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Reintroduction of lightly cooked egg - patient information

Description: This factsheet will explain how to safely reintroduce lightly cooked egg back into your child's diet at home.
Url: /Media/UHS-website-2019/Patientinformation/Childhealth/Reintroduction-of-lightly-cooked-egg-2426-PIL.pdf

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

Description: RECIPE BOOK For babies who need to get the most out of every mouthful Contents 04 06 11 14 15 16 18 20 22 Acknowledgements & introduction Getting started... and useful tips Weaning advice (chart) Simple feeding plan for the first month (chart) Simple week meal planner (chart) Some general advice Shopping list Recipes: Contents Recipes: Veggies � Sweet potato & cashew butter � Peas, potatoes & mint � Butternut squash, peanut butter & cinnamon � Peas & carrots Recipes: Fruit � Prunes, apricots & ground almonds � Peaches, sultanas & baby rice � Mango & almond butter � Raspberry, banana & almonds Recipes: Colours of the rainbow � PURPLE: Plum, aubergine & blueberry � RED: Beetroot, apple, red pepper & cashew butter � ORANGE: Sweet potato, butternut, carrot & cinnamon � YELLOW: Mango, yellow courgette, sweet corn & turmeric � GREEN: Pea, kale, pear & avocado � WHITE: Apple, cauliflower & celeriac Recipes: Growing up � Pollock, carrots, kale, butternut squash & potato � Avocado, apple, lentil, broccoli, courgette & mint � Beef & prunes with mashed potato � Aromatic chicken & rice � Mauritian lamb with lentils & rice Recipes: Family favourites � Fish fingers & sweet potato chips � Bobotie � Pasta bolognaise � 1st Birthday cake 24 26 32 36 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 a (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. The following people have provided generous help and feedback: � Parents of babies who need to make the most of every mouthful � thank you for your time and feedback, without which this book not be possible � Paediatric Dietitians � Catherine Kidd, Natalie Davies, Sian Phillips, Carol Fudge, Jennifer Hoare � for your expertise and invaluable comments � Paediatric Speech and Language Therapists � Lowri Daniel, Julia Robinson, Lucy Cuthbertson � for your guidance and practical instruction � Dr Rosan Meyer � for being so giving of her expertise and generously allowing us to adapt her weaning advice table � Specialist Paediatric Cardiac Liaison Nurses � Gill Harte, Colette Cochran, Cate Anson and Dr Tara Bharucha Consultant Paediatric Cardiologist � for your unfailing support and advice � Southampton Children's Hospital Charity and the publishers � Michelle Wheeler, Judith Stephens, Amy McBrayne, Alanna Lee for making it all possible � Angela Award Brown � for giving her time and photography for this book (http://www.feastsshootsandleaves.co.uk) and WhitSpaces, Arlseford for allowing us to use their incredible space � Heather Pierpoint (headfudgedesign.co.uk) � Graphic designer for bringing the publication to life Dedication For all the families and their precious babies who we are privileged to meet � your stories and journeys inspire us to do better. RECIPE BOOK For babies who need to get the most out of every mouthful From around 6 months � 12 months of age Who is this book intended for? Some babies are born with conditions which mean they need to get the most out of everything they drink and eat. These babies include those with congenital heart disease (CHD), cystic fibrosis (CF) and some babies who are born too early. For lots of different reasons weight gain and feeding problems are common amongst these babies and as a result some do not gain weight well. We have heard from parents that much of the advice available on parenting and baby websites does not give enough information to help with weight gain and moving babies onto food, which is why we have decided to write this book. This recipe book is the first of a series where we hope to provide practical advice as to how to get the most of our every mouthful. The recipes and advice within this booklet will not be suitable for infants with inherited metabolic disorders, kidney problems and for those with food allergies. If your baby has a food allergy or there is a history of food allergies in the family discuss food introduction with your paediatric dietitian. If you are unsure, please check with your dietitian/speech and language therapist or health care team about any of the information contained in this book. This book is not meant to replace medical advice and you should seek advice from your local health care professional if your baby is not gaining weight well or is having feeding difficulties. The information in this recipe book does not replace individualised dietetic or speech and language advice that has been adjusted for a child's oral motor skills. The information is correct at the time of publishing, and undergoes periodic reviews to ensure up-to-date evidence is used. Dr Luise Marino (RD, PhD) Clinical Academic Paediatric Dietitian HEE/NIHR ICA Clinical Lectureship Endorsement "As a new mum who is just about to start her baby's first weaning process it's so important that parents and carers get access to good dietary information, particularly if your child needs to get the most of every mouthful. This book has been created not only to support families through this process but with every penny raised going directly to the children's hospital to fundraise for valuable services to improve the life of children across the region" � Shelina Permalloo � Southampton children's hospital charity ambassador and winner of MasterChef winner 2012, restaurateur Lakaz Maman, Bedford Place, Southampton thank you 05 Getting started... What to expect in the beginning... Weaning your baby can be both an exciting and daunting process. Starting solids is a huge event for your little one. Up until now, they have