A PWS Friendly Birthday Cake

We’re celebrating a very special birthday in our house this week, our darling Jude is ONE!

I’m often sent cake recipes and asked my thoughts on whether I think this or that is appropriate for a PWS birthday and for the longest time I’ve wanted to come up with my own. So here is the first one.

This cake is wheat free and has no added sugars, it is not sweet at all yet still packed full of flavour from the berries, yoghurt and lemon. This recipe is actually based off my Berry Yoghurt Muffins which is in my ‘Finger Foods for kids with Prader-Willi syndrome’ e-guide and it was a client who made the muffins for her daughter’ birthday which gave me the idea to make it into a cake for Jude’s first birthday and I was so happy with how it turned out. Jude loved it too!

If you make this recipe, be sure to tag me on Instagram, you can find me at @catefoxdietitian

PWS FRIENDLY BIRTHDAY CAKE

cook time 40mins

Ingredients

1 ¾ cup almond meal

2 tsp baking powder

½ tsp baking soda

⅓ cup coconut oil, melted

2 large eggs

1 cup plain Greek yogurt

2 tsp vanilla extract

zest from 1 lemon

juice from ½ lemon

1 cup berries

Method

1. Preheat oven to 180C and grease a cake tin. For Jude’s cake, I used two 10x4.5cm (4x2”) round cake tins which gave me a little of the batter left over to make into muffins. Alternatively, you would have enough batter to make 3 cakes.

2. In a large mixing bowl, combine almond meal, baking powder, baking soda and lemon rind.

3. In a separate bowl, whisk eggs, add melted coconut oil, yoghurt, vanilla and lemon juice and stir until combined.

4. Add the wet ingredients to the dry mix and with a wooden spoon mix until well combined.

5. Gently fold the berries into the batter. I used frozen berries above. If you choose to use frozen berries make sure they are still frozen when mixing, this way the colour will not run.

6. Pour the batter into the prepared baking tins and bake for 40mins.

7. Remove from oven and let cool completely before turning cakes onto a wire cooling rack.

8. Stack the cakes on top of each other and cover with your choice of icing (frosting). For the cake pictured above, I used fresh cream placing a layer of cream between the two cakes and covering the outside of the cakes with a thin covering of cream. Alternatively, you could you a cream cheese frosting. Note: if using fresh cream don’t add this until you are ready to serve.

The Mediterranean diet for PWS

Although there is no one diet for PWS, many health professionals recommend following a Mediterranean style diet.

So what exactly is the Mediterranean diet?

Not a traditional “diet” where calories are counted and fat loss is intended, the Mediterraenean diet is a dietary pattern traditionally eaten by the people living in the Mediterreanean, countries such as Greece, Spain and Italy.

It’s a dietary pattern that focus’ heavily on fresh fruits and vegetables, whole grains, legumes, beans and lentils and healthy fats from nuts, seeds and olive oil (Extra virgin always). Foods such as fish and other seafood, dairy foods such as yoghurt and cheese and white meats such as chicken are eaten in smaller amounts and red meats, sweets and processed foods are only included on occasions.

It’s a dietary pattern that focus’ on social engagement, where families come together to share a meal, taking time to enjoy each others company and the food they are eating.

Although not typically a low carb diet and definitely not a low fat diet, it’s a diet that is typically low in saturated fat (unhealthy fats) and rich in monounsaturated fats (healthy fats). Fats are essential in the diet as they assist with brain development and fat soluble vitamin metabolism. With a focus on fresh, whole foods it offers a variety of fibre sources from fruits, vegetables, whole grains, legumes, nuts and seeds.

So how does it benefit those with PWS?

Studies looking at the Mediterranean diet have proven to support a wide range of health conditions from improving cardiovascular health, and fertility and lowering risk of diabetes and some cancers. Although there are few studies looking specifically at the Mediterranean diet and PWS, a study by Dr Miller et al (2012) saw greater improvements in body fat mass and weight reduction in children aged 2-10years who were following a diet that draws comparisons to the Mediterranean diet. People with PWS still need to follow a calorie reduced diet, however Miller et al. found that when kids were following a reduced calorie diet with total energy being made up of roughly 45% carbohydrates, 30% fat and 25% protein better improvements in body composition were seen.

