How to Make a Healthy School Lunch

By Monika Frauzem, dietetic technician, registered at CHOC Children’s

It’s back to school time and that means thinking about lunches to go! Lunch provides nutrition for your child’s school day. A good nutritional foundation will support learning and deliver the energy needed for play time. The good news is that preparing school lunches does not have to be a chore! You can make this quality time spent with your child and a positive learning experience.

Here are some things to think about when planning lunches and meals:

  1. Get informed

The MyPlate model designed by the United States Department of Agriculture shows the ideal balance of nutrients you should strive for at every meal. Which food group some of your favorite foods fit into might surprise you.

nutrition
The MyPlate model shows a great visual way to balance our food groups.

2.) Get inspired 

The CHOC Children’s Kids Health blog is filled with healthy and fun recipes that are sure to please kids and parents alike.

3.) Get organized

  • Include meal planning into your weekly schedule. Sit down with your child and agree on a time that will work for everybody involved. CHOC offers healthy meal prep tips for busy parents.
  • Create a menu for the week and make a grocery list.
  • Create a menu for the week and make a grocery list.
  • Create a master list of lunch options to use if time is limited or life gets in your way.
  • Get containers in various sizes and make sure containers are easy to open—especially for younger children. Consider the environment, and remember that reusable containers are better for the environment and cheaper in the long run. There are many innovative options available.
  • Buy produce that is in season in bulk—it’s good for your budget and your body!
  • Create snack stations in the fridge and pantry for easy access for hungry kids after school and when you are in a hurry assembling lunches.

4.) Include your child in the process

When creating meals, it is important to include all food groups. It will help your child feel full longer and have the energy they need to say alert throughout the day. The main idea is to combine protein, complex carbohydrates (such as grains), fruits, vegetables and healthy fats. Variety is the key. Remember: Have your child help! If your child participates, he or she is more likely to eat their lunch.

healthy school lunch
Eating a healthy school lunch can help your child have the energy she needs to power through the school day.

What Nutrients Does My Child Need?

Protein – Growing children need protein because it is an important component for bones, skin and muscles. Foods that are good sources of protein include: cottage cheese, Greek yogurt, yogurt, string cheese, turkey or chicken for wraps or roll ups, eggs (such as hard-boiled eggs or egg salad), tuna- or salmon salad, peanut or other nut butters, tofu, edamame, beans, lentils and hummus.

Grain – Grain provides carbohydrates, fiber, minerals and vitamins. Read labels and choose 100 percent whole grains when possible. Carbohydrates give your children the energy they need to learn and play. Read labels to limit the amount of added sugar and unhealthy fats. Healthy grain options include: whole-grain bread, flatbread, pita pockets, bagels, tortillas or English muffins; crackers, pretzels, cracker bread and rice cakes; cooked brown rice, barley, couscous and quinoa; granola bars; whole grain cereals.

Vegetables – Vegetables are a good source of carbohydrate, minerals, vitamins and fiber. You may include a dip such as low-fat salad dressing, bean dip or hummus. Try to get a variety of colored vegetables as these provide different nutrients. Some options include: broccoli, cauliflower, sweet potatoes, jicama, sugar snap peas, carrots, celery, kohlrabi, beets, bell peppers, corn, cucumber, tomatoes and spinach

Fruit – Fruit is a good source of carbohydrate, minerals, vitamins and fiber. Just like with vegetables, serve a variety from all the color groups because they contain different vitamins and minerals. Some ideas include: olive oil, vegetable oils, canola and sunflower oil, avocado, cheese, nuts, sour cream, butter, mayonnaise and salad dressings

Sending your child to school with a nutritious lunch can be a rewarding experience for everyone! With a little planning and organization, it doesn’t need to be a hassle. Pack lunches the night before so they are ready to go before the morning rush.

Include your child in the process. There may be times when they want the same lunch multiple days in a row and times when their taste changes. Just offer a variety of foods and options during the other meals of the day.

Remember: the lunch your child takes to school should be one they will actually eat and not one you want them to eat.

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How to Tell If Your Baby is Getting Enough Milk from Breastfeeding

By Michelle Roberts, registered nurse and certified lactation consultant at CHOC Children’s

Every year in August, we celebrate World Breastfeeding Week. This year’s focus is “Sustaining Breastfeeding Together.” As a lactation consultant, the most common question I get from parents of a breastfed infant is, “How do I know my baby is getting enough?” When we bottle feed an infant we can look at the measurements on the bottle to determine the exact amount that a baby gets. When a mom is breastfeeding, she may be concerned because she can’t see the amount taken. A common reason women give up on breastfeeding is feeling they are not producing enough milk.

Here are 5 key indicators a baby is getting enough milk directly from the breast.