only had the tastes of milk and medicine. But all of sudden there's a whole new world of tastes and textures to explore. Babies are not born knowing how to eat so don't be surprised if your little one isn't quite sure what to do, or if food is spat back out to begin with. As with drinking milk some babies find weaning easier than others, so try not to compare your little one to other babies or indeed other siblings. They will still be getting most of the nutrients they need from milk, so how much your baby eats is less important than getting them used to the idea of trying new flavours and textures. Ages and stages All babies are different � some babies take longer to move from the different texture stages, this is quite normal. Below is a general guide based on baby foods available in the supermarket. It also gives an idea of what home made foods should look like. � Stage 1: Smooth purees are best made with a blender and can be either - Thin puree runs easily off a spoon - Standard puree drops easily off a spoon - Thick puree can be eaten with a spoon � Stage 2: Thicker puree with tiny very soft lumps � Stage 3: Mashed foods usually blended - Thick puree with less sauce and small moist soft lumps around � the size of a 5p piece � Stage 4: Fork mashed and chopped are soft foods mashed down with a fork - Thick with small moist soft lumps around the size of a 5p � 10p piece Complementary food can be introduced from 17 weeks of age and by 6 months of age, depending on your little one's feeding readiness and oral skills To help you and your little one get started, here are some useful hints and tips for those first feeds � Always sit with your little one when they are eating � never leave them alone with food � Choose a time when both you and your little one are relaxed and there is not too much going on � usually mid-morning or lunchtime � After the first week or so you can introduce a new taste every few days to help expand the variety of foods they eat. Think of a rainbow and introduce a range of different coloured foods � Sit your baby in a supportive chair, or if able to sit, in their high chair. Use a small soft-flat weaning spoon and offer a very small amount When introducing something new... � Change only one thing at a time e.g. making a familiar flavoured pur�e slightly thicker or lumpier, or keep a familiar texture when you introduce a new food � Encourage your baby with smiles and sounds. It's important for them to know they're doing well � If possible have something to eat at the same time so they can see you are enjoying food too � Make gradual changes to texture sometimes just by adding a � a 5p piece amount of slightly lumpier food aid course which provides advice on what to do if your baby chokes on food � Remember all of the senses are involved in eating and drinking; smell, 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 you little one get messy - Smells of delicious food can encourage babies to eat 2 Offer your little one a variety of foods � think of a rainbow and all the different colours of food you could offer them to eat Before you start the exciting journey of introducing food It is important to consider whether your little one is ready � talk to your little one's health care team. As a general guide some signs of readiness are: � Your baby can hold their head up and has good head and neck control � Sits with support � You'll find your baby's mouth closes around the spoon and food stays in their mouth � You'll find your baby watches you eat and reaches for food � You'll find your baby leans forward and forward and opens their mouth when food approaches How do I know when my baby has had enough to eat? � Take your baby's lead to see when they've had enough � They'll start batting the spoon or bottle away, shut their mouth or turn their head away when they are finished � stop at this point � Your baby will also eat different amounts each day e.g. sometimes they may eat five teaspoons at one meal and very little at the next � it's all normal. You may even find your little one only eats well once every couple of days � All foods can be a choking hazard, so always sit with your baby whilst they are eating � it is a good idea to go on a first Babies should get messy when they eat � Let them get some food around their mouths, try not to wipe their mouth, hands and face clean after every mouthful e.g. with the spoon or wet wipe � Don't worry if your little one makes a face or even spits food out. Remember it can take 15 � 20 times of trying something before your little one will like it � so don't give up if they pull a face when you given them broccoli! 06 07 What foods should I give at this stage? The best food to begin with is often something like baby rice � it is very smooth and usually contains lots of extra vitamins and minerals, helping to support your baby's growth. Begin feeding your little one with a very small amount � for example 1 teaspoon. Then slowly increase the amount up to 1�3 measured tablespoons over a number of days or weeks. You'll also find that pureed vegetables such as carrots, parsnips, swede and potatoes are great first foods, as are unsweetened pureed fruits like apples and pears. Other good foods to include are; � Well-cooked red meat, chicken and fish, finely pureed with rice or vegetables � Smoothly pureed lentils, dhal or beans served with vegetables or rice � Eggs, soya and milk are also good sources of nutrients � The latest advice on peanuts encourages you to give your baby nuts � ensure nuts are finely ground to avoid choking or try nutritious smooth nut butters instead. Ready-made infant meals can be enriched using the ideas below. For home-made purees, there are some recipes included in this weaning guide � feel free to `swap' ingredients to make new combinations. To make the puree the right consistency for your little one, use your baby's usual milk instead of water. � Following a meal offer a fruit or full cream yogurt based dessert or custard or rice pudding or mashed avocado � For older babies e.g. > 10 months a teaspoon of grated cheese/cream cheese can be added to mashed potato or meat dishes, instead of a nut butter We do not recommend the addition of extra oil or cream to food � if you have had a heavy rich meal it can make you feel sick, babies have the same feeling. Instead try to use a teaspoon of smooth nut butters, coconut cream or smooth plain cream cheese or a small pinch of grated cheese. 