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Blood culture sampling policy April 2022 v8

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Blood Culture Sampling Policy for Adult and Paediatric Patients Trust reference Description Version number 8.0 This policy lists indications for
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/Media/UHS-website-2019/Docs/Policies/Blood-culture-sampling-policy-April-2022-v8.pdf

PLANETS texture modified recipe book

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A texture modified recipe book for patients with cancer of the oesophagus or stomach A texture modified recipe book for patients
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/Media/UHS-website-2019/Docs/Services/planets-texture-modified-recipe-book.pdf

Press release: Spinal surgeon warns holidaymakers of water park and shallow diving dangers

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A top spinal surgeon has urged people to recognise the dangers posed by water parks and shallow diving as they set
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/AboutTheTrust/Newsandpublications/Latestnews/2019/July/Press-release-Spinal-surgeon-warns-holidaymakers-of-water-park-and-shallow-diving-dangers.aspx

Anti-VEGF injection treatment aftercare - patient information

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Anti-VEGF injections are used to treat conditions that can cause abnormal blood vessels to leak under the retina (the layer
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/Media/UHS-website-2019/Patientinformation/Eyes/Anti-VEGF-injection-treatment-aftercare-1365-PIL.pdf

Recovering well after breast surgery (sutures) - patient information

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This factsheet explains what to expect after having breast surgery (using sutures for wound closure) and how you can help your
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/Media/UHS-website-2019/Patientinformation/Womenshealth/Recovering-well-after-breast-surgery-sutures-3099-PIL.pdf

After your eyelid surgery - patient information

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This factsheet explains what to expect after having eyelid surgery.
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/Media/UHS-website-2019/Patientinformation/Eyes/After-your-eyelid-surgery-2090-PIL.pdf

Pneumatic retionopexy - patient information

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Your doctor has recommended that you have a procedure called a pneumaticretinopexy to treat your retinal detachment. We hope this factsheet will help to answer some of the questions you may have.
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/Media/UHS-website-2019/Patientinformation/Eyes/Pneumatic-retionopexy-3432-PIL.pdf

Ambulatory electrocardiogram (ECG) monitor - Telephone appointment - patient information

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This factsheet explains what an ambulatory electrocardiogram (ECG) monitor is and how to use your monitor at home.
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/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Ambulatory-electrocardiogram-ECG-monitor-Telephone-appointment-4070-PIL.pdf

Breathing pattern disorders - patient information

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Breathing pattern disorders are patterns of overbreathing, where the depth and rate of breath are in excess of the body's needs
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/Media/UHS-website-2019/Patientinformation/Respiratory/Breathing-pattern-disorders-patient-information.pdf