  • Breastfeeding 8-10 times minimum per day. Newborn babies should be breastfed a minimum of 10 times per 24 hours. As the baby gets older and is gaining appropriate weight, they may cut back to 8 times per 24 hours. We recommend keeping a breastfeeding log. Start by downloading a template breastfeeding log.
  • Latches well and maintains latch. Babies should latch and remain latched without coming on and off throughout the feeding. It can be difficult to transfer adequate milk if they are not staying on the breast. For the most part, breastfeeding should not be painful. If you are experiencing bleeding or scabbing, the latch is not deep enough and can lead to low weight gain and low milk supply.
  • Audible swallowing. A baby’s suck pattern and frequency of swallowing will change throughout the first three to five days. When a baby is first born, they will be sucking more often than swallowing but as mom’s milk supply increases, the swallowing should increase too. Mom’s milk usually increases between Day Three and Day Five after giving birth.
  • It is important to track a baby’s diapers to make sure they are producing enough diapers based on their age. Your birth hospital or your pediatrician will provide you with a diaper log that will show you how many wet and dirty diapers are expected based on your baby’s age.
  • Weight Gain. All newborn babies lose some weight shortly after birth. Your pediatrician will determine if they lose too much weight. Once mom’s milk supply has increased in volume, the baby should gain an average of 1 oz. per day.

What do you do if you are not sure your baby is getting enough at the breast?

Your pediatrician is always a great person to help you determine whether your baby is doing well. It is also helpful to reach out to women in your life that have breastfed. Call your mom, your sister, a neighbor or a friend for support. It is also beneficial to be aware of your resources within your community. Most birth hospitals have lactation consultants that can work with you on an outpatient basis. A lactation consultant will be able to determine the amount of milk a baby transferred from your breast to your baby’s stomach by using a breastfeeding scale. They can also assist with supplementing at the breast directly.

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What Kind of Yogurt Should You Feed Your Kids?

By Laura Clapper, clinical dietitian at CHOC Children’s

Yogurt consumption has increased dramatically in recent years, especially Greek yogurt, for good reason. It contains important nutrients such as protein, calcium, potassium, and some are fortified with vitamin D for additional bone health. Current dietary guidelines recommend children consume 2-3 cups of low-fat dairy per day.

Many cultures around the world have consumed yogurt for over 2,000 years, but now the yogurt industry is taking over the dairy section of today’s local grocery stores. A few years ago, the yogurt choices were fruit on the bottom or mixed. Now, it can be overwhelming with so many options!

Some are packed with sugar, and some have more nutritional value than others. How do you know the right kind to buy for your family?

Plain Yogurt

Made by heating milk, cooling it, adding live cultures (or probiotics, which are considered “good bacteria”) and letting the mixture ferment until lactic acid is formed and the product gains a thicker consistency. This process is the base for many other yogurts. It retains liquid whey, which is high in calcium. It also is the mildest form of all the yogurts, which makes it an appealing option for children. Look for a seal on the label that says “Live and Active Cultures” to ensure the product was manufactured with a minimum of 100 million cultures per gram. These can be beneficial to the gut and immune system.

Greek Yogurt

Made using the same process as plain yogurt, but most of the liquid whey is strained away. Nutritionally, Greek yogurt has more protein, less lactose and fewer carbohydrates than regular plain yogurt. Manufacturers will often add back calcium which is lost with the whey. It is thicker, creamier and has a more tangy flavor than regular yogurt.

Skyr Yogurt

Pronounced Skeer, and commonly referred to as Icelandic yogurt, special Skyr cultures from Iceland are used to ferment nonfat milk. Water is strained away for a thick and creamy texture, leaving a high-protein product that has the same flavor as Greek yogurt, but a milder flavor and mouthfeel.

Kefir Yogurt

Kefir is a tart and tangy drinkable yogurt, using grains of a yeast starter to begin the fermentation process. It can be an acquired taste for some people, but those who prefer this kind enjoy the carbonation and thin consistency. People with lactose intolerance might be interested in giving this one a try, as it contains a very low amount of lactose.

Swiss Yogurt

Also known as stirred yogurt, this type of yogurt is thinner and creamier than Greek yogurt. It is made from cultured milk that is incubated and then cooled in a large container. Watch out, though: Swiss yogurt can have almost double the sugar and carbohydrates than Greek yogurt!

Organic Yogurt

According to the USDA, what you do get from organic dairy products is the benefit of knowing that no growth hormones or antibiotics were used on the animals that produced the dairy. It contains no pesticide residue from added fruits, and no GMOs.

Grassmilk Yogurt

It refers to yogurt made from the milk of cows that have been grazing on grass, with no grain, corn or soy as part of their diet — good for the cows, and good for us. It’s a nutrient-dense yogurt which is rich and higher in omega-3s.

