Advice from the Nutritionist (and update)

[Rachels]

So we saw the nutritionist yesterday. Abigail has lost another half pound, and I'm feeling very freaked out about the fact that she won't eat. Then today, she fell down and cut her gums, which just isn't going to help matters. Sigh. Fortunately, the nutritionist was really great and had lots of ideas for maximizing her caloric intake. This will be LONG, but I thought I'd share in case others are interested in free nutritional advice. The short lesson is that you cannot overdo fats for a baby. Reverse everything you do for yourself regarding fats, and you'll be on the right track. Anyway, this is all high-calorie stuff, so you don't need to fortify milks and puddings and shakes so much if your baby isn't low-weight. Here were some of her suggestions:

Snack ideas:

English muffin with melted cheese or cream cheese
Cheese, meat, poultry, or tuna sandwich with mayo or butter
Cereal with milk AND cream
Whole milk yogurt with granola or toasted wheat germ
Bananas or apple with yogurt dip
Milkshake / frappe (see below) - 1/2 - 3/4 cup for each snack
4 oz yogurt with 1 T heavy cream or nonfat milk powder
Pizza
Full fat ice cream
Crackers with hummus, butter, or cream cheese
Fortified pudding (see below) - 1/4 - 1/2 cup per snack

Shakes and Frappes:
* Vanilla shake (400 calories): 1.5 cups vanilla ice cream, 1/2 c. whole milk, 3 T nonfat milk powder.
* Strawberry Shake (530 calories): 2 c whole milk, 2/3 cup nonfat dry milk or 1pkg Carnation Instant Breakfast, 2.5 cups strawberry ice cream, 2 T heavy cream
* Creamsicle shake (560 calories): 1/2 cup whole milk, 2 T nonfat dry milk powder, 1/2 cup orange juice, 1 c. orange sherbet, 1 pkg Vanilla Instant Breakfast
* Banana Shake (670-790 calories): 1/2 cup whole milk, 1/2 cup orange juice, 1 cup vanilla ice cream, 2 bananas

Fortified Milk (180 - 210 calories): Add 2-4 T of powdered nonfat dry milk or 1 T of heavy cream to 8 oz whole milk

Fortified Pudding (326 calories): 1 cup fortified milk, 1 cup heavy cream, 1 pkg instant pudding mix

Super Grilled Cheese: Dip cheese sandwich into egg and fortified milk mixture, then grill with lots of butter. You can also put mayo or butter inside the bread.

Other calorie info:
* Butter, margarine, oil - 45 cal / tsp - add to everything, spread on crackers, sandwiches, breads
* Instant Breakfast Powder - 130 cal / packet
* Cheese - 100 cal / oz
* Cooked meats: 50-75 cal / oz
* Cream cheese: 50 cal / tsp - add to toast, crackers, breads, fruits, mashed potatoes, mac & cheese
* Heavy cream: 50 cal / Tablespoon - add to milk, cereal, mashed potatoes, eggs, cream soups, milkshakes
* Mayo: 100 cal / Tablespoon
* Sour cream: 30 cal / Tablespoon - use w/ potatoes, beans, squash, carrots. Add to gravies and casseroles and use for dip.

Sample meal plan: (ambitious-- there's no WAY a toddler is going to eat this much, but it's what to work toward in the first six years)

BREAKFAST:
1/2 cup juice
1/2 - 1 egg
or 1/4 - 1/2 cup cottage cheese
or 1-2 tsp of nut butter
or 1 - 1.5 oz cheese or meat
1/2 slice of bread with butter
or 1/4 cup cereal
4-6 oz whole milk or fortified milk

AM SNACK (see snack ideas)

LUNCH:
1 - 1.5 oz of meat, poultry, fish, or tofu
1/4 - 1/2 cup vegetable with butter or margarine
1/4 - 1/2 cup potato, rice, or pasta with butter or margarine
1/4 - 1/2 cup fruit
4-6 oz fortified milk

AFTERNOON SNACK (see snack ideas)

DINNER:
1 - 1.5 oz meat, poultry, fish, tofu
1/4 - 1/2 cup deep green or yellow veggie, sprinkled with cheese
1/4 - 1/2 cup whole grain bread, potato, rice, or other starch with 1-3 tsp gravy / butter /margarine / oil
4-6 oz fortified milk

EVENING SNACK (see snack ideas)

I hope this is helpful!