Recipe book - For toddlers who need to make the most of every mouthful

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RECIPE BOOK For toddlers who need to get the most out of every mouthful Contents 04 Acknowledgements & introduction 06 Questions, tips & answers 12 Table 01: Foods which can be used for extra calories and protein 13 Table 02: Examples of exercise and the benefits 14 Food & feeding advice for young children (table) 16 Simple week meal planner 18 Shopping list 20 Recipes: Contents 22 Recipes: Breakfasts � Marvelous nut dust � Granola � Breakfast porridge � Prunes, dates & ground almonds � Peaches, sultanas & ground almonds � Mango & almond butter � Raspberry, banana & almonds 28 Recipes: Power energy balls � Date & apricot power balls 29 Recipes: Warming soups � Dino soup � Super hero orange soup 31 Recipes: Bento boxes � Fusilli, ham, peas & cheese � Ham & cheese pitta & fresh fruit � Ham & cheese sandwich, broccoli, cucumber, orange & nutty chocolate balls � Falafel & hummus pitta, red pepper, cucumber, figs, strawberries � Cream cheese & smoked salmon wheels, avocado & melon � Pitta strips, avocado, hummus, chickpeas, orange peppers � satsumas � Tuna, lettuce, mayo, peas, cucumber, & pepper � Boiled eggs, brown pitta pockets, avocado, watermelon, melon & raspberries � Avocado & raspberries snack fest � Peanut butter, salad & berries � Chicken & BBQ sauce, corn on the cob, cucumber, clementine, & whole wheat wrap � Chicken & cous cous rainbow salad 43 Recipes: Snack boxes 44 Recipes: Meals for sharing � family favourites � Fish fingers & sweet potato chips � Pasta bolognaise � Lasagne � Mild chicken curry � Chicken bunny � Pesto � Salmon, pasta & peas 57 Recipes: Sweet things � Chocolate & almond cup cakes � Apricot, almond & chocolate cereal bars � Nutty flapjacks � Fruit pots � Chocolate peanut butter smoothie � Raspberry & almond smoothie 66 A last note... enjoy... 02 Acknowledgements This book has been written by Dr Luise Marino (RD, PhD) Clinical Academic Paediatric Dietitian at Southampton Children's Hospital. This book is part of independent research arising from (Dr Luise Marino, Health Education England/NIHR Clinical Lectureship (ICA-CL-2016-02-001)) supported by the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, Health Education England or the Department of Health. In writing this book we have received the generous help and feedback from the following people: � Parents of children who need to make the most of every mouthful � thank you for your time and feedback, without which this book would not be possible � Paediatric Dietitians � Catherine Kidd, Natalie Davies � for your expertise and invaluable comments � Dr Rosan Meyer � for sharing your immense knowledge and skills � Paediatric Speech and Language Therapist � Julia Robinson � for your guidance and practical instruction � Specialist Paediatric Cardiac Liaison Nurses � Gill Harte, Colette Cochran, Cate Anson, Hannah Carver � for your unfailing support, feedback and advice � Dr Tara Bharucha, Consultant Paediatric Cardiologist � for supporting this initiative � Members of the British Dietetic Association Paediatric Cardiology Interest group for their generous help and feedback; in particular Neam Al Mossawi (HCA Healthcare), David Hopkins (Yeovile Hospital) � Dominic and Helen Hoile (info@Shootingpeas.com) � for their generosity opening up their studio and giving of their time to take the photographs. � Heather Pierpoint (headfudgedesign.co.uk) � Graphic designer, for bringing the publication to life � Southampton Children's Hospital Charity and the publishers � Michelle Wheeler, Judith Stephens, Amy McBrayne, Alanna Lee for making it all possible � Nutricia Medical � for supporting the project with an educational grant Dedication For all the families and their children who we are privileged to meet � your stories and journeys inspire us to do better. RECIPE BOOK For young children who need to get the most out of every mouthful Who is this book intended for? This book is intended for children between 1 and 5 years of age. Some children need a little bit longer with puree or fork mashed food so don't worry if your child is not quite at the age stages in this book. Some children are born with medical conditions which means they need to get the most out of everything they eat and drink. For some, whose medical issues may not be such a problem as they were when they were babies, they may now develop feeding difficulties, causing parents just as much concern. This recipe book is part of a series, published by Southampton Hospital Charity, to provide practical advice on how children can get the most of every mouthful. The advice within this booklet may not be suitable for those with delayed oral motor skills, inherited metabolic disorders, kidney problems or food allergies and should not replace individualised medical or nutritional advice. If you are unsure as to whether the advice in this book is suitable for your child, please check with their health care team first. The information in this book was correct, at the time of publishing, and undergoes periodic reviews to ensure up-to-date evidence is used. You should seek advice from your local health care professional if your child is not gaining weight well or is having feeding difficulties. Dr Luise Marino (RD, PhD) Clinical Academic Paediatric Dietitian HEE/NIHR ICA Clinical Lectureship thank you Ask for help If your child is showing signs of feeding difficulties (sensory or oro-motor disorders) which can include coughing, gagging or vomiting at the sight or smell of food or drink, food refusal, eating less than 10 different types of food in a week or you are in any way worried about how your child eats, then ask your child's team to refer you to Dietitian and Speech & Language Therapist for extra support. How will this book help me and my child? The aim of this book is to try and provide some useful tips and advice as well as some finger licking food to tempt your little one with. This book will help give you ideas about: � � � � � � How much to expect your child to eat How often should you expect your child to eat What textures can you expect your child to eat How to create a positive mealtime experience How to cope with stressful mealtimes How to cope with fussy eating 05 Questions, tips & answers... How much should I expect my child to eat? The amount of food young children eat varies from one meal to the next � this is normal. There are lots of resources available providing portion size ranges � with some examples below: � British Nutrition Foundation: https://www.nutrition.org.uk/ attachments/article/734/BNF%20 Toddler%20Eatwell%20Leaflet_OL.pdf � Infant and Toddler Forum https://www.infantandtoddlerforum. org/portion-sizes-table-2015 How often should I offer my child food? Try to have: � Regular mealtimes � aiming for breakfast, lunch and supper � Have at least a 3 hour break between each main meal � this will give them enough time to get hungry, but not too hungry � Try not to offer too many snacks between meals as they may then not be able to eat as much at a main