Be aware of added sugars in yogurt

Within each of these categories you can choose nonfat, low-fat or full fat versions, creamy, whipped, soy milk, fruited flavors, or added fibers. But whichever one you choose, take time to glance at the label. All yogurt will have sugar listed because all yogurt naturally contains the milk sugar lactose. Expect around 7-15 grams of naturally occurring sugar for a six-ounce serving. The new labels starting to come out this year differentiate between naturally occurring sugar and added sugar. Skip the added sugars by adding your own sweetness with fruit, cinnamon or a touch of honey.

Drinkable and squeezable yogurts are often marketed to kids but contain added colors, sugars and artificial flavors. Look at the added sugars in this nutrition label of a popular tube yogurt for kids:

yogurt for kids

Yogurt can be used in a variety of ways and at any time of the day. For breakfast, try it as a spread on toast or as part of a smoothie. For lunch or dinner, use in place of sour cream, heavy cream, or mayonnaise in recipes for pasta, tuna or potato salad. Mediterranean dishes feature dips and sauces such as raita, tzatziki and labreh made with yogurt and spices. For dessert, try freezer-mold popsicles with equal parts yogurt, nonfat milk and fruit. Or for a parfait, layer yogurt with fresh fruit, berries, or angel food cake and top with a sprinkle of high fiber granola and serve in clear containers. Any way you serve it up, your kids will love this delicious, healthy treat.

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Summer Snack Ideas and Safe Food Tips

By Stephanie Nathanson, registered dietitian at CHOC Children’s

With summertime approaching, it’s time to grab your sunscreen, your beach towel, your picnic basket, and hiking boots and get outdoors! There are countless opportunities for outdoor activities, especially during the summer heat, but packing meals and snacks can be a bit of a puzzler. What can I bring that will keep me satisfied for an action-packed day, without spoiling rotten or getting mushy in my backpack?

Not only should you consider what to pack up for a full day in the sun, but how do you keep foods safe? One important consideration is to keep hot foods hot, and cold foods cold. Most bacteria do not grow rapidly at temperatures below 40 degrees, and above 140 degrees. The temperatures in between are known as “the danger zone” because bacteria multiply quickly and can reach dangerous levels after two hours, or after only one hour if it’s toastier than 90 degrees outside.

When planning a daylong hike or outing, pack enough food for one meal plus snacks. Aim for primarily non-perishable items. To keep cold foods cold, consider freezing a water bottle or juice box to use as an ice pack. After you eat your snack you’ll have a refreshing, cold drink.

snack ideas

Snack and meal ideas for summer days:

  • Peanut butter sandwich with sliced banana and honey
  • Protein/energy bars
  • Beef jerky
  • Individual nut butter packs
  • Canned tuna or chicken – mix with avocado instead of mayonnaise to eliminate the risk of bacterial growth
  • Dried fruit and nuts
  • Homemade trail mix recipes:
    • Almonds, walnuts, peanuts, cashews, pecans, raisins
    • Walnuts, pumpkin seeds, sunflower seeds, cinnamon, nutmeg, sea salt, dried apricots, dried cranberries
    • Cashews, brazil nuts, dried mango, coconut flakes, banana chips
    • Create your own mix and match of nuts and seeds + dried fruits including: almonds, cashews, walnuts, pecans, pistachios, brazil nuts, hazelnuts, sunflower seeds, pumpkin seeds, apples, mango, blueberries, cranberries, cherries, goji berries, figs, dates, apricots, pineapple, raisins, banana chips. *Caution with adding chocolate bits as they may melt in the heat.

Weekend camping trips

For longer trips, you will need to pack a cooler filled with ice for meat and other perishable items. An ice block will last longer than cubes, unless you are located near a convenience store to replenish your ice supply each day. Remember to pack a thermometer to ensure cooking temperatures are satisfactory within FDA standards.

  • Cook burgers made of raw ground beef, pork, lamb and veal to an internal temperature of 160°F
  • Heat hot dogs and any leftover food to 165°F
  • Cook all poultry to a minimum internal temperature of 165°F
  • Cook all raw beef, pork, lamb and veal steaks, chops and roasts to a minimum internal temperature of 145°F
  • All cold food items should be below 40°

The rule of thumb for day outings and overnight camping trips is to plan ahead. Decide beforehand what you are going to eat and how you are going to prepare it, including the equipment you will need.

  • Bring a cooler if needed, especially for overnight trips.
  • Keep raw foods separate from other foods.
  • Bring a cold source, such as ice packs or frozen juice boxes, to keep cold foods, such as meat and dairy products, cold.
  • Don’t forget your biodegradable soap for dishwashing.
  • Bring bottled water for drinking and teeth brushing, or check out in advance if you will have access to a filtered water source.

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The Latest Guidelines for Introducing Solids to Babies

Many parents are familiar with this scene: It’s dinner time, and your baby is eyeing every bite of food you put in your mouth. Is it time for baby to try solid foods?