4 From 7�8 months of age � offer textures and finger foods as well as pureed food at mealtimes When should I start adding texture? Amazingly, your baby doesn't need teeth to chew! Once your little one has become used to smooth textures and mild tastes, now is the time to gradually move them on to finely mashed foods. It'll encourage chewing which is important for developing muscles, and, believe it or not, speech. To begin with, if you are using pouches or a jar, take � � 1 teaspoon of stage 2 food and add it to the stage 1 food, mixing well. You may find your little one doesn't notice or gags a little bit, this is normal. Once they have got used to this texture add 2 � 3 teaspoons in until you have completely moved over. If you are using home made food, before it is a very fine puree take � � 1 teaspoon of a slightly coarser texture out and follow the same process. teach your baby simple tastes, e.g. green and orange vegetables and offer finger foods of these vegetables at the same time so they can learn what family foods look and feel like � Move onto textures that suit their age and stage. If your little one has had reflux or a nasogastric tube they may find it difficult to move onto food which has lumps and they may stay on one stage a little longer � don't worry too much if at 10 months of age they are still on smooth purees, your therapist will be able to provide advice � Change over to more textured food slowly making small changes every 2 � 3 days � Offer a mix of puree and finger foods at the same meal, so your little one can pick up items and self-feed. It may take a while for them to get the hang of it � All babies develop differently and they may only want to feed themselves when they are much older. So don't worry if they are not interested yet � Let your little one play with their food and get messy! It all helps them learn to accept lots of different foods � Babies and toddlers learn from watching you eat. So if they see you enjoying fruit and vegetables with your meal, they'll learn to love them too � Ideally your baby will sit in a high chair at the table and eat at the same time as the rest of the family Finger food for little fingers from around 7 months of age At first most of the food that is offered will go on the floor, but don't worry! Remember, we eat with all of our senses, so let them enjoy this journey of discovery. The easiest type of finger foods are those that dissolve � these make good first finger foods: � Puffs, baby biscuits The following finger foods are quick to prepare, packed with goodness and let your little one practice their picking up skills � the aim for these is to get your little one used to seeing what family foods look like � so don't worry if they are not eaten: � Soft-cooked vegetable batons like carrots, swede, sweet potato broccoli, avocado � Strips of meat are not usually offered until 10 months � Peeled soft fruit batons/thin slices such as melon sticks, banana, pear, peach slices � Baby biscuits like rusks that dissolve without crumbling How can I make meals energy-nutrient dense? As babies have small tummies (about the size of their fist) it is tricky to fit a lot in without either making them feel or be sick. You can use the nutrient dense recipes provided in this book or add the following examples to your little one's meals; Breakfast: � Add � � 1 teaspoon of smooth nut butter (almond, cashew, peanut) to warm baby porridge or � Add 1 tablespoon smooth fruit puree � To make the puree to the right consistency for your little one use your baby's usual milk instead of water Lunch and supper: � Offer protein at both main meals such as meat, fish, chicken or beans/lentils with a starch (rice/potatoes/pasta) and vegetables � add � � 1 teaspoon of a smooth nut butter � As you baby gets older e.g. over 9 months of age and their portion size increases, increase the amount of nut butter to 1 � 2 teaspoon per meal 3 How long will my baby need energy-nutrient dense feeds for? Your little one's dietitian or health care team will be able to provide advice Should I use shop bought or home-made food? Most families like to mix and match between puree meals they have made at home and ready to use infant food. Shop bought baby food is made to very high standards, so for busy families it is often a good alternative to home-made meals. What about finger foods? � Below are some tips on how to use a `mix and match' approach to weaning � at mealtimes � Offer individual tastes of puree foods to 08 09 Weaning advice: For babies needing to make the most of each meal Once your little one reaches 7 or 8 months, they may have a firmer grip � sometimes this develops a little later in babies who have had a number of operations. At this stage they may be able to use a finger and thumb to pick up smaller foods which helps them keep hold of foods like broccoli and develop their hand-to-eye co-ordination. Getting to grips with food is a great way for your baby to learn about exciting new tastes and textures. As all little ones learn new things at a different pace some will take a bit longer to learn to hold smaller bits of food. It is good to carry on offering pieces of food that are long enough to grip with the palm of the hand so they can bring it up to their mouth. HELP! � my baby is gagging during a meal It is normal for babies to gag when food is being introduced. The most important thing to remember is this is all new to your baby � some babies take longer than others to get the hang of it. 