meal � If your child is too tired they may find it difficult to eat, so sometimes lunch may be better after a nap � Offer water to drink at mealtimes � It is alright for your child still to prefer puree food � but continue to try to introduce lumpier and soft finger foods too � This will let children practice their chewing skills try to slowly increase the amount of texture in the meal e.g. 5p � 10p amount of a coarser texture until you have moved onto chunkier and lumpier food � Always give some finger food and a spoon at each mealtime so new skills can be practiced � bite and dissolve foods are good as are other finger foods (see the table at the end of this section for more tips) � Remember all of the senses are involved in eating and drinking; touch, sounds, sight and smells; - We eat food with our eyes, so it is important to make food look good - Touching food is as important as eating, so let your little one get messy - Smells of delicious food can encourage children to eat � Try not to compare how much your little one eats with siblings or other children of the same age � Try not to comment on how much or how well your little one is eating, some children get put off eating by all of the attention and focus on them � Don't follow your child around with a spoon begging them to eat; meals happen as a picnic or at a table not walking around � Encourage your little one to feed themselves; sometimes children like the attention of being fed, but it is good to encourage their feeding skills by letting them do it themselves � Children of all ages like food in boxes � Bento boxes, sandwich boxes or little bags or boxes of food appeal to their growing sense of independence � Food that little fingers can easily pick up is good as they can be more independent � don't worry if they play with it and get messy as this is all part of their learning experience � Eat with them � have a meal or snack at the same time; children learn about eating from those around them so if they see their carers or siblings enjoying the same food as them, they are more likely to try it. It is important that mealtimes are seen as a sociable activity to be enjoyed � If your child gets up from the table then calmly end the meal � there is always the next meal � After a main meal offer a small dessert such as fresh fruit and full fat yogurt, small cup cake and custard Have short mealtimes of up to 20 minutes How do I know when my child has had enough to eat? Let your child tell you when they've had enough � it is really important that you listen to their cues. � As when they were babies, they will start closing their mouth, trying to get down from the table, turn their head away, splay their hands or start spitting, shouting or crying, stop at this point � they are finished � If they say they have had enough to eat � try not to ask them to have a few more mouthfuls, you are teaching them to overeat. Respect their fullness � even if they have only have 1 mouthful Keep offering new food � it will take time before a new food is accepted and liked It can take a while before children will eat new foods � so long in fact that many parents give up! Children are often wary of trying new foods or foods they like that look slightly different e.g. different type of yogurt or packet of pitta bread. Children can take up to 15 tries (or even just looking at something) before they will like something new � for some it can take even longer. Offer regular meals and eat together as this helps children learn that food can be delicious and sociable What general advice is there for encouraging positive mealtimes? � Keep calm and don't rush � some days are better than others � Keep offering new foods � they will eventually try them � Children eat in colour � think of a rainbow when you are making their meals � Children like fun � so make their food look fun � Children like to help and want to please � involve them in the buying, preparing and cooking � Offer small portions and give your child lots of praise and attention when they finish it. You can then offer a second helping What texture should I expect my little one to eat? � Children who are weaned late during the first year of life may have missed some of the milestones for accepting new foods and textures, which can make moving on from smooth puree's harder (but not impossible) � Continue to offer your child lots of different kinds of foods, try not to get put off if they reject new foods If you are finding it difficult to get your little one to accept new textures speak to your child's team Children find sitting still very difficult and get bored quickly � Have short mealtimes of not more than 20 minutes or shorter if your child gets upset and does not want to eat � Use a stop watch on your phone or buy a 15 � 20 minutes sand timer � children like to watch the sand going down and it helps to put a limit on the length of mealtimes � Limit the amount of distractions at mealtimes e.g. electronic devices, television � chatting while you eat is good Mealtimes should be fun! Young children usually live to play, not eat. For many they would much rather be listening to a story or playing than sit down and eat. Therefore, it is important to make mealtimes fun and enjoyable, for the whole family! Don't enter into food battles � if they don't want to eat, don't bargain or bribe them You could try reading books with vegetable and fruit characters such as "mighty broccoli and cheeky cherry", this has been shown to increase young children's interest in tasting new foods. All children are unique � as is their appetite and how much they will eat 06 07 Don't enter into food battles � if they don't want to eat � don't bargain or bribe them Try not to enter into food battles with your little one � they will win! It is important to ensure you serve up child size portions � remember the size of their clenched fist; � If your delicious lovingly prepared mini dish of food is greeted with a "yuk � I am not eating that" � Respect your little ones decision with a "that's fine � you don't have to eat it... but you do have to sit here as it is dinnertime" � The family � even if it is just you and your little one then sit down to a meal � Respect them not eating anything or only eating the thing they like � Always offer a dessert � don't use dessert as a bribe as you are reinforcing the fact the main meal is so "yuk" that a bribe is needed to eat it Fussy eating is really common amongst young children and up to 40% of parents report their child has refused food at some point. Between 12 � 18 months of age, all young children develop "neophobia" � the fear of new food or familiar food offered in a different way. As fussy eating is such a common problem there are lots of tips and advice available � importantly: � Children like to eat with others and will often eat more in a group or when there is a relaxed family environment � Try to eat similar food at meals times to your little one e.g. fork mashed or squares of sandwich � Always, always make some part of the meal you know they will eat, then you know they won't go hungry � Eat with them