How do you incorporate the Mediterranean diet into a PWS meal plan?

When building a PWS friendly meal, start with vegetables - the more colour the better. Ensure variety day to day to avoid food fatigue and change up the ways you offer these vegetables for example, some days salad, some days roasted in EVOO, some days steamed. Include a protein source and try to include “meat free” days each week. For this you will need to focus on things such as lentils, beans and chickpeas to ensure protein needs are met. Aim for fish 2+ times per week, poultry 1-2 times per week and red meats <2 times a week. Add in a small serve of complex carbohydrates such as brown rice, quinoa, oats or ancient grains such as Freekah. If using bread, opt for well made sourdough. The fermentation process which occurs in sourdough lowers the glycemic index and slows down the speed at which sugar enters the blood stream. Add a healthy fat such as avocado, olive oil, nuts and seeds (walnuts are an excellent source of omega-3s) or olives. And lastly use a small amount of fruit - whether at a meal or as a snack, that’s entirely up to you.

I have complied a brief list of foods which shows you which food group certain foods lie. For example what a carb, fat or protein is. If you haven’t already, you can download this FREE resource HERE.

Another important component in managing PWS is setting consistent food rules. These will look different for every family and may change as your child ages however I strongly believe that one food rule should be a non-negotiable (and is the same advice I’d give all families whether PWS was apart of their life or not). My one non-negotiable is that where ever possible, meals should be eaten together at the table, no devices, no distractions just family conversation on any topic as long as its not food. This sense of connection has so many benefits and is after all, what the Mediterranean diet is founded on - togetherness, inclusion and community.

PWS or not, following a diet that focus’ on fresh fruits and vegetables, whole grains, lean protein such as fish and legumes along with encouraging good use of healthy fats such as omega-3s which have proven benefits for everything from eye, brain, heart and joint health is definitely an eating pattern that gets the tick of approval from me.

Davis et al. (2015) Definition of the Mediterranean diet: A literature review. Nutrients. 7(11) 9139-9153.

Miller et al. (2013) A reduced-energy intake, well-balanced diet improves weight control in children with Prader-Willi syndrome. J Hum Nutr Diet. 26, 2-9

Nutritional Considerations in Prader-Willi Syndrome

Prader Willi Syndrome is thought to affect 1 in every 15000 births. It is a rare, non-inherited genetic disorder where several genes on chromosome 15 are either deleted or not expressed. To date, there is no cure.

PWS affects the hypothalamus, the area of the brain responsible for regulating many of the body’s systems including metabolism, the development of muscle tone, regulating temperature control, blood pressure, heartbeat and sleep/wake cycles, the expression of emotions and many other body functions including controlling hunger. Due to this, a person with PWS exhibits low muscle tone, small statue, a slower metabolism, intellectual disabilities, anxiety and an insatiable appetite.

A Dietitian can play a significant role in a person with PWS’s life. PWS is the number 1 genetic cause of childhood obesity with issues with appetite being a component in PWS that significantly affects an individual and is quite contradictory in its presentation across their lifespan. There are 7 main stages of appetite in PWS (1).

- stage 0 - in utero, less growth in weight and length than their unaffected siblings

- stage 1a - from birth, no interest in feeding, may need to be tube fed

- stage 1b - feeding normalises and infant grows steadily along the growth curve

- stage 2a - weight increases without change in calorie intake

- stage 2b - weight gain associated with an increase interest in food

- stage 3 - hyperphagia, food seeking and lack of satiety (this generally occurs around 8yrs of age)

- stage 4 - rare cases of some adults no longer hyperphagic and are able to feel full

So what are the nutritional considerations for someone with PWS?

There is a high risk of obesity in individuals with PWS due to individuals having a slower metabolism, being placed on restrictive diets and who are preoccupied with or obsessive about food. In order to maintain a healthy weight once an individual becomes hyperphagic, an individual often requires dietary restriction of 50% of the estimated energy requirements for a person of the same age without PWS. In order to achieve this strict dietary regime, cupboards and fridges are typically locked to prevent anxiety and temptation around food and to keep the individual safe. A person with PWS could quickly consume a large volume of food resulting in choking or a perforation to the lining of the stomach which in severe cases can lead to death.

