So your child is underweight, not eating well, not growing well. You’ve been told to give him calorie dense drinks like Ensure, Pediasure, or Boost; lots of butter, pudding, whole milk, and cream; and of course, lots of ice cream. Is this healthy?
Seeing these common recommendations is one of my least favorite findings as a dietitian in private practice working with kids. There are four problems here that can interfere with restoring your child’s robust health:
One, these drinks and foods are made with conventionally raised dairy products, which can contain bovine growth hormone, pesticides, traces of genetically modified feed corn proteins, and antibiotics, not to mention possible heavy metals from agricultural chemicals. All of these agricultural interventions have been linked to problems ranging from higher incidence of ADHD to earlier onset menses, other hormone disruptions in boys and girls, allergies, and neurological disorders.
Two, the child’s underweight status may be at least partly due to an undiagnosed milk protein intolerance or allergy – which irritates and inflames the gut, making nutrients and energy even harder to absorb. Be sure to get this sorted out before relying on any milk protein sources in your child’s diet.
Three, milk protein (casein) is often a constipating protein source, especially in children with some digestive insufficiency issues, like reflux or imbalanced gut microflora. Healthy gut microflora (bacteria) add enzymes to help us digest and absorb food, and keep bowel habits on track. If your child is unable to comfortably pass a soft formed stool most every day, then appetite can weaken – exacerbating the problem of packing in calories.
Last but not least – drinks like Ensure, Boost, and Pediasure rely on refined sugars and corn syrup (in various forms) to up their calories. I don’t like this because corn syrup is noted for containing a bit of mercury in every teaspoon, thanks to agricultural processing. Corn is also a genetically modified crop. Emerging research suggests that proteins in foods from genetically modified crops can trigger allergy. More allergy = more gut inflammation = more difficulty absorbing nutrients and energy = poor growth and gain. And, there is no sound argument for relying on refined sugars as a major strategy for growth and gain in children.
You can do way better.
First, make sure you are not battling undetected food sensitivities or food allergies. Get tested! You may need to avoid milk protein sources entirely, in order for your child to feel hungrier and digest more comfortably. Many labs and providers can assist with this, and this is a specialty in my practice too. Make sure you look deeper than just IgE allergy responses with a conventional MD allergist. For more information on this, see either of my books.
If eggs and nuts are allowable, get a powerful blender or food processor – the sky’s the limit, with those two ingredients adding creaminess without milk or ice cream. Everything on my list below is organic, no added sweeteners in the milk substitutes, and raw where possible. When using nuts, blend those first to smooth consistency with ice and a small amount of the recipe’s liquid. Then add remaining ingredients til smooth.
Banana Cream: ¼ cup raw cashews, 1/2 ripe banana, 1 cup almond milk, dash vanilla flavoring, 1/2 c crushed ice, 2 TBSP sesame tahini, 1/8 teaspoon stevia powder, hefty dash cinnamon. Add cacao nibs or if you don’t have those, organic mini dark chocolate chips (1 teaspoon) for additional zip. Blend ice, cashews, tahini, and 2-3 ounces of almond milk together first, until smooth and creamy. Add vanilla and remaining almond milk, and blend again til smooth. Add cacao nibs and blend to desired consistency.
Raw cashews, tahini, and banana with ice, almond milk, vanilla, and stevia make this smooth and creamy.