at the same time � encouraging your child with smiles and positive sounds change or copy other children, so eating with others may not help them to accept new foods or textures � Some children may also have sensory issues and refuse to wear certain clothes or colours. They may also not like to get messy or sticky and dislike seeing people eating food they do not like � which can make them gag or vomit. For these children encourage messy play � This can be done with different kinds and textures of food � Shaving foam is also good fun for your child to put their hands in � Jelly is a great food to play with � wibbly and wobbly � Chocolate pudding on a chopping board for cars to drive through At mealtimes: � Be sensitive to what your child likes and dislikes If this is you: � It is easier said than done, but try to have a relaxed approach to mealtimes � Put the radio on and sing along or listen to a radio programme as it will distract you from the mealtime � Have something to eat at the same time, so your attention is not just on your child. They can also learn to enjoy their food by watching you enjoy it too choking risk children should be sitting whilst eating � Children should not have whole nuts under the age of 5 years � Other hard food, including Granola, should be ground into a finer crumb and not have any hard bits in it � it should also be mixed into food before serving � Always keep crumbed or hard food out of children's reach and always supervise snack or mealtimes � Sometimes doing a child first-aid course can help with any anxiety around mealtimes and choking risks. Ask your Health Visitor to find out what is available near home Most children love to get messy � however, some find it really stressful � so start slowly � outside of mealtimes � Try not to put really disliked food on the same plate as food which is liked � as some children will refuse the whole plate � Away from a mealtime offer tiny tastes of foods that your child might be willing to try � Offer your child different things to smell zest of lemon, herbs, melted chocolate � make a chart and together tick off the smells they like or don't like Children pick up on your non-verbal cues � if they feel you are tense about mealtimes � Don't worry if your child doesn't eat anything � sometimes children aren't hungry for their meals and this is normal � Invite a friend or family member to come and have a few meals with you � as having someone else to talk to can help � Have a picnic instead of eating at the table � you can have an indoor picnic if it is too cold to eat outside � Go out to a caf� and have a drink � offering your child food in a new environment can help My child is really fussy � what shall I do? For some parents feeding their baby has always been easy, but for others their little one's feeding journey has been really challenging � with vomiting, reflux and poor weight gain. As a result of these negative experiences associated with eating, some young children may have developed feeding difficulties or fussiness around food. Some children are fussier than others, but the good news is that with the right encouragement most children will have outgrown being fussy by 6 years of age. Most children love to get messy � however, some find it really stressful � so start slowly � outside of mealtimes � First start with general play with sand and water or paint � Play-doh, kinetic sand and painting are also good tactile games � Once they are comfortable with this take some dry uncooked pasta and place a top on top of the pasta for your child to pick up � Let them see you do it too � Once they are happy with this step, hide the toy in the dry pasta for them to find � Moving on to cool cooked pasta, hide the toy For children who need to gain weight � add nut butters to main meals Children have small tummies (about the size of their fist) so it is tricky to fit a lot in without either making them feel ill, or be sick. Examples of ways to get the most out of each mouthful are as follows; Snacking between meals does not suit all children as it can impact on their hunger and willingness to eat at a main meal. All children are different, so work out whether your child would prefer to have just 3 meals a day or 3 meals and one or two snacks. Snacks can be a useful back up if your child does not eat that well at mealtimes, but don't use snacks to replace main meals. Toddlers usually develop "neophobia", which simply means they don't like new foods � Change only one thing at a time � don't offer too many new foods at once, it can be overwhelming � Do not let new foods touch a favourite food as this can put them off their favourite food � Children who have very strong opinions about food are less likely to accept HELP: I feel really stressed about mealtimes! How can I relax? Our children know us really well. They read our body language and pick up on how tense we are through our faces and the way we sit or stand. For some parents, mealtimes are really stressful and even though they try to smile, their child senses something is wrong... I worry my child will choke � are there any foods I need be careful of? � Peel all fruit and vegetables. Cut round slippery foods length ways into quarters e.g. cherry tomatoes, grapes. As this is a 08 09 For children who need to catch up in terms of growth aim to provide; � Ages 1 � 3 years: an extra 200 � 300kcal, 7.5g protein per day � Ages 4 � 5 years: an extra 300 � 500kcal, 12.5g protein per day Table 1 can be used to plan ways in which to provide extra calories. It is important to use energy-nutrient dense foods e.g. nut butters. For example 6 teaspoons of peanut butter a day is almost 200kcal and 7.5g protein. We do not recommend the addition of extra oil or cream to food � if you have a heavy rich meal it can make you feel sick, children have the same feeling. Instead try to use a teaspoon of smooth nut butters, coconut cream, smooth plain cream cheese or a small pinch of grated cheese. Breakfast: � Add 1 � 2 teaspoons of smooth nut butter (almond, cashew, peanut) to warm porridge or � Toast with 1 � 2 teaspoons of nut butter and marmite or chocolate spread � Add 1 � 2 teaspoons of a nut butter to a home-made fruit smoothie � Add Marvelous nut dust (finely ground) to other breakfast options � mixing it in before serving Lunch and supper: � Offer protein at both main meals such as meat, boneless fish, chicken or beans/lentils with a starch (rice/ potatoes/pasta) and vegetables � add 1 � 2 teaspoons of a smooth nut butter or Marvelous nut dust � A small amount of grated cheese/ cream cheese can be added to mashed potato or meat dishes, instead of a smooth nut butter � Following a meal offer - Fruit or full cream yogurt - Full cream custard with a small cup cake - Rice pudding with 2 teaspoons of chocolate nut butter - Mashed avocado with toasted pistachio dust mixed into the avocado Eating veggies � children need to see you eating them too We all like sweet foods, so for many people veggies may not be their first choice of food. We should all eat 5 or more portions of fruit and vegetables a day. Some children really