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 � we are here to help. Talk to you little one's health care team and speech and language therapist about how you and your baby can be supported. Food and feeding advice Stage 1: Around 6 months Introduce dairy, eggs, ground nuts meat, chicken, fish, wheat and soy Stage 2: Around 8 �10 months Encourage finger foods Stage 3 & 4: Around 10 months Encourage family foods and self feeding � Continue on breast milk or nutrient energy dense feed (16�18oz) � Continue with vegetables and fruit � place 1 or 2 food pieces on the highchair table � Continue with yoghurt/cheese � Main meals should include protein e.g. chicken, fish, beans, lentils, meat along with veggies and start e.g. potato, rice, pasta � If you are using ready to use baby food, add 1 teaspoon of smooth nut butter to each meal including porridge at breakfast Type of food to offer If you are making food at home, try some of our recipes in this booklet. � Continue on breast milk, usual formula milk or a nutrient energy dense feed formula (20 �22oz per day) � Offer 1 new fruit, vegetable or starchy food per day � First, offer baby rice, baby cereal (these have extra vitamins and minerals), cooked fruits or vegetables � Move on to foods such as milk, egg, nuts, chicken, turkey, lamb, beef, fish, wheat and pulses � After a few weeks every meal can have a carbohydrate, veg/fruit and a protein portion � If you are using ready-made baby meals add ��1 teaspoons of smooth nut butter to each meal including porridge at breakfast � Start with 1�2 ice cube amounts of food per meal. � Offer 1 meal per day then over 1 � 2 weeks increase to 3 meals per day. � At this stage of weaning, new tastes are more important than the portion size � Know when your little one has had enough e.g. turning his/her head away, closing his/her mouth � From around 7 months give soft lumps and finger foods put out on highchair table at same time as other food � Mealtimes should last for up to 15 minutes � When your baby can sit, introduce a high chair and make sure they are well supported in the highchair � Provide a spoon to play with and encourage playing with food � getting as messy as possible! � Continue on breast milk or nutrient energy dense feed formula (18�20oz) � Main meals should include protein e.g. chicken, fish, beans, lentils, meat along with veggies and start e.g. potato, rice, pasta � If you are using readymade baby meals add 1 � 2 teaspoons of smooth nut butter to each meal including porridge at breakfast � Try some of our recipe ideas from page 20 Portions � Soft lumpy meals (bigger lumps) � Know when your little one has had enough e.g. turning his/ her head away, closing his/ her mouth � Mealtimes should last for up to 15 minutes � Small pieces and bigger lumps � Promote finger foods � Know when your little one has had enough e.g. turning his/ her head away, closing his/her mouth � Mealtimes should last for up to 20 minutes Mealtimes � Should sit in a high chair � Provide a spoon to play with � Let your little one touch or play with food � Should sit in a high chair � Let your little one touch or play with food � Encourage self feeding * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) 10 11 Weaning advice: For babies needing to make the most of each meal Stages 1 Weaning advice: For babies needing to make the most of each meal Texture � Your little one's therapist may suggest a particular thickness of pur�e � Smooth pur�e can be either: - Thin pur�e runs easily off a spoon - Standard pur�e drops easily off a spoon - Thick pur�e can be eaten with a spoon � The thickness of a pur�e is changed by heat e.g. as food cools it can become thicker � Other foods such as cereals may need extra liquid or extra time for the milk to soak in � At this stage the lumps should be small and soft � When you are moving onto this texture there should only be a small amount of lumps � Blend the food stopping just before it is a smooth pur�e � take out a teaspoon of very well mashed food and put to one side� carry on blending then add the coarser texture back in � If your little one still finds this texture difficult � try half a teaspoon next time � Gradually increase the texture every 2 � 3 days unless your therapist advises otherwise � Fork mash needs some preparation in the mouth before swallowing � Avoid offering foods that have a mix of textures e.g. lumps floating in liquid such as cereal in milk What does it look like � Foods in this stage are very smooth and have no lumps � This is usually the first stage of foods that are tried � These foods need to blended or sieved for a very smooth texture Feeding skills � Smooth pur�es can be swallowed easily � No chewing is needed � Pur�e can be managed by sucking and swallowing � A standard pur�e that drops easily off a spoon is the easiest for little ones starting out to eat Stages Finger foods What does it look like � From around 7 months start to offer finger foods put a variety of different foods out on highchair table at same time as other puree foods � To begin with most food will end up on the floor � To begin with, 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. carrot puffs � 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, such as well cooked carrots sticks, banana, avocado, soft pear, soft flaky fish, toast finger, pasta shells � 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 Feeding skills � Always try the food yourself to check it dissolves easily before giving it to your little one � Foods that dissolve should initially be placed at the side of the mouth where their back teeth will come to encourage tongue movement � With practice your little one may be able to bite