GI Soother: 2 peeled apples, 3 stalks celery with leaves, 5 mint leaves, 1/3 seeded peeled cucumber, 2 teaspoons ground flax seed or ½ teaspoon flax seed oil, ½ – ¾ cup white grape juice, 2 TBSP whole coconut milk, crushed ice
Not Latte: 1 cup organic brewed iced (decaf) coffee, 1 raw egg, 1/2 teaspoon maple syrup, 1 TBSP sesame tahini, 3 TBSP cashews, 3 ounces almond milk, 3 ounces whole unsweetened canned coconut milk, crushed ice
Power Peanut: ½ soft ripe avocado, 1 TBSP cacao nibs, 1 TBSP hemp protein (such as Nutiva brand), 1 TBSP peanut butter, 3 ounces whole unsweetened canned coconut milk, 3 ounces almond or hemp milk, 1 teaspoon honey, crushed ice
Pineapple Smoothie: Fresh pineapple chunks ¼ cup, 1 ripe banana, 3 ounces whole coconut milk, 3 ounces unsweetened almond milk, dash vanilla, 2 teaspoons flax seed meal, 1 whole egg + 1 TBSP egg protein powder (option: try soaked hemp nuts in this one too)
These two are modified from a favorite book of mine called Raw Food Cleanse, which has several great recipes for smoothies, soups, and dips.
Soup Option, serve warm: ¼ cup raw cashews, 1 cup vegetable broth (such as Imagine brand organic), 6 stalks fresh young asparagus, 2 stalks celery with leaves, ¼ teaspoon fresh thyme leaves – blend all til smooth.
Pumpkin Navel: ¼ cup raw pecans, 1 navel orange, ¼ teaspoon orange zest, ¼ cup pitted dates (soak these ahead of time to soften), dash vanilla, crushed ice, ½ cup almond milk, 2 TBSP cup cooked canned pumpkin puree, 1/2 teaspoon honey or dash stevia
Honeydew Lime Creamsicle: Click here for this really good smoothie – doubles as frozen pops in hot weather.
– For any smoothie with fruits like kiwi, berries, papaya, peaches, pear, or mango, adding a raw egg or ground flax seed will create a creamy texture while adding healthy fats, protein, and minerals. Using egg protein powder is an option too. This will make your smoothies fluffy and creamy at the same time, but won’t add the fats you might like.
– Raw nuts blend to a nice creamy consistency with the right tool – a powerful blender, Vitamix, or Bullet mixer. Soak raw nuts (and seeds) ahead of time if you like a more smooth, less grainy texture.
– Hemp seeds, flax seeds, chia seeds, and cacao nibs are up and coming as alternative sources of protein, healthy fats and oils, and minerals. Add these to any smoothie to boost nutritional value along with calories.
– Wean sugar-holics off their favorite processed calorie booster drinks by making your own without any added sugars: Instead of honey, maple syrup, or molasses, switch to an organic stevia powder, which is potently sweet at a tiny dose. One eighth teaspoon is enough to sweeten an 8 ounce blended drink. Add cinnamon in larger amounts – 1/4 to 1/2 teaspoon – to kick up the sweet and benefit from cinnamon’s blood sugar modulating effects.
– Unconventional but healthy options for sweeteners in smoothies can create the creamy texture kids like, plus add extra fiber, vitamins, and minerals to smoothies. Try left over baked sweet potato (skins removed), cooked canned pumpkin, or leftover roasted mashed parsnips, which have a surprisingly pleasant and gentle sweetness when prepared this way (easy, fast, and good; use ghee, not butter, for extra sweetness and to avoid dairy protein).
– Cook brown rice in whole coconut milk with honey, nutmeg, and cinnamon for an alternative to all the pudding your child may have been told to eat. Use a slow, low heat method and add almond or coconut milk to the liquid if needed during cooking. An hour or more of slow cooking may be needed.
– Use coconut milk to make mild (but calorie laden) curry sauces that can go over favorite chicken or fish dishes.
– A good blender or VitaMix will turn raw nut pieces into a creamy smoothie, but organic nut butters are an option if using whole raw nuts is too gritty a texture for your child.
– Get the benefit of butter without the allergy or GMO hassle by using organic ghee (clarified butter). Pricey, but when you need it, you need it. Ghee has a sweeter taste than butter that isn’t clarified.
– Skip the soy. Even if it isn’t genetically modified, it’s a frequent allergy offender, just like dairy protein. And there are endocrine effects from soy that are concerning enough for me to suggest that parents don’t use it as a major daily protein for a child. Translation: A serving here or there is fine, but don’t use it as your child’s protein source at every snack and meal daily. Soy protein is a common addition to bottled smoothies, energy bars, and protein powders.