What is the current dietary advice for PWS?

There is no specific diet for PWS. Different dietary approaches work for different families. What is typically recommended however is to aim for a Mediterranean style diet that focuses on good quality lean proteins, healthy fats, fresh fruits and vegetables and complex carbohydrates.

The level of calorie restriction is very individualised with a ‘no one size fits all’ approach and although a reduced calorie diet is effective in controlling weight in children with PWS, studies have found that calorie restriction alone does not control the amount of body fat as well as a carbohydrate controlled diet (2). Research suggests that a calorie controlled diet providing ~45% carbohydrates, 30% fat and 25% protein with at least 20g fibre works best for weight control and improved body composition (2).

Sweet foods, sugar and sweeteners should be avoided in those with PWS. Apart from typically being higher calorie, nutrient poor foods, sweet foods when they hit our tongue, activate reward sensors in our brain signalling to want more and more. The sweet taste, whether it comes from natural sources or artificial sweeteners promotes an increased desire for sweet foods and this mechanism is more pronounced in those with PWS.

Micronutrient supplementation should be individualised and based off consultation with a doctor and dietitian. Depending on the type of diet the family follows will determine what vitamins and minerals may be of concern.

What are the common dietary management strategies?

Having a food and eating schedule can be particularly important for people with PWS as it helps the individual to understand that food will be offered at certain times and removes the uncertainty about what exactly will be offered. This helps to remove any DOUBT that food will be offered again and the HOPE (or chance) of getting more food that isn’t planned which helps to reduce stress and anxiety. Lastly, there will be no DISAPPOINTMENT as the child has received the food they could expect and at the time they were expecting (3).

Setting rules around eating such as only eating while seated at the table or only allowed to eat from their plate/lunch box can also help to establish positive behaviours. Never using food as a reward nor giving into tantrums are also ways in which some families manage this aspect of the condition. That being said, food should never be restricted as a form of punishment either nor should other family members eat “treat” foods or restricted foods in front of the family member who has PWS.

Exercise is another weight management strategy that should be encouraged from an early age. Physical activity is recommended for people with PWS as it improves mobility and prevents unwanted weight gain. A recent study (2019) found that long term (>6 months), consistent physical activity saw improvements in cardiovascular fitness, body weight and composition and glucose metabolism in adults with PWS and T2DM(4).

With the right support from medical professionals and having friends, family and other care givers on the same page as to what is best for the child, families can manage their child’s dietary pattern and weight and redefine their child’s future.

(1) Miller et al. (2011) Nutritional Phases in Prader-Willi Syndrome. Am J of Med Genet. 9999, 1-10

(2) Miller et al. (2013) A reduced-energy intake, well-balanced diet improves weight control in children with Prader-Willi syndrome. J Hum Nutr Diet. 26, 2-9

(3) New Concepts in Nutrition: PWS Nutrition Revised - Linda M. Goulash, MD, Pittsburgh Partnership, 2017

(4) Morales et al. (2019) Physical Exercise and Prader-Willi Syndrome: A systematic review. Clin Endo. 90, 649-661

PWS New Zealand, Dietary Management, www.pws.org.nz

Introducing Solids

Confused about starting solids? You’re not alone. With so much conflicting advice on when to start, what foods to offer and in what order plus trying to decide between doing baby led weaning or traditional purees, its enough to send even the most seasoned parent into a head spin.

If you’re onto your second or subsequent baby, or you’re at least out of that newborn bubble, you’ll have realised that every baby is oh so different and develops at very different speeds. Even between siblings, one baby reaches certain milestones before another and that goes for starting solids too. Its important that you tune into your own baby, not worry about what the other babies in your mother’s group are doing and follow your baby’s cues and your own intuition. That being said, some of us need a little more direction with tackling this exciting, yet sometimes overwhelming stage. If that’s you, then I’ve written this post to highlight what the guidelines says, what the evidence suggests and to (hopefully) point you in the right direction with a little more confidence.

So what are the current guidelines on when to start offering solid foods?