pieces off (bite-anddissolve) Texture � Always sit with your little one when they are eating any food � If able offer bite and dissolve foods e.g. vegetable flavoured puffs between meals � Move on to soft cooked vegetables, small pasta shells and soft fruit. � It is sometimes useful to offer these foods as in between meals snacks, so you are your little one can enjoy them exploring new foods and textures together 2 � When your little one is ready to move onto stage 2 foods, start by offering a thicker smooth stage 1 pur�e � Foods in this stage are still blended but to a coarse pur�e with a thick sauce � There will also be small moist, soft lumps and � the size of a 5p piece � In this stage flavour combinations are more complex and have a slightly stronger taste, e.g. cottage pie � In this stage your little one will be developing their feeding skills further learning to use their lips and tongues more for eating � Some little ones take a while to adapt to a change in texture � this is normal as not every baby develops at the same pace � Try to make very small changes of one thing at a time � Some foods may still need to be smooth pur�e and others mashed e.g. vegetables can be a thick mash, but meat may still need to be a smooth pur�e � Lumps should be moist and soft � Lumps should not be bigger than a 5p piece and they should be soft Choking hazards 3 � Foods in this stage can be well fork mashed and have less sauce � Babies often enjoy quite stronger tastes e.g. mild lamb curry and new combinations e.g. sweet and savoury chicken � Foods are forked mashed with some bite size pieces that older babies can pick up as finger foods � 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; � All finger foods should be cut in short thin sticks 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 and remove any pith - Chunks of fish flaked should be checked for bones 4 � Foods at this stage can have tender pieces: soft cooked pieces e.g. 10p piece size in thick sauce � Sometimes when little ones are not well, they go back a couple of stages in terms of textures and feeding � this is normal so try not worry * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) 12 13 Simple feeding plan for the first month: From around 6 months of age Stages NOTE: Simple week meal planner: From around 6 months of age Day MONDAY How much and when? All babies are different � some babies eat more than others at meal times, this is quite normal Examples � Purees should be very smooth Waking Baby's usual milk Breakfast Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Baby cereal with milk & � teaspoon smooth nut butter Mid morning Baby's usual milk Lunch Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Purple meal* Or Baby's usual milk Evening meal Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Fruit pot Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Yogurt Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Oat based pudding Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Fruit pot Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Yogurt Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Oat based pudding Meat, chicken or fish based ready prepared baby food & � � 1 teaspoon smooth nut butter Custard Evening milk Baby's usual milk TUESDAY WEEK 1 � Usual milk feeds plus small but increasing amounts of solids � Days 1 & 2 � In the middle of or after one milk feed, offer 1 small teaspoonful of solids � Days 3 & 4 � In the middle of or after one milk feed, offer 1 � 2 teaspoons of solids � Days 5 & 6 � After one milk feed, offer 2 � 4 teaspoons of solids � Day 7 � After one feed offer 2 � 5 teaspoons of solids � Usual milk feeds plus solids at one or two feeds a day � Breakfast � baby's usual milk plus 2 � 5 teaspoons of solids � Lunch or evening meal � baby's usual milk plus 2 � 5 teaspoons of solids � Usual milk feeds plus solids at two feeds a day � Breakfast � baby's usual milk plus 2 � 3 tablespoons of solids � Lunch or evening meal � baby's usual milk 2 � 3 tablespoons of solids � � � � Usual milk feeds plus solids at two or three feeds a day Breakfast � baby's usual milk plus 2 � 3 tablespoons of solids Lunch � baby's usual milk 2 � 3 tablespoons of solids Evening meal � baby's usual milk plus 2 � 3 tablespoons of solids � Baby first rice cereal � Baby first rice cereal with puree apple � Baby first rice cereal with puree carrots WEDNESDAY Baby's usual milk Baby's usual milk Baby's usual milk Baby's usual milk Baby's usual milk Baby's usual milk WEEK 2 � Baby first rice cereal with � teaspoon of smooth nut butter � Sweet potato & almond butter or peas, potato and mint THURSDAY Baby's usual milk Baby's usual milk Baby's usual milk FRIDAY WEEK 3 � Baby first rice cereal with � teaspoon of smooth nut butter � Peas and Carrots or Prunes, apricots and ground almonds as a butter � Baby first rice cereal with � teaspoon of smooth nut butter � Peas and Carrots or Prunes, apricots and ground almonds � Butternut and smooth peanut butter or peaches, sultanas and baby rice Baby's usual milk Baby's usual milk Baby's usual milk SATURDAY WEEK 4 Baby's usual milk Baby's usual milk Baby's usual milk SUNDAY Baby's usual milk Baby's usual milk Baby's usual milk * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) NOTES: 1. As your little one gets bigger rainbow meals can be used as side dishes. * for rainbow meals see recipes on page 28 2. Rainbow, growing up or ready prepared baby meals can be offered at lunch and evening meal * Suggested feeding times: 8-9 am, 11-1 pm, 4-5pm with milk in between (this is just a guideline) 14 15 Some general advice Recipes, foods to avoid, textures, safety and hygiene, storing, reheating, do's and don'ts Recipes The recipes below make 100g portions � Colours of the rainbow, fruit & veggies recipes make 100g portions of food, to begin with your little one may only manage 2 � 5 teaspoons at