struggle with veggies, so here are some tried and tested tips; � Children need to see you enjoying veggies � so cook your favourites and eat them as a snack or with your meal � Most children 3 years and above like frozen peas � put a small amount in a pot and offer them whilst they are still frozen � Chop leafy veg such as kale and cabbage into really small bits � Cook leafy veggies with some chicken, pancetta or add a little gravy to give it a more savoury taste � Eat the same veggies as your children � Put mayo or tomato ketchup on salad � Don't insist they try it � all you can do is make it look yummy � Make up fun names � rocket man, pirate peas, beautiful butternut � Look for video clips of other children eating vegetables � Play with veggies � getting them to tear it, wash it, mash it � Take veggies selfies � Start with 1 teaspoon of a new veggie on their plate or side plate Continue with positive touch, massage and encouraging smiles � this all helps to reinforce positive messages about food. It is a good idea to start brushing your child's gums and teeth from when you see the first tooth. � Try not to let young children fall asleep with a bottle of milk in their mouth � offer milk before they go to bed, brushing their teeth afterwards � Use a toothpaste containing fluoride � it should have 1,350�1,500 parts per million (ppm) fluoride � Below the age of three years, children only need just a smear of toothpaste � Children aged 3 to 6 should use a peasized blob of toothpaste � Under the age of 7 years old you should brush your child's teeth for about two minutes twice a day: once just before bedtime and at least one other time during the day � Make tooth brushing as fun as possible by using an egg timer to time it for about two minutes � Don't let children run around with a toothbrush in their mouth, as they may have an accident and hurt themselves STEP 1 If your child is gagging or retching at new food on their plate, to begin with put a small amount e.g. 1 cooked carrot finger stick on a plate in the kitchen STEP 2 Encourage your children to be active � do activities as a family All children and young people should engage in `moderate to vigorous' physical activity for at least 60 minutes every day. You should also try to include some `light' activity and some `strength' activity.' It is important when doing sport that you exercise your whole body in a fun way! Why is it important to be active for at least 60 minutes each day? When they are able to look at it away from the table � put the new food on a plate in the middle of the table Don't comment on the food, just leave it there STEP 3 Once this has been accepted, move the plate closer to their plate � again don't comment or ask them to try it Make food fun Green soup can become "super hero" soup � add crispy croutons on top, serve it in little tea cups and just leave it for them to look at. If children see you eating something and enjoying it � they will eventually try it. Role playing about food outside of mealtimes, shopping games, helping with cooking such as passing vegetables is a good way of engaging children. Watching cooking programmes and talking about food, describing the smell and taste whilst you watch can help. Making colourful meal boxes � Pick a colourful Bento box/food container STEP 4 As they get more comfortable with the idea of a new food, then put a small amount on their plate e.g. 1 broccoli stem � they don't need to try it Brush your child's teeth at least twice per day � Helps keep our hearts and muscles healthy � Helps us keep a healthy weight � Improves bone health � Improves self-confidence and self-esteem � Develops new social skills and meet new people STEP 5 Once they are happy with the new food on their plate � ask them if they would pick it up and smell it Help teach your child how to brush their teeth properly � There are some fun clips on brushing children's teeth https://www.youtube. com/watch?v=kuLxz5IrZ6Y � Guide your child's hand so they can feel the correct movement � Use a mirror to help your child see exactly where the brush is cleaning their teeth STEP 6 After smelling, move to licking � then a small bite, they are allowed to spit it out � then to progress to swallow It can take weeks to get to this point � after a while the process will get easier and it will be quicker Make food fun � give dishes fun names... � Use colourful food picks to make a mealtime fun � Add edible cartoon eyes to food � Use a brightly coloured silicone muffin cup 10 11 Table 1: Foods which can be used for extra calories and protein Food item < 50 kcal 1 teaspoon chocolate spread 1 heaped teaspoon cream cheese 50�100 kcal 2 teaspoons smooth peanut butter Bacon � lean rasher Fruit smoothie 1 tablespoon Marvelous nut dust (see page 22) 100�150 kcal Egg, (1) scrambled with milk Chicken, drumstick Cubes of cheese 150�200 kcal Avocado, half 75g 183 1 Yogurt, full fat 175ml 180 7.7 60g 40g 45g 105 110 150 6.2 11 10 Meatball, small Milk, full cream Baked beans 60g 200ml 125g 125 125 116 16 6.4 6 10g 40g 150ml 15g 100 2.3 58 69 2.4 12.9 Egg, boiled Raisins � small box Banana Olives (cut in half lengthways) 60g 27g 100g 10 88 88 92 60 7.6 0.86 1.3 <0.5g 5g 10g 15 34 0.8 0.6 1 teaspoon peanut butter Cheese (pinch) 5g 10g 29 35 1.2 2 Table 2: Examples of exercise and the benefits Amount Energy (kcal) Protein (g) Exercise Light Amount Energy (kcal) Protein (g) Food item What is it and how does it help your body? This won't make you hot or sweaty. It gets your body moving and is a great way to get into doing more physical activity if at the moment you don't do very much. This will make you feel warmer and breathe harder. You should feel your heart beating faster, but still be able to carry on a conversation. This exercise is good for your heart. Examples � Walking � Playground activities Moderate � � � � � � � � � � � � � � � � � Walking Playground activities Slow swimming or playing in the water Riding a scooter Skateboarding Roller blading Riding a bike on flat ground or with very few hills Riding a horse Running or playing running games such as `stuck in the mud' Swimming Team sports such as Hockey / Basketball / Football Fast cycling or on hilly terrain Swinging on playground equipment Hopping and skipping Sports such as gymnastics or tennis Playground games such as `tug of war' Rock, rope or tree climbing Vigorous * This will make you out of breath and possibly red in the face, making it more difficult to carry on a conversation. This type of exercise is good for your heart. Strength This helps to make your bones and muscles strong. * if you are not sure check with your health care team before you do anything that is very vigorous HELP: none of this advice is working If you are finding any aspect of introducing food difficult or your little one is showing signs of not wanting to eat at all � don't suffer in silence � your child's team can help. 12 13 Food & feeding advice for young children Food and Feeding Advice Type of food to offer If you are making food at home, try some of our recipes in this book. From 12�18 months of age � Continue with