The NH&MRC Infant Feeding Guidelines (2012) recommend that solid foods are introduced around 6 months of age in order to meet your baby’s increasing nutritional and developmental needs. It is around 6 months of age that stores of iron and zinc are declining, that appetite is increasing, the extrusion reflex is disappearing, their digestive system has matured to be able to digest starches and the baby is now increasingly aware of their environment and is curious of new textures and flavours.

So what foods do you offer first?

If you ask your own mum or grandmother what your baby’s first foods should be you might hear the many restrictions that were once considered normal practice. Luckily though, these days parents have greater freedom in what foods are considered acceptable first foods and there are less rules on how to introduce foods to our bubs. The only “rule” so to speak is that as long as foods rich in iron are included in those first foods, foods can be introduced in any order and at a rate that suits the baby.

So what exactly does that mean, I hear you asking?!

Breastmilk, and or formula should still be the baby’s main nutritional source. However, once you decide that your baby is ready for solids those first few tastes could include single fruit or vegetable purees. Babies are use to thin, sweet tasting breastmilk or formula so starting with smooth purees of pumpkin, sweet potato or pear might be a good place to start. Only offering fruit or sweetening vegetables or other purees with fruit is not recommended. Other first tastes could include:

- avocado

- cooked apple

- carrot

- zucchini

- broccoli

Once first tastes have been established and your baby is tolerating small amounts of pureed foods you can start to get creative with different flavour combinations that contain iron rich foods such as meats, fish, poultry, legumes or tofu and gradually start to add varying textures. If you’re reading this and thinking ‘but I want to do baby led weaning’ then you can read about that here.

It is important that textures increase and are varied to ensure correct oral muscular development. Purees should progress from smooth to mashed foods, then to minced and finally chopped foods. Your baby will learn quickly how to navigate and manage mashed and minced foods and it is essential the introduction of these textures aren’t delayed until after 10 months of age to prevent feeding difficulties later on.

Regardless of which feeding method you start with, either traditional purees or baby-led weaning, by around 8 months most babies can manage soft finger foods in long finger shaped strips to allow the baby to grab onto them and start to self feed. Some babies can tolerate finger foods from 6-7 months of age so be guided by your baby and do what feels right. Allowing your baby to feed themselves helps with growing independence and helps to develop fine motor skills. Finger foods can start to become smaller pieces by around 9 months of age when the baby is developing their pincer grip.

By 12 months of age, your baby should be tolerating family foods offered in age appropriate forms such as small, chopped up pieces.

The only other advice for foods that should be included in the first 12 months of your baby’s life include offering your baby foods that are high allergen risk foods such as eggs, nuts (nut butters to avoid choking), shellfish, wheat, dairy and soy. Evidence suggests that by delaying introducing these foods, you might increase the risk of your child developing a food allergy. The evidence also points towards regular consumption of high allergen risk foods once introduced to increase protection against food allergies.

What not to feed your baby?

There’s a few foods that aren’t suitable for babies under 1y which include:

- honey due to the risk of botulism

- whole nuts or other hard, small foods due to the risk of choking. Nuts in the form of nut butters should be included

- animal or plant based milks as a main drink are not suitable due to the protein and electrolyte concentrations. A small amount of these milks for use in cooking is suitable

- fruit juice or drink offer no nutritional benefit

- caffeinated or sugar sweetened drinks can lead to iron deficiency or dental caries

Are you ready to learn all you need to know to get your baby started on solids and setting them up for a lifetime of positive eating behaviours? If so - join hundreds of parents, just like you, who have enrolled in my online Introducing Solids course . This is a self-paced, 100% online course you can start anytime, as soon as you and your baby are ready!

Constipation in Children

I get asked multiple times what's the best management for their child’s constipation which is not surprising as constipation affects around 30% of children and most commonly arises around the time of the introduction of solids, at the onset of toilet training or at times of stress or change in the child’s life, such as starting school. Normal bowel movements for children are highly variable depending on several factors but commonly, children over 6 months of age will open their bowels 1-2 times per day. 