a meal, but as they get bigger they may eat 100g portions � Growing up recipes are between 200 � 260g servings and can be used for lunch and supper or as a single meal as your little one gets bigger � All of the recipes can be: - made in bigger batches, just scale up the amounts accordingly Textures All of the recipes can be adapted to the texture that suits your baby such as: � Stage 1 � 2 : Smooth purees are best made with a blender and can be either - Thin puree runs easily off a spoon - Standard puree drops easily off a spoon - Thick puree can be eaten with a spoon � Stage 3: Mashed foods usually blended - Thick puree with less sauce and small moist soft lumps around � the size of a 5p piece � Stage 4: Fork mashed are soft foods mashed down with a fork - Thick with small moist soft lumps around the size of a 5p � 10p piece Cool food as quickly as possible (ideally within 1 � 2 hours) and put it in the fridge or freezer. Food in the fridge should be eaten within 1 � 2 days. Frozen food should be thoroughly defrosted before reheating. The safest way to do this is to put frozen food in the fridge overnight or using the defrost setting on the microwave. Reheat food so it is really hot, but remember to let it cool down before you offer it to your baby. To cool food quickly, put it in an airtight container and hold it under a running cold tap, stopping to stir the contents from time to time, so it is cool all of the way through. DO'S Always wash your hands before preparing foods. Wash your baby's hands before feeding Wash all bowls, spoons and other utensils in hot soapy water or put on a hot wash in the dishwasher. Keep chopping boards and other utensils clean DON'TS Don't save and reuse food that your child has half eaten Avoid raw eggs � this includes uncooked cake mixture, homemade ice creams, mayonnaise or desserts that contain uncooked raw eggs. Always cook eggs until the yolks and whites are firm Avoid any shark, swordfish or marlin � this is because the levels of mercury in these fish can affect your baby's growing nervous system. You should also avoid giving raw shellfish to babies to reduce their risk of getting food poisoning Foods to avoid: � Salt � unless advised by your health care professional salt should not be added to your little one's food � Sugar � your little one doesn't need sugar added to any food � Honey � very occasionally honey contains a bacteria that produces toxins in your little one's intestines causing a serious illness called infant botulism. It is best not to give honey until your little one is over 1 year of age Keep utensils, chopping boards and surfaces clean. Keep any pets away from food or surfaces where food is prepared When reheating food from frozen, make sure it is hot all of the way through. If you are using a microwave, ensure you always stir it and check the temperature before feeding it to your baby. Cook all food thoroughly and cool it to a lukewarm temperature before giving it to your baby Keep cooked and raw meats away from each other in the fridge. Always wash your hands after touching raw meant Wash and peel fruit and vegetables, such as apples and carrots Safety & hygiene As a baby's immune system is still developing, bacteria in food can cause food poisoning. If you follow a few simple guidelines this will help protect your baby from germs. Don't give children food or drink whilst sitting on the potty Don't reheat cooked food more than once, as this increases the risk of food poisoning 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 � Bu tter nu t sq ua to � Swee t po ta � Ka le � Co urge tte � Swede � Pa rs ni ps 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 � Ba by rice /c er ea l (s tage 1) � (n ot orga nic) � 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 � Po tato � Ba na na � 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 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 on � Grou nd cin nam 18 19 RECIPES Veggies � Sweet potato & cashew butter � Peas, potatoes & mint � Butternut squash, peanut butter & cinnamon � Peas & carrots Fruits � Prunes, apricots & ground almonds � Peaches, sultanas & baby rice � Mango & almond butter � Raspberry, banana & almonds Colours of the rainbow � Purple � Plum, aubergine & blueberry � Red � Beetroot, apple, red pepper & cashew butter � Orange � Sweet potato, butternut, carrot & cinnamon � Yellow � Mango, yellow courgette, sweet corn & turmeric � Green � Pea, kale, pear & avocado � White � Apple, cauliflower & celeriac Growing up � Pollock, carrots, kale, butternut squash & potato � Avocado, apple, lentil, broccoli, courgette & mint � Beef & prunes with mashed potato � Aromatic chicken & rice � Mauritian lamb with lentils & rice Family favourites � Fish fingers & sweet potato chips � Bobotie � Pasta bolognaise � 1st Birthday cake 20 21 VEGGIES: Sweet potato & cashew butter Ingredients � 90g sweet potato � 10g smooth cashew butter (or other smooth nut butter) Peas, potatoes & mint Ingredients � � � � 20g frozen garden peas 70g potato 10ml (2 teaspoons coconut cream) 2 � 3 mint leaves or 1 teaspoon frozen chopped mint Butternut squash, peanut butter & cinnamon Ingredients � 85g frozen or fresh butternut squash � 10g (2 level tablespoon) smooth peanut butter � 5ml (1 teaspoon) coconut cream � pinch of ground cinnamon Peas & carrots Ingredients � 30g frozen or fresh peas � 60g frozen or fresh carrots � 5g (1 teaspoon) smooth peanut butter Method � Peel the sweet potato and place in pan of unsalted cold water � Bring to the boil and cook until tender � Using a stick blender puree until smooth � Add in 20g or 2 tablespoons of smooth cashew butter � Using the stick blender to mix well � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the carrots in a pan of boiling hot water, bring to the boil and cook until tender � Drain the carrots and place in a bowl � Cook peas in hot water for 2 