– If multiple allergies are in the picture – and nuts, eggs, and seeds are out – then work with a knowledgeable nutritionist who can assist with using essential amino acids, medium chain triglycerides, and safe oils to build smoothies around tolerated carbohydrate sources like ripe peaches, pears, avocado, plums, or winter squashes and pumpkin.
These options will give your child several nutrients, healthy fats, more protein, and calories to burn that are head and shoulders above some corn syrup, vitamins, and milk from a cow raised on chemicals. Remember that poor appetite and weak growth pattern can be signs of deeper problems with the GI tract, digestion, absorption, or inflammation. For strategies to sort these out, see either of my books, or get in touch. Troubleshooting growth pattern is one of my specialties in practice.
Do these guys know anything about nutrition?
“Ask your pediatrician.” That’s the mantra women hear over and over once we become moms. If you have questions on anything baby or child, it’s always “ask your pediatrician”.
Okay, here’s a twist… Just don’t ask about nutrition. It turns out that pediatricians may not know much more about nutrition – perhaps the single most powerful driver of your child’s health and well-being – than you do. It’s widely lamented that nutrition is marginalized in physicians’ training. The authors of Nutrition In Pediatrics (2008) wrote “the teaching of nutrition in medical schools is fragmented at best [and] appears to be entirely unsatisfactory”. A 2006 published report described efforts to encourage medical students to consider studying it. The solution touted in this report was a “ten hour workshop” (it was optional). By comparison, my RD (registered dietitian) credential required 900 nutrition-specific hours of rotations in hospitals, clinics, and health departments, plus dozens of credit hours in undergraduate and graduate health and nutrition sciences.
But pediatricians must pick up this knowledge somewhere, right? Well… An older study (1975) found that “physicians learn about nutrition haphazardly”. Twenty years later, another study pegged pediatricians at about a C level (some as low as a D grade) for infant feeding knowledge. What about 2010? I checked the pediatric residency curriculum requirements for the Harvard-affiliated MassGeneral Hospital for Children, one of the world’s top training programs for pediatrics.
The word “nutrition” isn’t even on the page.
With deeper digging around their site, I unearthed a page for the Pediatric Gastroenterology and Nutrition Fellowship, an expertise that specialist physicians may pursue. But this is years’ of optional study and practice beyond what a general practice pediatrician gets – even though it covers basic topics like how to diagnose food allergies. In fact, nutrition is so absent from our pediatric health care landscape that it once triggered a peculiar phone call to me from a claims adjustor, on behalf of one of my patients. The call went like this:
Insurance Company: “Hello this is so and so insurance company calling in regard to your patient John Doe, age x.”
Insurance: “What are you?”
Me: “Beg your pardon?”
Insurance: “What type of provider are you?”
Me: “I’m a licensed registered dietitian.”
Insurance: “So what is that? What is the claim for? Is that physical therapy?”
How nutrition – arguably the single most important thing to get right during pregnancy, infancy, and childhood – became an elective in an obscure pediatric specialty is a whole other blog topic. But it remains a long established fact that healthy nutrition during pregnancy and early infancy lays the foundation for learning, growth, brain and whole body development, and IQ for years to come. For all babies and kids at any age, it affects sleep pattern, behavior, cognitive ability, attention, focus, and of course, growth again. It’s complex, and intertwined with every disease condition now saddling this generation of kids like never before. From asthma to autism, food allergies to ADHD, growth failure to obesity, diabetes to epilepsy, parents these days have a lot of nutrition questions that their pediatricians can’t answer.
That’s why registered dietitians specializing in children’s health are a resource you may want to know about. Here are a few examples of what a registered dietitian can do for you that a pediatrician doesn’t know how to do, doesn’t have time to do, or doesn’t want to do:
– Help you collect and troubleshoot an accurate food intake on your child. What a child likes to eat, refuses to eat, or how strong his appetite is are all diagnostic clues for dietitians – clues that may save you time and money on lab tests or unnecessary specialist referrals.