-Rachel
Mom to Abigail Rose
5/18/02

[alkagift]

Rachel,
It sounds like you've gotten some good advice there. I thought Abigail was off dairy so I didn't have any good ideas. But from your list it looks like she might be able to eat dairy, so perhaps my lone thought will be helpful: pimiento cheese. It's is a great thing and heavy--grated cheese, mayo and pimiento--you can put pepper in it or not. I ate it on celery sticks as a kid, but crackers or bread are good too. Kids like it because it's a tad bit sweet with the pimiento. If you'd like the recipe, just PM me or reply and I'll post it. You can always buy it too, but it's cheaper and better if you make it yourself.


Allison\r\nMom to Matthew Clayton, 5/19/03

[Karenn]

This is great, I've printed it! Thank you for typing it all in to share!

[Rachels]

Oh, you're right, she was. She seems to have outgrown her milk sensitivity. I'm nervous-- really nervous-- about giving her milk to drink, but the last two rounds of food tests have shown milk to be fine, so I guess we're trying it.

-Rachel
Mom to Abigail Rose
5/18/02

[COElizabeth]

Rachel,

Thanks for posting this info. I was wondering what if anything the nutritionist said about the timing of nursing sessions. I know BM is pretty high in calories and fat, so I have not been worrying too much about whether James nurses before or after a solids meal, but I am wondering if I should change that either now or in the next few months.

Elizabeth, Mom to James, 9-20-02

[etwahl]

I definitely want to see how she does on milk. lauren's poops are still like watery diarrhea, but at least they're not green.

i hope it all works out better.

Tammy,\r\nMom to Lauren Genevieve\r\n03/12/2003\r\nwww.evantammy.com

[newbelly2002]

Sorry to hear that Abby's dropping weight, but it sounds like you've been given lots of good advice and support. Thanks for taking the time to type all that out. It's got some great ideas!

Paula, Mama to Dante\r\nhttp://www.shutterfly.com/osi.jsp?i=67b0de21b32384e84594 -6/25 update

[Andrea S]

Thanks for sharing all that info. I am always looking for different stuff to feed Andrew. I am also curious about when you nurse. Right now we nurse first thing in the morning then 1-2 hours later he has breakfast then nurse before am nap lunch around noon adn nurse before pm nap then dinner 5-6 and nurse before bed. I guess that we nurse instead of snacks.


Andrea
mom to Andrew 8/14/02

[Rachels]

We sort of do that, too. We nurse in the morning when she wakes up, then before and after naps and whenever she bumps her head. Then we cluster nurse in the evening after dinner-- snuggle, nurse, play, check back in and nurse, play, nurse. Evening breastmilk has the highest fat content of the day, so I let her nurse as often as she likes in the evening.

They didn't say anything much about the timing of nursing. The nutritionist was clear that breastmilk is the perfect food, so that was helpful. The GI doctor would have me quit nursing now in favor of formula, which I'm not about to do. Personally, I don't want to monkey around with her nursing schedule, either. I figure she knows when she needs to nurse, and I respect her clock. She doesn't seem to nurse for hunger in quite the same way that she used to, so I'm not too concerned about trying to figure out a ratio of milk to solids. Also, breastmilk is one thing she will ALWAYS tolerate, even when she's refusing food. It scares me to think what would have happened these couple of weeks if she wasn't getting that.

FWIW, I asked about sugar in some of those recipes-- ice cream, yogurt, pudding. The nutritionist told me that she's not nearly as concerned about that as she is about fat and calories. I made one of the fortified shakes and Abby downed about a third of a cup of it, which is the most she's eaten at one stretch in several days.

-Rachel
Mom to Abigail Rose
5/18/02

[nigele]

Rachel,

Thanks for posting the info. and I'm glad you got some helpful suggestions from the nutritionist.

I was wondering if she mentioned PediaSure? Our ped. wants Tom to drink one can a day but I'm lucky if he drinks a quarter of it. I was thinking about trying Carnation Instant Breakfast and I was so excited to see the nutr. recommended it for Abby. I'm going to give it a try and see if he likes it.

Edited to add one more thing: Tom nurses a lot during the day when he has to wear his eye patch. I let him since he is so upset about the patch and anything I can do to make up for it is fine with me. I have had a lot of comments from people that he WOULD eat real food if I would stop nursing him so much, which worries me. At the same time, there is no way I am going to refuse him a comfort measure when he needs it. I feel like I'm stuck between a rock and a hard place!