bites (from University of Iowa)

What you ne e d to know about kids

T e mpe ra me nt, E a ting Style , Ag e s & Sta g e s o f De ve lo pme nt

Temperament

 E a sy-g o ing  Diffic ult  Spirite d  Stub b o rn  T imid  E ve ry c hild is diffe re nt  T e mpe ra me nt e ffe c ts re spo nse to fo o d

E a ting Style

• E

nthusia stic E a te r: a dve nturo us; trie s a nd a c c e pts ne w fo o ds e a sily

• Ste a dy Ac c umula to r: mo st c hildre n; a c c e pt a nd

a c c umula te ne w fo o ds o ve r time with e xpo sure

• L

a te Blo o me r: e xtre me ly c a utio us with fo o d; re ve a ls tra it whe n sta rting so lids

• Supe r-T

a ste rs: he ig hte ne d se nse o f ta ste , mo re se nsitive to se nso ry c o mpo ne nts o f fo o d (sme ll te xture , a ppe a ra nc e )

Development Considerations in Feeding Young Children

• Importance of structure (family)
• Food jags
• Slow growth influences eating
• Importance of snacking
• Safety issues in feeding
• Hunger/fullness recognition
• Allow self‐feeding

Birc h e t a l. Ob e sity, 2006; 2008 F IT S

Introducing New Foods

(University of Iowa)

2/9/2017 5 Nutrient Needs of Toddlers/Preschoolers

Age (years) Protein (g/day) RDA 1-3 13 4-8 19

DRIs, 2002

Nutrient Needs of Toddler/Preschool

Age (mo) EER- girls (kcal/d) EER- bodys (Kcal/d) Kcal/kg boys Kcal/kg girls 12 768 844 82 81 24 997 1050 83 82 35 1139 1184 83 83

DRIs, 2002

Psycho‐social tasks 1‐3 Years

Autonomy

Child: “I c an do it” Pare nt: “I kno w yo u c an and I ’ m he re to he lp if yo u ne e d me .”  F e e ds se lf with he lp c utting fo o ds  Ab le to e a t with ha nds a nd g e t me ssy  Cho o se s wha t a nd ho w muc h to e a t fro m wha t is o ffe re d  Pa re nt re spo nsive to hung e r/ fullne ss

Shame and Doubt

Child: “I c an’ t do it.” Pare nt: “Yo u’ re to o yo ung , no yo u c an’ t.”  Is fe d/ a ssiste d mo re tha n ne e de d  Co ntro lle d fo o d  No t a llo we d to g e t me ssy/ e xplo re fo o d

Psycho‐Social Tasks 3‐5 Years

Initiative

Child: “E ating is fun—I ’ m g o o d at it!” Pare nt: Yo u c an make g o o d de c isio ns.”  He lps with me a ls, se tting ta b le , e tc  Se rve s se lf a t me a ls, e nc o ura g e d to ho no r fullne ss, hung e r  Vo ic e s like s a nd dislike s, fo o d pre fe re nc e s c o nside re d b ut no t c a te re d

Guilt

Child: “e ating is no t fun—I make so many mistake s.” Pare nt: “Yo u c an’ t do this, yo u ne e d my he lp.”  Adult disc o ura g e s inde pe nde nt fo o d se rving  No t a llo we d to turn do wn fo o d

• utside o f ho me

 Pre ssure d to finish me a ls, e a ting pe rfo rma nc e e mpha sis  Re q uire d to ta ste e ve rything

Helpful Mealtime Strategies

• Regular structured

meal times

• Appropriate seating
• Environment calm and

comfortable

• Some children

respond well to music

• r too distracting for

some

Resource

• University of Iowa vignettes

– Http://cals.uidaho.edu/feeding/aboutus/index.ht ml.

• Thank you Oregon for sharing this