– Separate problems that are easily treated with nutrition tools from problems that need referral to an MD specialist.
– Tap expertise on breastfeeding, preemie feeding, specialized infant formulas, food allergy or intolerance in infancy, or toddler feeding challenges.
– Identify clinical signs and symptoms that signal nutrition problems, and tell you exactly how to fix them with the right nutrition intervention.
– Discern whether or not your child is actually getting the right amount of food every day, growing as expected or not, or needing more of certain types of foods or nutrients.
– Help you choose effective supplements and decide whether your child should use them.
– Strategize with you on recipes, lunches, snacks, and meals that work for your household.
– Connect you with special diet resources and practicalities of all sorts, from ketogenic diets for seizure control to diets for multiple food allergies (like GF CF diet, or diets that also omit egg, nuts, or soy) to strategies to either grow and gain more weight, or lose weight, that are safe and effective for kids.
It’s a matter of when, not if, nutrition expertise will infiltrate our pediatric health care system. Parents need it, seek it, and are very happy when they see their children thrive once it is applied. If your pediatrician is not answering your nutrition questions, find more expertise through your state dietetic association, which can refer you to dietitian experts in pediatric nutrition. You may also find help from naturopathic doctors, who study more nutrition in their training than MDs typically do. When working with a naturopath, check for long experience working with infants and children. Or, start with my books:
Special Needs Kids Eat Right: Strategies To Help Kids On The Autism Spectrum Focus, Learn, and Thrive
Special Needs Kids Go Pharm-Free: Nutrition-Focused Tools To Minimize Meds and Maximize Health and Well Being.
Biomedical interventions for autism can get a little overwhelming
Recently I held a “Biomedical Troubleshooting” session at the Imagine! Colorado offices, sponsored by Autism Society of Boulder County. Both veteran and newbie parents showed up – parents who had done everything from heavy metals chelation and special diets, to nothing but behavioral interventions – but across the board, the same questions were asked: Which diet does my kid need for an autism diagnosis? What lab tests? Special food, weird meal routines, hours in the kitchen making bone broths and nut milks – is it worth it?
Well, there is no “diet for autism”. Every child with autism in my practice is unique. There are several nutrition and GI problems that come up often with an autism diagnosis, and these are treatable. I map those for families, using clinical standards for nutrition assessment as well as functional nutrition lab tests that look deeper for problems. Find the trouble, make a plan to fix it, and children feel, function, learn, grow and behave better. Nutrition perfectly supports and complements all your child’s other interventions. All are important. But none unravel underlying physiological barriers to progress the way a targeted nutrition program can.
It comes down to being a nutrition detective, and finding that nutrition understory that is meaningful in your child’s case. Whether you have placed your child on Gut and Psychology Syndrome diet (GAPS), Specific Carbohydrate diet (SCD), gluten – casein free (GFCF), low oxalate (LOD), Body Ecology diet, yeast free diet, Paleo, Feingold, or no diet at all – you first need to know if it’s the right measure for your child. I meet families week after week who implement special diets without expert help. Sometimes it works wonders… and sometimes it just drives a family nuts.
This didn’t emerge anew in the last few years, just for kids with autism. I’ve been a registered dietitian since 1989. In both my graduate and undergraduate training, much emphasis was placed on infant and child health, and how nutrition impacts these. Since about the mid 1990s, “biomedical treatment for autism” tools have tapped tenets in pediatric nutrition, and expanded on that evidence base with an integrative medical approach. This works for kids with any chronic condition – from autism, to ADHD, epilepsy, growth or feeding problems, Down’s syndrome, or severe behavior and mood problems. And, good news, pieces of this may be accessible within insurance networks you already have.