minutes, drain and mash the peas through a sieve to get rid of the skins � Add the peas, carrots and smooth peanut butter together � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel the potatoes and place in pan of unsalted cold water � Bring to the boil and cook until tender � Drain the potatoes and leave to one side � Cook peas in hot water for 2 minutes, drain and mash the peas through a sieve to get rid of the skins � Add the pea pulp to the potatoes and using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the chopped butternut and a pinch of cinnamon in a pan of boiling hot water, bring to the boil and take off the heat � Using a stick blender puree until smooth � Add in 10g of ground almonds or 1 level tablespoon of smooth peanut or other nut butter along with 1 teaspoon of coconut cream � Use the stick blender and mix well � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Nutrition content per 100g 164 kcal / 3.7g protein / 5.5g fat / 26.2g carbohydrate / 9% protein energy ratio Nutrition content per 100g 104 kcal / 3g protein / 3.8g fat / 15g carbohydrate / 11.5% protein energy ratio Nutrition content per 100g 105 kcal / 3.3g protein / 7g fat / 8g carbohydrate / 12.5% protein energy ratio Nutrition content per 100g 105 kcal / 3.3g protein / 7g fat / 8g carbohydrate / 12.5% protein energy ratio 22 23 FRUIT: Prunes, apricots & ground almonds Ingredients � 75g tinned prunes in juice � 15g ready to eat apricots � 10g ground almonds Peaches, sultanas & baby rice Ingredients � 75g tinned peaches in juice � 15g sultanas � 20g baby rice Mango & almond butter Ingredients � 85g fresh mango � 15g (3 levels teaspoons) almond butter Raspberry, banana & almonds Ingredients � 40g fresh or frozen raspberries � 45g banana � 15g ground almonds Method � Place the tinned prunes and ready to eat apricots (approximately 4) with the prune juice in a pan and simmer on a low heat for 5 minutes or until the fruit it soft � Add in 10g or 1 tablespoon of ground almonds � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the tinned peaches and sultanas with the juice in a pan and simmer on a low heat for 5 minutes � Add in 20g or 4 tablespoons of baby rice � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the fresh mango into chunks � Place in a bowl along with 15g smooth almond butter (3 level teaspoons) � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place the raspberries in a pan, adding 20 ml of water � bring to a boil and then simmer for 2 � 3 minutes until cooked � Pour the raspberries into a bowl along with the banana and ground almonds � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays 1 � 2 cubes can be added to your little one's usual breakfast cereal Nutrition content per 100g 132 kcal / 3g protein / 6g fat / 13g carbohydrate / 9% protein energy ratio Nutrition content per 100g 190 kcal / 4.1g protein / 1.5g fat / 42.6g carbohydrate / 8.6% protein energy ratio Nutrition content per 100g 120 kcal / 3.4g protein / 7g fat / 10g carbohydrate / 11% protein energy ratio Nutrition content per 100g 146 kcal / 4.2g protein / 8g fat / 13g carbohydrate / 11.5% protein energy ratio 24 25 COLOURS OF THE RAINBOW COLOURS OF THE RAINBOW: PURPLE RED ORANGE Plum, aubergine & blueberry Ingredients � � � � 40g plums canned in syrup 30g aubergine pulp (without the skin) 10g blueberries 20g chickpea flour or baby cereal Beetroot, apple, red pepper & cashew butter Ingredients � � � � � 30g beetroot 30g apple 25g red bell pepper 15g (3 teaspoons) cashew butter 20ml water Sweet potato, butternut, carrot & cinnamon Ingredients � � � � � � 30g sweet potato 30g butternut squash 25g carrots 15g (3 teaspoons) peanut butter pinch of cinnamon water Method � Peel and chop the aubergine into chunks, sprinkle with salt and leave for 10 minutes, before washing thoroughly under cold running water � Place aubergine chunks, plums and syrup, blueberries and chickpea flour in a pan � Simmer on a low heat until the aubergine is soft � add your little one's usual infant formula or breast milk as required � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the beetroot into chunks � Dice the red pepper and peeled apple � Place all the beetroot, apple and red bell pepper into a pan, add in 50ml of water � Simmer on a low heat until the mixture is soft, drain off any excess water � Add in the cashew butter � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Place all the sweet potato, butternut, carrot and a pinch of cinnamon into a pan cover with cold water and bring to the boil � Simmer on a low heat until the mixture is soft, drain off the excess water � Add in the peanut butter � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Nutrition content per 100g 94 kcal / 4.4g protein / 1.2g fat / 17.5g carbohydrate / 18.7% protein energy ratio Nutrition content per 100g 128 kcal / 4.3g protein / 9g fat / 9g carbohydrate / 13% protein energy ratio Nutrition content per 100g 143 kcal / 4.3g protein / 9g fat / 13g carbohydrate / 12% protein energy ratio 28 COLOURS OF THE RAINBOW: YELLOW GREEN WHITE Mango, yellow courgette, sweet corn & turmeric Ingredients � � � � � � 30g mango 25g yellow courgette (or green with no skin) 35g sweet corn 10g chickpea flour or baby cereal pinch of turmeric water � 50ml Pea, kale, pear & avocado Ingredients � � � � � 30g frozen garden peas 20g pear 20g kale 30g avocado water � 50ml Apple, cauliflower & celeriac Ingredients � � � � � � 25g apple 20g cauliflower 20g celeriac 20g chickpeas 5ml olive oil water � 50ml Method � Peel and chop the pear � Chop the kale into ribbons � Add the kale and pear into a pan with 50ml water � Simmer on a low heat until the mixture is soft, add in the peas and cook for a further 2 � 3 minutes � Take off the heat and add in the mashed avocado � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the apple and celeriac � Break the cauliflower into florets � Add