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

2/9/2017 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 Controversy and Issues in ECE • So why the controversy – David S. Ludwig, an pediatric endocrinologist in Boston practice, identified by states 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. Bonnie A. Spear, PhD, RDN, FAND – 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? • Fats • Toddlers are picky eaters: – provides twice as many calories per gram as do – They have tiny tummies carbohydrates and proteins. – Toddlers don't like to sit still for anything. – healthy fats are a necessary component of the vital • Milk tissues—especially the brain and central nervous – contains calcium, potassium and vitamin D, which system—that are growing so fast in your toddler. helps the body balance levels of calcium and – when you switch to two percent milk, you must add phosphorous for stronger bones. other healthy fats to your baby's diet. – milk and other dairy products have been known to • Need for fat improve bone health & reduce the risk of – Until age of 5 brain myelination‐ which is essential for osteoporosis. brain development continues. Requires saturated fat – important to drink and eat dairy at a young age when to develop. If a child does not add other forms of fat bones are forming. that then the brain maybe at risk Milk (per 8 oz.) Calories Fat Pro Carbs Whole Milk 150 8g 8 g 12 g • In a 2013 JAMA article, researchers suggested 2 Percent Milk that whole milk may be the better option (also known as reduced 120 5g 8g 12 g fat milk) when giving children dairy drinks. • A study in the Archives of Disease in 1 Percent Milk 100 2 g 8 g 12 g (also known as low‐fat Childhood in March 2013 showed that milk) children who drank lower‐fat milk were more Skim Milk 80 0 g 8 g 1 2 g likely to be overweight later in life. (also known as nonfat milk) 20 g ( 8 g Non‐fat Chocolate milk 120 0 g 8 g sugar) 1

2/9/2017 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. It’s Not About E ating Engaging child care workers in Helping Their Kids eat It’s About F e e ding F e e ding is WHAT (fo o d, nutritio n) Mealtime Conversations 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

2/9/2017 “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.” R e war ding Feeding Relationship  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) “Parents/child providers are responsible  F o o d pre fe re nc e s impa c te d o ve r time for WHAT children are offered to eat;  De va lue he a lthy fo o d; fa vo r le ss he a lthy children are responsible for HOW fo o d MUCH they eat.”  Ge ts kids to e a t to da y, b ut do e sn’ t g e t Childre n do n’ t kno w ho w to c ho o se balanc e d me als, re g ular the m to L IK E fo o d to mo rro w 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. 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 www.e llynsa tte r.c o m 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 Energy Intake Regulation Restricting  (Birch, 1991) 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 L imit se c o nd he lping s, • Meal‐to‐meal energy intake highly variable o nly lo w kc al fo o d  Po o r se lf-re g ula tio n o f e a ting o ptio ns, no • Day‐to‐day variability of total daily energy swe e ts/ junk/ so da in  I nc re a se d risk fo r o ve rwe ig ht the ho use intake is very low  Va lue re stric te d fo o d 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 Controlling Prompting/Pressure 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. Re minding the pic ky e ate r to e at, c hasing the to ddle r Child: “I do n’ t want to e at that.” with a sippy c up o f milk, le aving fo o d o ut all day to Pare nt: “T he n yo u must no t be hung ry fo r de sse rt e nc o urag e mo re e ating , e xc e ssive talking abo ut fo o d e ithe r.” and nutritio n at the dinne r table • L o we r a b ility to re g ula te inta ke  Unc le a r influe nc e • 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)  During infa nc y, c o ntro l o ve r wha t a nd ho w • Slo w & fussy e a ting muc h pro duc e s a lo we r BMI a t a g e 2 • Ove re a ting  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 ishe r e t a l, AJCN, 2002; We b b e r e t a l. J Am Die t Asso c . 2010 F a rro w e t a l, Pe dia tric s, 2008 3

2/9/2017 What you No Thank you Bites ne e d to know about kids ( from University of Iowa) T e mpe ra me nt, E a ting Style , Ag e s & Sta g e s o f De ve lo pme nt E a ting Style Temperament   E E nthusia stic E a te r: a dve nturo us; trie s a nd a c c e pts ne w a sy-g o ing fo o ds e a sily  Diffic ult  Spirite d  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  Stub b o rn  T imid  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  E ve ry c hild is diffe re nt  Supe r-T a ste rs: he ig hte ne d se nse o f ta ste ,  T e mpe ra me nt e ffe c ts mo re se nsitive to se nso ry c o mpo ne nts o f re spo nse to fo o d fo o d (sme ll te xture , a ppe a ra nc e ) Development Considerations in Feeding Young Children Introducing New Foods • Importance of structure (family) (University of Iowa) • 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 4

2/9/2017 Nutrient Needs of Nutrient Needs of Toddler/Preschool Toddlers/Preschoolers Age (years) Protein (g/day) Age EER- EER- Kcal/kg Kcal/kg RDA (mo) girls bodys boys girls 1-3 13 (kcal/d) (Kcal/d) 12 768 844 82 81 24 997 1050 83 82 4-8 19 35 1139 1184 83 83 DRIs, 2002 DRIs, 2002 Psycho‐social tasks Psycho‐Social Tasks 1‐3 Years 3‐5 Years Shame and Doubt Initiative Guilt Autonomy Child: “I c an’ t do it.” Child: “E ating is fun—I ’ m g o o d at Child: “e ating is no t fun—I make Child: “I c an do it” it!” so many mistake s.” Pare nt: “Yo u’ re to o yo ung , no yo u Pare nt: “I kno w yo u c an and I ’ m c an’ t.” Pare nt: Yo u c an make g o o d Pare nt: “Yo u c an’ t do this, yo u he re to he lp if yo u ne e d me .” de c isio ns.” ne e d my he lp.”  F e e ds se lf with he lp c utting  He lps with me a ls, se tting ta b le ,  Adult disc o ura g e s fo o ds  Is fe d/ a ssiste d mo re tha n e tc inde pe nde nt fo o d se rving  Ab le to e a t with ha nds a nd g e t ne e de d  Se rve s se lf a t me a ls,  No t a llo we d to turn do wn fo o d me ssy  Co ntro lle d fo o d e nc o ura g e d to ho no r fullne ss, o utside o f ho me  Cho o se s wha t a nd ho w muc h  No t a llo we d to g e t hung e r  Pre ssure d to finish me a ls, e a ting to e a t fro m wha t is o ffe re d me ssy/ e xplo re fo o d  Vo ic e s like s a nd dislike s, fo o d pe rfo rma nc e e mpha sis  Pa re nt re spo nsive to pre fe re nc e s c o nside re d b ut  Re q uire d to ta ste e ve rything hung e r/ fullne ss no t c a te re d Resource Helpful Mealtime Strategies • University of Iowa vignettes • Some children respond well to music – Http://cals.uidaho.edu/feeding/aboutus/index.ht • Regular structured or too distracting for ml. meal times some • Thank you Oregon for sharing this • Appropriate seating • Environment calm and comfortable 5