For instance, before you leap into provoked urine toxic metals tests, spaghetti squash fries, and methylcobalamin injections (all of which their place when indicated), knock off the simple stuff first with your mainstream physician. These are things that can also profoundly impact a child’s behavior, sleep, growth, learning, appetite, immune function, or development – and may prevent progress with more novel therapies if left unaddressed:
1 – Is your child underweight, below 5th percentile for age for body mass index (check here), eating enough most the time? A shortage of just one or two hundred calories a day over the long term is enough to derail a child. In fact, low body mass index is linked to more frequent, more severe infections in kids, as well as more difficulty with sleep, behavior, focus, and attention.
2 – Does your child hold it together through the school day, then blow up or show rage and reactivity once home? Does this shift abruptly with a hefty snack? Check usual calorie needs for kids here, to see if your child is coming up short. Check usual protein needs here. You can also work with your provider to screen for bowel infections, and rule out inflammation from foods with food allergy and food sensitivity testing – both of these can drive mood swings, anxiety, and appetite in kids. If your in network provider isn’t familiar with thorough testing, this is my niche – schedule a free ten minute chat to talk to me!
3 – Got iron? Iron is key for learning, focus, attention, mood, behavior, sleep, and immune function. Some children with autism don’t absorb or metabolize this typically; anemia and poor iron status are common problems for children with or without autism, across the US. Balancing iron metabolism is crucial for kids. Ask your pediatrician to check ferritin, serum iron, and transferrin to get a sense of whether diet or supplements can help. Ferritin levels below 30 – though considered “in reference range” – usually correlate with lesser ability for focus, attention, and behavior – plus more frequent infections – in my experience. Since iron can become toxic if used incorrectly, don’t use iron supplements for a child without your provider’s input.
4 – Got pica? If your child puts non-food items in his mouth often, eats non food items, has oral tactile sensitivity for certain food textures, or has difficulty swallowing or tolerating food textures in his mouth, then a review of mineral intakes from foods or supplements is in order. These symptoms can signal problems like poor status for iron or zinc, or heavy metals exposures. Eating non-food is called pica, and is a classic flag for mineral imbalances. Learn more about pica here. Correcting mineral balance can dramatically improve behavior, mood, self regulation, anxiety, rageful reactions, and more.
5 – Gut biome – the bacteria populating your intestines – is crucial for digestion, absorption, and even immune function. Is your child dependent on Miralax or reflux medication? Needed antibiotics? These can disrupt that biome, and change how foods and nutrients are digested and absorbed. If your child isn’t able to pass comfortable stool daily without prescription medications, then screen for bowel infections or inflammation from foods. Many functional nutrition lab tests can define the biome in enough detail to direct treatments, so chronic constipation or diarrhea can be resolved. Normal passage of stools means optimal uptake of nutrients, and this means the brain gets what it needs to function every day.
6 – If you feel you’ve done it all and just want to throw in the towel, two thoughts: One, call me and let’s see if you really un-turned all the possible stones. Two, call me, and let’s discuss how to explore immune dysregulation (autoimmune reactions, immune deficiency) as an underlying piece of an autism presentation. Promising treatments are becoming more and more available and I am happy to pass these resources on to my patient families.
There are many other nutrition-detective steps I take in practice to bring children through assessment. We create a sequence that fits your family. In fact, nutrition intervention may be one of the least expensive and most beneficial tools you engage. I offer new patient families a six month, six visit Nutrition Transition package for at $1200 that maps the journey, from lab tests to supplements, foods, recipes, and meal plans. We move at a good clip and get results. I find discounted supplements and lab test fees where possible for my patient families, and throw in free copies of my books too.
Jumping out of sequence can backfire, which is why many families have mixed results when using nutrition care, biomedical tools, and special diets for autism. But working a methodical, professionally monitored nutrition plan may afford your child a few nice leaps, before you order up a $3500 battery of tests with an out-of-network doctor and pay thousands for six hours of his face time. For more info on sequencing, troubleshooting, and using nutrition-focused tools for autism, see Special Needs Kids Eat Right and Special Needs Kids Go Pharm-Free. And, call me!