your child's usual milk or a nutrient energy dense infant formula around 12 � 16oz � Main meals should include protein e.g. chicken, fish, beans, lentils, meat along with veggies and starch e.g. potato, rice, pasta � If your child needs to gain weight add 2 teaspoons of smooth nut butter to each meal including porridge at breakfast � Keep offering new foods � although it should not touch any favourite food � At this age children start not to need as many calories to gain weight as they did when they were babies � Eats ground, mashed, or chopped table foods (including soft pieces of meat chopped cut up very small) by 15 months � All finger food should still be soft, must fit easily into your child's hand and be just the right size to easily fit into your child's mouth � Know when your child has had enough � signs include starting to play with food, tries to get out of their high chair From 19�24 months of age � Continue with your child's usual milk or a nutrient energy dense infant formula around 10 � 12 oz � Main meals should include protein e.g. chicken, fish, beans, lentils, meat along with veggies and starch e.g. potato, rice, pasta � If your child needs to gain weight add 2-3 teaspoons of smooth nut butter to each meal including porridge at breakfast � Keep offering new foods � although it should not touch any favourite food � Food refusal of favourite or new foods is common around this age � your child will start to show clear likes and dislikes � Chopped texture, small soft pieces including adult style foods � Offer foods with a firmer texture to promote chewing skills � At this age children chew with up/ down and side to side action � All finger food must fit easily into your child's hand and be just the right size to easily fit into your child's mouth � Know when your child has had enough � signs include starting to play with food, tries to get down from the table � Encourage sitting at the table � children should not be walking/running when eating � Encourage the use of small child size utensils e.g. fork, spoon � Is able to feed themselves using a spoon � with less spills � Able to keep their mouth closed when chewing and swallowing � Start to stab food with a fork and get it to the mouth � Should have adult supervision at meal/ snack times � Some young children start to eat very fast � encourage them to eat slowly chewing their food � Mealtimes should last for up to 20 minutes From 2 years to 5 years of age � Continue with your child's usual milk or a nutrient energy dense infant formula around 10 � 12oz � Main meals should include protein e.g. chicken, fish, beans, lentils, meat along with veggies and starch e.g. potato, rice, pasta � If your child needs to gain weight add 2�4 teaspoons of smooth nut butter to each meal including porridge at breakfast � Keep offering new foods � although it should not touch any favourite foods � May become a "fussy eater" refusing foods that were previously liked � By three years of age your child should be able to eat the same foods as the rest of the family � All finger food must fit easily into your child's hand and be just the right size to easily fit into your child's mouth � Know when your child has had enough � signs include starting to play with food, tries to get down from the table Food and Feeding Advice Finger foods From 12�18 months of age � The best types of foods to start off with are ones that dissolve easily e.g. sweetcorn puffs. � Dissolving foods melt evenly in the mouth without leaving lumps e.g. wotsits � These types of food help with chewing skills as your little one needs enough skill to be able to hold the food in the mouth until it melts � Other good finger foods to then move onto are steamed well cooked carrots sticks, banana, avocado, soft pear, soft flaky fish, toast finger, pasta shells All finger food should be soft, easily fit into your child's hand and be just the right size to easily fit into their mouth. Cooked soft finger shaped foods are helpful rather than round shapes. From 19�24 months of age � Even with finger foods children should be sat down � they should never eat and walk/run � As your child's skills increase they will be able to manage different types of soft food � It is sometimes useful to offer these foods as in between meals snacks so you and your little one can enjoy them exploring new foods and textures together All finger food should be soft, easily fit into your child's hand and be just the right size to easily fit into their mouth. Cooked soft finger shaped foods are helpful rather than round shapes. From 2 years to 5 years of age � Always sit with your children when they are eating any food including finger foods � As a snack offer soft cooked vegetables and dips in small pots � It is sometimes useful to offer these foods as in between meals snacks so you and your little one can enjoy them exploring new foods and textures together All finger food should be soft, easily fit into your child's hand and be just the right size to easily fit into their mouth. Cooked soft finger shaped foods are helpful rather than round shapes. Textures Choking hazards Mealtimes � Should sit on a high chair � Is able to feed themselves using a spoon � although expect some food to drop off � It is common for a little bit of food or saliva to still fall out of their mouth � Encourage self feeding � Should have adult supervision � Offer drinks from a sippy cup � Should have adult supervision at meal/ snack times � Mealtimes should last for up to 20 minutes � Encourage sitting at the table � children should not be walking/running when eating � Your child will have definite food likes and dislikes and may refuse certain foods � Continue to encourage new foods � which may take 15 tries before being accepted � Drinks from a cup or beaker � Encourage independent feeding using small child size utensils e.g. fork, spoon � A spoon and fork should be held between the fingers palm up. Introduce a child size knife for practice � Should have adult supervision at meal/ snack times � encourage slow eating � Mealtimes should last for up to 20 minutes � Some types of food are a choking hazard and should be avoided in babies and young children � This list may not included everything � so it is important that you sit with your little one at each meal & snack time � Young children should be encouraged to sit down and eat rather than run around � Hard lumps of any size should be avoided � Raw vegetables are often hard � so offer soft cooked sticks e.g. carrot, courgette and celery � Hard pieces of raw fruit such as apple and pear should not be given � Avoid slippery foods such as pieces of canned fruit � cut them up into small pieces or mashed e.g. sweet corn kernels; � Hard lumps of any size should be avoided in children under the age of 3 years, as they require very developed chewing skills. � Raw vegetables, hard or stringy meat, hard peas and beans, hard dried fruit, toasted or hard sugar syrup coated cereals and `granola' type products and hard crisp or chip products are all examples of foods that should be avoided. � For toddler and young children all