Around 95% of cases of constipation in children arise from a functional issue meaning there is no underlying medical condition. However, constipation in babies before the transition to solids or under 3 months of age have a higher likelihood of having a medical cause and advice should be sought from a medical professional.

In most cases, the cause of functional constipation is behavioural withholding where a child resists the urge to go and therefore stool builds up in the colon and rectum leading to fluid being reabsorbed into the large bowel. This results in a harder and larger stool to pass which makes defecation painful and therefore often more withholding. Over time the colon can become stretched which leads to uncontrolled soiling which is often mistaken by parents as having loose bowels or diarrheoa instead of being a sign of overflow from impaction.

How is constipation diagnosed?

Constipation is more complex than just not having a bowel motion. The definition of constipation is having 2 or more of the following symptoms for more than 1 month:

·      2 stools or fewer per week

·      Excessive stool retention

·      Painful or hard bowel motions

·      The presence of a large stool in the rectum

·      A history of a large diameter stool

·      More than 1 occasion per week of faecal incontinence after the child is toilet trained.

How is constipation treated?

Firstly, after consultation with your child’s GP or Paediatrician, disimpaction of the child’s bowel will need to happen. This means the build-up of stool is removed. This is usually done through an oral laxative. Once there has been at least 1 week of watery soft stools, treatment progresses to maintenance therapy.

Maintenance therapy involves a combination of dietary therapy and behaviour modifications. The diet should include adequate fluid intake to ensure stools are soft and easier to pass. Most younger children need around 1.0-1.2L of fluid per day and older children (>8yrs) will need 1.4-1.9L/d.

Dietary fibre also needs to be increased. It is important to note that increasing dietary fibre without increasing fluid may make the constipation worse and that’s why I always recommend fluid intake is increased first. It is recommended that dietary fibre comes from a well-balanced diet which includes whole grains, fruits and vegetables. Fruits such as stone fruits, pears, apples, prunes and avocados as well as watered down prune, pear and apple juice are strongly recommended as these fruits and juices are high in non-absorbable carbohydrates known as sorbitol and polyols and help to draw water into the bowel creating a softer stool. However, it is recommended that juice alone is not the only source offered as the process of chewing helps to stimulate the gut and the need to pass stools, and therefore a combined intake of the physical fruit and the juice is beneficial.

Cow’s milk protein (CMP) allergy or intolerance can also cause chronic constipation and therefore if the above treatments strategies have not worked, trialling a removal of CMP for 4 weeks under medical supervision may be of benefit to rule out a possible allergy or intolerance. Your child’s diet will need to include alternative dietary sources of protein and calcium to ensure dietary needs are met.

Positive toileting behaviours are also highly effective and part of the maintenance therapy. Children should be encouraged to sit on the toilet after meals, for instance 3 times a day for no longer than 10mins each time. This process should be unhurried and positive. The use of books or toys can be offered as a distraction to reduce stress and anxiety. The child’s seating position is also important. The child’s feet should touch the floor or a foot stool, and seated in an upright non-slouched position.

When constipation is not from a functional cause.

Only 5% of cases of constipation arise from an organic cause or result from an underlying medical condition. Most of these cases present in early infancy, however other red flags include the following, and advice from a Paediatrician is necessary.

·      Onset before 1 month of age

·      Delayed passing of meconium

·      Rash, red sore eyes or mouth ulcers

·      Intermittent and explosive diarrhoea

·      Weight loss/poor growth or persistent vomiting

·      Brown or dark coloured blood in the stool

·      Developmental delay

·      No history of withholding or incontinence

If you would like more help managing your child’s constipation, please call us on 0418 962 149 to book a consultation.

Nurko, S & Zimmerman LA. Evaluation & Treatment of constipation in children and adolescents: American Academy of Family Physicians 2014: 90 (2) 82-90

National Health & Medical Research Council. (2014) Nutrient Reference Values - water. Retrieved 17th December 2019 from https://www.nrv.gov.au/nutrients/water

The Royal Children’s Hospital (2017) Melbourne RCH. Constipation. Retrieved 17thDecember 2019 from https://www.rch.org.au/clinicalguide/guideline_index/Constipation/

Tabbers, M.M. et al. Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. J of Pediat Gastro and Nutr, 2014:58(2), 265-281.

