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Ask The Dietician

Announcing the very first installment in our “Ask the Dietitian” series!! In this blog series, Hannah Stahmer, Registered dietitian at the University of Florida answers your questions about feeding your child with PWS! Would you like to see your question answered in an upcoming installment? Log into Facebook ,visit https://www.facebook.com/Prader-Willi-Syndrome-Association-Ask-the-Dietitian-343199949408216/ , and ask your question there! Hannah will be answering questions on a regular basis. Please remember, Hannan cannot answer medical questions or questions about specific children. 

 

How much should I feed my 9 month old infant?

Good question! Every baby is different and not all babies with PWS are able to eat solid foods at 9 months. If your baby is eating well from a spoon and is eating a variety of pureed foods, then it is a good idea to work up to 3 meals a day. The amount will vary based on how hungry your little one is and what foods are offered.

Breast milk or formula will still provide the majority of nutrition at this age, but it is still good to introduce new foods, textures and flavors.  The important thing is to introduce nutrient dense foods and avoid teaching your baby to like baby puffs, fruit pouches and Goldfish crackers, and sweet foods.  Each “meal” should have at least 2 different foods so that your baby gets a mixture of grains, protein, vegetables, and fruit daily.

Avoid egg whites (egg yolks are fine) and shellfish until 12 months of age due to risk of allergies. If your baby is tolerating foods well, you can try a tablespoon of plain yogurt starting at 10 months (plain yogurt-the kind that tastes like sour cream.)

Sample Menu:

Breakfast: whole grain oatmeal, fruit or avocado

Lunch: protein (pureed meat, beans) and vegetable (green one)

Supper: protein (pureed meat, beans), vegetable (yellow one), small amount of grain (oatmeal, baby quinoa)

 

How do you give infants 8 months or older chia or nut butters?  What proteins are good for infants?

You can mix chia in with other baby foods like fruit, vegetables, and yogurt.  Nut butters are trickier because there is always a risk of an allergic reaction (and choking.) If your baby is tolerating nut butter already, it is important to mix nut butters with something like pureed fruit, vegetables, or yogurt to keep it from getting too sticky as this can be a choking hazard.  Other good sources of protein for babies are legumes (beans) and tofu in addition to pureed meats. Cooked beans can be a good finger food too!

 

How are parents supposed to know when to go up on a tube-fed baby’s oral feeds?

Every tube feeding situation is different so there is not set answer for this. Your pediatrician and speech therapist should be able to assess how oral feeds are going. If your baby is already taking oral feeds, seems interested in feeding, and is not at risk for aspiration, then you may be able to offer the oral feed first when your baby is showing signs of hunger. The g-tube can be used to give the remainder of the feed if there is any left.  If you baby is showing signs of hunger after a feed, then it may be necessary to go up on the volume as your baby grows.   Some babies need to use a tube feeding longer than other babies, so it is important to have regular weight checks and have your pediatrician determine if your baby is following his or her own growth curve.

 

Is there a calorie goal for 2 year olds?

Every child, with or without PWS, has different calorie needs, so there is not one set calorie goal for each age (just like all of us need different calories daily.) It all depends on how your child is growing and how active your child is daily. For example, a 2 year who is not walking will need fewer calories than a 2 year old who is running around. Your child may need anywhere from 700-1000 calories a day. Because calories don’t reflect the composition of the diet, it is often best to focus on the types of foods offered instead of the total calories. Calorie needs will change during periods of growth and as your child enters different nutritional phases.    The growth chart is the best guide of how your child is doing.  The key is to have all calories you offer your provide nutrients. Avoid offering anything that has calories but no nutritional value. This includes gummy snacks, toddler puff snacks, nutrition bars, juice, and many processed snacks.

 

My child has high cholesterol- What foods can help lower cholesterol?

Heart healthy foods include foods that contain soluble fiber and omega-3 fats. Good sources of soluble fiber include legumes (beans), oatmeal and fruits (berries and apples) and vegetables.

Foods rich in omega-3 fats include:  flaxseed (add to oatmeal), nuts, and fish.  Mix up your oils when cooking: olive, soybean, flaxseed, and walnut oils give a foods new flavors and offer additional omega-3 fatty acids.

 

What should I do when my 2 ½ year old won’t eat?  Should I make her something else?

Many children go through phases where they don’t want to eat or want to eat only their favorite foods. This is common toddler behavior and can be very frustrating! Instead of becoming a short order cook, offer dinner and if she doesn’t eat it, let it go. If she asks for food later, you can offer her the rest of her dinner later.  If she is really hungry, she will eat!

If you are offering a new food, it often takes 20 or more times for a child with PWS to accept a new food. Don’t assume your child doesn’t like something if she turns her nose up after 1 or 2 times.  Keep trying!

 

What is a good serving size for a toddler?

In general, a toddler’s serving is ¼ of an adult serving. For example, an adult’s serving of a banana is ½ a banana. This means a toddler’s portion would be a ¼ of that (or just the tip of the banana!)  Toddlers’ tummies are small. Another way to estimate portions is to offer 1 tablespoon per year of age of each food item.

Here is an example of a toddler meal:

One ounce of meat or 2-3 tablespoons of beans

1-2 tablespoons of vegetable

¼ slice of whole grain bread or 1-2 Tablespoons of quinoa or sweet potato

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