finger foods should be cut in short thin stick e.g. lengthways rather than then being round in shape, as this reduces the risk of choking - Mini sausages / mini scotch egg balls - Cut whole grapes, berries, cherries, melon balls, cherry / plum tomatoes lengthways into quarters - Cut orange / satsuma segments into quarters � take the pips out - Chunks of fish flaked should be checked for bones * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk before or with breakfast and just before bedtime (ensure you brush you little children's teeth at least twice a day e.g. after breakfast and before bed) 14 15 Simple week meal planner From 12 months of age Day With or before breakfast Child's usual milk Breakfast Mid morning Lunch Evening meal Before bed Child's usual milk MONDAY Porridge with milk, peaches & granola (ground into a fine crumb) Vegetable sticks & hummus Mini packed lunch* Meat, chicken or fish based ready prepared child's food Fruit pot Meat, chicken or fish based ready prepared child's food Yogurt Meat, chicken or fish based ready prepared child's food Oat based pudding Meat, chicken or fish based ready prepared child's food Fruit pot Meat, chicken or fish based ready prepared child's food Fruit pot Meat, chicken or fish based ready prepared child's food Oat based pudding Meat, chicken or fish based ready prepared child's food Custard TUESDAY Child's usual milk Toast with smooth peanut butter & banana Porridge with milk, peaches & ground almonds Toast with smooth almond butter & jam Grated cheese, cherry tomatoes & grapes Asparagus wrapped in ham Mini packed lunch* Child's usual milk WEDNESDAY Child's usual milk Mini packed lunch* Child's usual milk THURSDAY Child's usual milk Broccoli, olives & breadsticks Mini packed lunch* Child's usual milk FRIDAY Child's usual milk Porridge with milk & dates, prunes Baby sweetcorn, mange tout & avocado Baby sweetcorn, mange tout & avocado Vegetable sticks & mashed avocado Mini packed lunch* Child's usual milk SATURDAY Child's usual milk Toast with smooth peanut butter & marmite Porridge with milk, raspberry & ground almonds Mini packed lunch* Child's usual milk SUNDAY Child's usual milk Mini packed lunch* Child's usual milk NOTES: A. Children between the ages of 1 and 3 need to have around 350mg of calcium a day. About 300ml of milk will provide this. Non-dairy calcium enriched drinks may also be used. B. All round or slippery foods e.g. olives, cherry tomatoes, grapes, cucumber should be cut lengthways into thirds or quarters. Where possible they should also be peeled. C. Children should eat sitting down and be supervised at all times whilst eating D. Hard foods such as carrots should be lightly cooked E. *Mini packed lunch � see the recipes for lunch boxes below � these can be adapted for the age of your child and what textures of food they can eat e.g. fork mashed F. If your child needs to gain weight add: 1 � 2 teaspoons of Marvelous nut dust or smooth peanut butter to each main meal 16 17 Shopping list For the recipes you can buy fresh, frozen or tinned fruit and vegetables. All of these ingredients are available in budget as well as other supermarkets. Fr ui t & Ve gg ies � Frozen pe as ixe d pe pp ers � Frozen /f re sh m rn � Frozen swee t co rrot s � Frozen /f re sh ca sh, ge m sq ua sh � Bu tter nu t sq ua swee t po tato � Swee t po tato, ble Ka le, ca bb age, � Al l gree n ve ge ta urge tte, gree n Br us se l Spro uts, co ga r sn ap pe as, be ans, cucum be r, su li, runner be ans m ange to ut, broc co pa rs ni ps � Swede, tu rn ip s, s , pi ne apple , ch er rie � Banana, m ango es ache s, ne ctar in (withou t stones), pe � Av oc ado spbe rr ies � Frozen /f re sh ra ue be rr ies � Frozen /f re sh bl ango � Frozen /f re sh m in ju ice � Ti nned pe ache s ju ice � Ti nned pr unes in ric ot s � Re ad y to eat ap � Su lta na s Nut bu tters (n o adde d suga r va rie tie s) � Smoo th pe an ut bu tter � Smoo th ca sh ew bu tter � Smoo th almon d bu tter Pu ls es & grai ns � Ch ic kp ea, be an or gram flo ur � Ti nned ch ic kp ea s � Le nt ils � gree n an d re d � Grou nd almon ds � Q ui no a Oi ls � Co co nu t crea m � Ol ive oi l Fi sh & meat � Whi te or oi ly fish � Lam b � Be ef � Ch ic ke n He rb s & sp ice s in t � Frozen /f re sh m ri an de r � Frozen /f re sh co nger � Frozen /f re sh gi ic � Grou nd tu rmer namon � Grou nd cin 18 19 Recipes � Breakfasts � Power energy balls � Warming soups � Bento boxes � Family favourites � Sweet things 20 21 Marvelous nut dust This Marvelous nut mix is bursting with goodness � nutritious nuts are rich in protein, fats, energy and micronutrients. For those who are trying to make the most out of every mouthful use the Marvelous nut dust on cereal in the morning, an added crunch to a pitta pocket or sprinkled on pasta and rice dishes to provide an unexpected flavour burst. The Marvelous nut dust can be spiced up with some dried chili flakes. Granola Ingredients � � � � � 100g Pistachios 100g Almonds 100g Pecan nuts 100g Walnuts 100g Brazil nuts Other kinds of nuts that can be included: � � � � Macadamia Hazelnuts Chestnuts Peanuts Ingredients � � � � � � 300g oats 200g chopped nuts (almonds, pistachio, hazelnuts) 50g dried apricots 45g (3 tablespoons) golden syrup 2 tablespoons of olive oil � teaspoon vanilla extract Method 1. Where possible buy ground nuts e.g. ground almonds 2. For whole nuts, use a hand held blender or mini food processor to blitz the nuts into a fine dust. For larger nuts such as Brazils cut into pieces before blitzing 3. Store in an airtight container Method 1. Heat the oven to 200oC / 180oC fan / gas mark 6 2. Add all of the ingredients to a mixing bowl and stir until everything is covered in golden syrup/oil � it may be easier to mix using your hands 3. Spread the mixture in a thin layer on a baking sheet (use greaseproof paper) 4. Bake for 10 minutes until lightly toasted 5. Cool before storing then crumble into small pieces 6. Store in an airtight container for up to 2 weeks Nutrition content per 100g 655 kcal / 14.5g protein Serving suggestion 1 tablespoon = 15g � 100kcal / 2.3 protein Serving suggestion Important to note: � For children under the age of 5, nut dust should be ground into a fine crumb with no hard lumps or chunks of nuts which may be a choking hazards � As there is a choking risk with crumbs, it is also important the nut dust is mixed well into food and not offered only as dust � The nut dust should be kept in a sealed container out of the reach of young children � If your child has a nut allergy do not use the Marvelous nut dust in food. If there is a history of nut allergies in the family and you are unsure if your child can tolerate nuts, please discuss nut introduction with your Health Care Professional. Add 2 � 3 tbsp to your usual cereal and milk Important to note: � For children under the age of 5, Granola is not suitable and should be ground into a fine crumb with no hard lumps or chunks which may be a choking hazards � As there is a choking risk with fine crumbs, it is also important the granola crumb is mixed well into food. � The granola should be kept in a sealed container out of the reach of young children. 