Singh H & Conner F. Paediatric constipation: An approach and evidence-based treatment regimen. Australian Journal of General Practice. 2018: 47:5, 1-10.

Fussy Eating

11 Top tips to deal with a fussy eater…

1. Don’t label kids as fussy (to their face)

   Kids will often live up to the names they’re labeled as so be mindful of the language you use around them. This goes for grandparents, daycare or school teachers too, so if you hear someone label your kid as fussy have a kind word to them and ask them to use phases like “you’re still learning” instead. For example, you could say ‘my daughter is still learning to like carrots’ instead of saying ‘my daughter hates carrots’ or ‘my daughter is fussy when it comes to carrots.

2. Don’t pressure kids to eat, take a bite or finish their plate

   If kids are forced to eat something they are more likely to strongly dislike that food forever. Take myself for instance, as a child I was forced to eat potato. It was usually boiled and I was not a fan but I wasn’t allowed to leave the table until I had finished it. Now these days, I don’t hate potato but it’s definitely not my favourite and I hardly ever buy white potato for my family and if i do, trust me, its not boiled! Now, would i eat more potato these days had i not been forced to eat it as a kid? Well who knows, but its not the end of the world that i don’t eat it.

   Bribing kids to eat is also a form of pressure. “Eat your veggies and you can have dessert”. This starts to put food on a rating system and kids will start to hate the veggies more and increase their desire for dessert which perfectly leads into my next point.

3. Don’t label food as good/bad or even healthy/unhealthy.

   If you start to label food as good or bad then research shows that kids start to want more of the “bad” foods and less of the “good”. It can also lead to feelings of guilt and lead people to think that if i eat chocolate cake (perceived as a bad food) then I must be a bad person. Food has no moral value so it can’t be good or bad. I love how Kids.Eat.In.Color define it which is that some foods do a lot in our bodies, such as veggies, and some do a little, such as chocolate.

   As well as not wanting my kids to grow up and feel bad about themselves if they eat cake, I don’t want them to think less of someone else if that person eats cake too. Food shouldn’t define us, so I would hate to hear my kids come home from school speaking negatively towards a classmate because of what was in that kids lunchbox.

4. Let kids make mess when eating

   Starting from when kids are babies, let them be messy with food and even (to an extent) let them play with their food. If pushing their peas around on their plates pretending their fork is a bulldozer leads them to eating those peas then let it be!!

   And if you are always coming at your baby or kid with a cloth to wipe their hands or face then they will be too worried about getting messy to enjoy their food, so embrace the mess!

5. Take your kids to the supermarket or farmers market

   I know it can be hard, take twice as long and you might have to deal with the 1000 requests for whatever but kids need to see food and they need to see all food. A good trick when at the supermarket is have your child put the fruits and veggies in the trolley themselves. Get them to touch the veggies and instead of talking about whether they will try that food later, talk to them about how it feels, or the colour or get them to come up with an imaginative story about it “What if broccoli were trees in a forrest…”

   Having kids see chips, biscuits and lollies is also a good opportunity to talk about what these foods do in our bodies and how they might make us feel and why we don’t eat these foods every day. The important thing is to not demonise these foods. You might not say any of those things and instead simply say “thats not on the shopping list this week, maybe we will get that next week”. Remember, food has no moral value. Food is food.

6. Keep offering

   If your child doesn’t like tomatoes for instance, try offering them a different way or at a different meal or snack. Exposure is so important for kids when learning to try something. They need to feel safe before they will take the leap and try something new. So don’t be disheartened and automatically say they don’t like something after one attempt at offering it. It might take 2 exposures, it might take 200 exposures, it might even take 2000 exposures.

7. Stick to a meal time schedule

   If kids are constantly grazing then they will come to the dinner table and not necessarily be hungry so they will be less likely to eat whats in front of them. Offer meals and snacks every 2-3 hours and only allow water in between these times. It is ok for kids (and adults) to feel a little hungry, kids need to learn what hungry feels like as it will teach them to listen to their bodies and their hunger cues which will set them up for positive eating behaviours later in life.