Solid foods can be introduced as early as six months of age, according to guidelines from the American Academy of Pediatrics and the World Health Organization. That’s when a baby’s digestive system is developmentally ready for food. Prior guidelines recommended starting solids at four months, but research has shown that introducing solid foods earlier could increase the chances of developing diabetes, obesity, allergies and eczema, according to Vanessa Chrisman, a pediatric dietitian at CHOC Children’s.

Age is not the only requirement for solid foods. A baby should also show the following signs of readiness: they can hold their head up, they can sit up without support, they can close their mouth around a spoon, and they no longer reflexively push things out of their mouth with their tongue.

“If a baby spits the food back out with her tongue every time a parent offers food, she’s probably not ready for solids yet,” says Chrisman.

At first, solid foods are more for practice and exposure to new flavors and textures, rather than for nutrition. A baby’s main source of nutrition will continue to be breast milk or formula up until one year of age. As a baby eats larger amounts of solid food and approaches the one year mark, they may begin to drink less breast milk or formula.

Introducing Solids to Babies

Solid foods are traditionally introduced in puree form. Single foods are blended to a smooth consistency and fed by spoon. As a baby eats larger volumes and tries more foods, parents can move on to a thicker texture: mashed foods. At around nine or 10 months old, a baby may start eating finger foods in small pieces.

Baby Led What?

Another method of introducing solid foods to babies is called baby-led weaning (BLW). This method has been popularized in the United Kingdom over the last decade and is starting to gain popularity in the United States.

“Baby-led weaning is a way of introducing solid foods beginning with whole but manageable pieces, and skipping purees and mashed foods,” Chrisman says.

Babies are offered foods that the rest of the family is eating, except for choking hazards such as whole grapes, hot dogs, raw carrots, popcorn, nuts, raisins and very tough meat. Parents can cook and spice the food as they normally would for themselves.

BLW teaches baby to feed themselves, helps them develop motor skills and gives them control over how much food they want and if they want it. “If they’re the ones deciding when to stop eating, it can help them regular their appetite later,” Chrisman says.

A recent study by the AAP determined that babies are not at a higher risk of choking from BLW than they are with traditional purees. Regardless of the food method, it’s always a good idea for parents to know infant CPR, Chrisman says.

As with puree-fed babies, BLW babies must meet the same signs of developmental readiness before starting solid foods. One thing a baby doesn’t need, though, is teeth. “Babies have strong gums that can soften food, along with their saliva,” says Chrisman.

Chrisman recommends that parents choose the method that fits their baby’s personality. An independent baby may take to BLW more than a baby who prefers to be spoon-fed. The key to remember is that every baby is different: “What might work for your friend’s baby might not work for your baby,” Chrisman says.

Straight from a Pediatric Dietitian

Chrisman offers these expert tips to parents as they introduce baby to solid foods:

  • Introduce simple foods one at a time, such as individual fruits, vegetables and proteins. Wait at least three to four days before introducing another food, to watch for adverse reactions. “Don’t go too fast, too soon,” Chrisman says. “Your baby has their whole life to eat all these foods.”
  • As solid foods are introduced, give baby a variety, which will help ensure they will like a variety of foods later in life.
  • Don’t add salt or sugar to baby’s foods. Not only could this cause baby to develop a taste for these strong flavors, it also prevents baby from experiencing the true flavor of a food.
  • Model healthy eating habits. Include a variety of healthy foods on your own plate so baby will learn to imitate your behavior. Encourage your family to sit at the table together and put away distractions so baby understands what meal times should be like.
  • “Make sure feeding time is a relaxing time, not stressful,” Chrisman says. Don’t force baby to eat more than they want and pay attention to their signals. If they are throwing food off their tray, pushing food away or turning their head away, they are done.
  • Feed baby solid foods in between their regular mealtimes, when they’re only somewhat hungry. A hungry baby won’t have the patience for solid foods to reach their tummy.
  • Avoid honey for babies under age one. Honey can carry spores that cause botulism, which is dangerous for infants.
  • Avoid fruit juice before age one. A recent change in AAP policy says fruit juice should not be given unless a doctor recommends juice to manage constipation. The high sugar content in juice may increase a child’s risk of obesity and teeth problems.
  • Avoid cow’s milk before age one. Cow’s milk should not be given on its own, according to the AAP, though it may be fed in other foods, such as whole fat yogurt.
  • Don’t give up on foods that baby rejects a few times. It could take up to 15 times of trying a food before they like it.
  • If baby isn’t eating any solids or purees by 10 months of age, talk to your pediatrician. There could be a feeding issue that needs extra help. Some babies may have an oral aversion to foods, oral motor dysfunction, textures issues and/or poor muscle tone.

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