22 23 Breakfast porridge Ingredients � 50g rolled oats � 300ml full cream milk or your child's usual milk � Pinch of salt Prunes, dates & ground almonds Ingredients � 150g tinned prunes in juice � 30g ready to eat apricots � 20g (2 tablespoons) ground almonds Method 1. Place the tinned prunes and ready to eat apricots (approximately 8) with the prune juice in a pan and simmer on a low heat for 5 minutes or until the fruit is soft 2. Add in 20g or 2 tablespoons of ground almonds 3. Using a stick blender, puree ingredients until smooth 4. Portion into ice cube trays Method 1. Add the oats and full cream milk to a pan 2. Place on a medium heat 3. As the mixture starts to bubble, stir well 4. Once it is thick, take off the heat and serve in a bowl 5. Add your favourite topping (from the following pages) and eat whilst warm Serving suggestion 2 � 3 cubes added to your porridge Important to note: � Instant porridge can be used following manufacturer's instructions, rather than making your own � If you don't like hot porridges you can add one more of the toppings below to your usual cereal with milk, to which you can add a dollop of yogurt 24 25 Peaches, sultanas & ground almonds Ingredients � 150g tinned peaches in juice � 30g sultanas � 40g (4 tablespoons) ground almonds Mango & almond butter Ingredients � 200g fresh mango � 30g (6 level teaspoons) almond butter Method 1. Peel and chop the fresh mango into chunks 2. Place in a bowl along with 30g smooth almond butter (6 level teaspoons) 3. Using a stick blender, puree until smooth 4. Portion into ice cube trays Method 1. Place the tinned peaches, juice and sultanas in a pan and simmer on a low heat for 5 minutes 2. Add in 40g or 4 tablespoons of ground almonds 3. Using a stick blender, puree until smooth 4. Portion into ice cube trays Serving suggestion (both) Serving suggestion 2 � 3 cubes added to your porridge 2 � 3 cubes added to your porridge Raspberry, banana & almonds Ingredients � 200g fresh or frozen raspberries � 200g banana � 50g ground almonds Method 1. Peel and chop the banana into chunks 2. Put the raspberries into a bowl along with the banana and ground almonds 3. Using a stick blender, puree until smooth 4. If the puree is a little thick add a splash of almond milk/whole milk 5. Portion into ice cube trays 26 27 POWER ENERGY BALLS Date & apricot power balls These are great for little mouths as between meal snacks or as part of a dessert with some fresh fruit. Dino soup Ingredients � � � � � � � WARMING SOUPS Method � � � � � 500ml water 150ml single cream 1 tablespoon of olive oil Salt and pepper Home made croutons e.g. soft bread cut into small cubes 1. Heat the oil in a large saucepan over a medium heat 2. Add in the finely chopped celery, onion and cook until soft 3. Add in the broccoli, courgettes, peas, basil, chicken stock and water 4. Bring to the boil and cook until the vegetables are tender (5 minutes) 5. Using a stick blender carefully blend until the soup is smooth 6. Add in the single cream and seasoning 7. Serve the soup in bowls or teacups, sprinkle with croutons � this makes a great between meal snack Ingredients � 250g walnuts or ground almonds, or other nut/seed of choice � 250g shredded unsweetened coconut � 320g soft Medjool dates, pitted � 2 tablespoons sunflower oil � � teaspoon sea salt � 1 teaspoon vanilla extract 400g broccoli 400g frozen peas 400g courgettes 2 sticks of celery 2 onions finely chopped Small packet of basil 500ml chicken stock Important to note: � For children between the ages of 1 � 3 years of age, offer small cubes of soft bread dipped in the soup instead of ready to eat croutons which are too are too hard for young children and may pose a choking risk. Method 1. Roughly chop the dates 2. Keep � of the coconut to one side in a bowl for rolling the balls in, to coat them in coconut 3. Put all of the ingredients into a bowl. Using a hand held whisk or food processor blitz until it is a smooth paste 4. Take a teaspoon or tablespoon of mixture (depending on the size of ball you want) and roll into a ball 5. Roll the ball in the coconut 6. Place on parchment or greaseproof paper 7. When finished rolling the balls, put them in a greaseproof paper lined container and put them in the freezer 8. Pop a few in a snack box or as a dessert � can be eaten frozen! 28 29 Super hero orange soup Ingredients � � � � � � � � 800g butternut squash 400g sweet potatoes 2 sticks of celery 2 onions finely chopped Small packet of coriander 500ml chicken stock 500ml water 50ml orange juice � 150ml coconut cream � 2 tablespoons nut butter � Small pinch of chili (optional) � 1 tablespoon of olive oil � Salt and pepper � Home made croutons e.g. soft bread cut into small cubes WARMING SOUPS Bento boxes Method 1. Heat the oil in a large saucepan over a medium heat 2. Add in the finely chopped celery, onion and cook until soft 3. Add in the butternut squash, basil, chicken stock, orange juice, coconut cream, chili (optional), seasoning and water 4. Bring to the boil and cook until the vegetables are tender (25 � 30 minutes) 5. Using a stick blender carefully blend until the soup is smooth 6. Serve the soup in bowls or teacups, sprinkle with home-made croutons � this makes a great in between meal snack Important to note: � Use home made croutons using small cubes of soft bread. Ready to eat croutons are too hard for young children and may pose a choking risk. 30 31 BENTO BOXES Fusilli, ham, peas & cheese Ingredients � � � � � � Photo 1 Ham & cheese pitta & fresh fruit Ingredients � Small toasted wholemeal pitta, cut into strips � Handful of grated cheese � Slice of ham � Olives � Red pepper � Passion fruit, figs, grapes (or other seasonal fruit) BENTO BOXES � Edamame or green beans 50g fusilli � Pomegranate seeds 1�2 slices of ham � Grapes 25g frozen peas � Pear 30g grated cheese Carrots ribbons 1 teaspoon Marvelous nut dust Method 1. Cook some fusilli in boiling water until al dente (has a bite to it), add the peas and cook for a further 1 � 2 minutes 2. Whilst the pasta is cooking shred the ham and grate the cheese 3. To the hot drained pasta add the ham, Marvelous nut dust and grated cheese mixing well 4. Using a vegetable peeler make some carrot ribbons 5. Take 10 � 15 edamame beans and thread onto a food pick or plastic skewer 6. Cut the fruit lengthways, add a few pomegranate seeds 7. Put into the bento box Photo 3 Photo 2 Method 1. Arrange the pitta strips in the Bento box with the ham and grated cheese 2. Put the olives, cut length ways in half or quarters with the lightly steamed red pepper pieces 3. Arrange the fresh fruit in the other side of the Bento box, peel and cut grapes length ways in half or quarters 4. Use a child size soft teaspoon to scoop the inside of a fig or passion fruit (Photo 3) Photo 4 Important to note: � All vegetable and fruit should be washed before eating � Lightly steam hard vegetables � All vegetables and fruit should be cut length ways into small pieces, and some will need to be peeled � Recipes can be change to inclu
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