   Having a rough idea what is going to be served at meals and snacks is also a good way to look at nutrients across the day rather then trying to get all nutrients in at each meal or heavily focusing on the veggie component at dinner. Its also a good idea to not just offer those “healthier” foods at meal times (breakfast, lunch, dinner) and then allow “junkier” foods at snack times. Kids will clue onto that pretty quickly and hold out for morning and afternoon tea rather then eating their meal.

8. Eat meals as a family

   Whenever possible, sit and eat with your kids. This goes for breakfast, lunch and even snacks too, not just dinner. Now eating every meal together might be too hard but try to have at least one meal a day where everyone sits and eats together. Kids learn by watching others, so set a good example. If you want your kids to eat more veggies, then you’ll need to too. It’s also a way to show kids how to behave if there is something on their plate that they don’t like. Not everyone has to like everything. You might not like mushrooms. It’s still a good idea to have them on your plate and quietly push them to the side so that your kid can learn that if there is something that they don’t like then it can still be on their plate and they don’t need to have a tantrum about it.

9. Don’t become a short order cook

   Be considerate that kids are still learning to like foods but don’t cater to their every request. Follow the parents provide, children decide motto. You as the parent, decides what will be served at that meal/snack and the child decides what, if anything they will eat. Calmly state that there won’t be another opportunity to eat until the next meal/snack time. What if they decide not to eat anything at dinner and the next meal isn’t until breakfast? Well, if dinner is more than 2 hours before the child goes to bed you could offer a snack (the parent decides what the snack will be). Do always offer at least one food that you know your child likes but incorporate it into the family meal. If you have offered something that they like and they still choose nothing, trust that your child isn’t hungry and don’t make a big fuss.

10. Don’t offer foods they like the same way

    If you have discovered that your kid likes a particular food, try offering it in different ways, at different meal times and if its a packaged food, try different brands from time to time. This creates variety in a familiar or safe food which can broaden their acceptance.

11. Try buffet style meals

    Kids like to feel in control, so being able to serve themselves is a great way for them to do so and can often lead to them trying different foods. Tongs are also a fun utensil to use so let them have a go. If meal times are fun and relaxed, everyone wins!

When to seek more help?

If you are highly stressed, your child is really anxious or stressed at meal times, if there is an issue with certain textures or colours of food or your child’s height or weight are faltering then it might be a good idea to contact your healthcare provider which could include your GP, Dietitian, child health nurse or if its a sensory issue a Speech Pathologist or Occupational Therapist.

Baby Led Weaning

Baby Led Weaning is a term that Jill Rapley (UK) used to describe a particular way of feeding babies. Typically, purees and spoon feeding is out and the first foods baby tries are offered in pieces that are the size and shape that the baby can handle easily. Simply put, BLW allows the baby to be in control of when they start transitioning on to solid foods.

So, how exactly? If you want to go down the BLW path, have your baby sit with you and the family at meal times, allowing your baby to join in on meals when they are ready. When your baby starts to show interest in foods, allow them to explore foods with their hands. At this point it doesn’t matter if your baby eats a little or any at all. You should offer foods that have been prepared in ways that are easy for your baby to pick up. Generally speaking, foods should be long, thin finger shaped pieces that the baby can hold onto. The baby feeds themselves from the start and its the baby who decides how much to eat.

Advocates for BLW will say this way of feeding has many benefits such as being enjoyable and a natural way of eating. It allows the baby to learn about food through smell, taste and texture by exploring food through sight and touch. People say this way of feeding has a developmental benefit and allows the baby to gain confidence and trust as babies are allowed to go at their own pace. BLW allows babies to learn to regulate their appetite and to join in on family meal times which are benefits that will develop into positive eating behaviours later in life.

Despite all the benefits, it can be a messy approach and so for some parents this way of feeding does not sit well with them or suit their family. Some parents are also concerned with choking, however if foods are prepared correctly and babies are supervised when eating, choking is avoided.

Personally, I did a combination of both spoon feeding and BLW for my 2 children and I think its really important to note that BLW doesn’t have to be done in the strictest ‘no spoons at all’ way that some people argue. When you’re about to start solids find a way that works for you, your family and most importantly your baby. Trust your gut and do what feels right.