all of the ingredients, including the olive oil into a pan with 50ml water � Simmer on a low heat until the mixture is soft � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Method � Peel and chop the mango � Chop the yellow courgette or peeled green courgette if yellow are not available � Add all of the vegetables, chickpea flour, pinch of turmeric and 50ml water into a pan � Simmer on a low heat until the mixture is soft, drain off the excess water � Using a stick blender puree until smooth � If the puree is a little thick add a small amount of your little one's usual infant formula or breast milk � Portion into ice cube trays Nutrition content per 100g 107 kcal / 3.8g protein / 1.8g fat / 18.9g carbohydrate / 19% protein energy ratio Nutrition content per 100g 93 kcal / 3g protein / 6.6g fat / 5.6g carbohydrate / 13% protein energy ratio Nutrition content per 100g 89 kcal / 2.4g protein / 6g fat / 7g carbohydrate / 10.7% protein energy ratio 30 GROWING UP: Pollock, carrots, kale, butternut squash & potato Ingredients � � � � � � 15g white fish* 30g carrots 60g kale 35g butternut squash 60g potato 1 teaspoon coriander Avocado, apple, lentil, broccoli, courgette & mint Ingredients � � � � � 50g avocado 30g apple 20g red lentils (cooked) 30g broccoli 25g courgette � 25g rice (makes 100g cooked rice) � 50ml water � lemon juice � few sprigs of mint Method � Chop the carrots, kale and fish � Add the carrots, butternut squash, potato, fish, olive oil and coriander into a pan � Simmer on a low heat until the mixture is soft, add in the kale and cook for a further 2 � 3 minutes � Before mashing the mixture take out a couple of pieces of carrot and fish to be used as finger foods during the meal � Using a stick blender or fork mash the rest until soft lumps remain � If the meal is a little thick add a small amount of your little one's usual infant formula or breast milk Method � Cook the rice and lentils in unsalted water until tender � Cut the courgette and broccoli into small pieces, steam over the cooking rice � In the meantime grate the apples and cube the avocado, sprinkle with a little lemon juice to stop the mixture going brown � Wash the mint leaves and finely chop � Keep some grains of rice, lentils, vegetable and fruit mixture to one side � Mash the rest of the rice and lentils with a fork, then add in the courgette, broccoli, grated apple and avocado until soft lumps remain � If the meal is a little thick add a small amount of your little one's usual infant formula or breast milk From around 7 months of age introduce finger foods, take a few pieces of carrot and fish from the mixture before you puree it. Offer as finger foods at the same time as serving the meal. This way your little one gets used to see what different food looks like. Nutrition content per 100g 135 kcal / 5.8g protein / 6.1g fat / 15g carbohydrate / 17% protein energy ratio Nutrition content per 100g 278 kcal / 6.8g protein / 11.4g fat / 40g carbohydrate / 9.7% protein energy ratio 32 *For fish always check for bones. 33 GROWING UP: Beef & prunes with mashed potato Ingredients � � � � � 20g mince beef 10g onions 80g butternut 35g carrots 20g prunes (2) � � � � � 100g potato 100ml water 5ml olive oil pinch of ginger pinch of turmeric Aromatic chicken & rice Ingredients � � � � � � 20g chicken breast 10g onion 30g mango 80g sweet potato 30g spinach 15g rice (60g when cooked) � � � � � � 100ml water 5ml olive oil 10ml coconut cream pinch of coriander pinch of ginger pinch of turmeric Mauritian lamb with lentils & rice Ingredients � � � � � 20g lamb mince 10g apricots (2) 10g green lentils 80g carrots 30g kale � 75g macaroni or small shaped pasta � 100ml water � 10ml coconut cream � pinch of cinnamon � pinch of turmeric Method � Braise the mince beef and onions in the oil, add in the pinch of turmeric and ginger and cook on a low heat until the onions are soft � Chop the butternut squash, carrots and prunes into small cubes, then add to the beef mixture with an additional 100ml of water cook on a low heat until all of the ingredients are soft and the liquid is reduced � In a separate
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Level 7 diet (easy to chew) - patient information

Description: We have given you this factsheet because a speech and language therapist (SLT) has advised that you should follow a level 7 diet (easy to chew).
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Procedure for USING THE SECA mBCA VALIDATION TEST KIT

Description: NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a tight quality assurance system for the writing, reviewing and updating of Standard Operating Procedures. As such, version-controlled and QA authorised Standard Operating Procedures are internal to the BRC. The Standard Operating Procedure from which information in this document has been extracted, is a version controlled document, managed within a Quality Management System. However, extracts that document the technical aspects can be made more widely available. Standard Operating Procedures are more than a set of detailed instructions; they also provide a necessary record of their origination, amendment and usage within the setting in which they are used. They are an important component of any Quality Assurance Framework, but in themselves are insufficient and need to be used and interpreted with care. Alongside the extracts from our Standard Operating Procedures, we have also made available here an example Standard Operating Procedure and a word version of a Standard Operating Procedure template. Using the example and the Standard Operating Procedure template, institutions can generate their own Standard Operating Procedures and customise them, in line with their own institutions. Simply offering a list of instructions to follow does not assure that the user is able to generate a value that is either accurate or precise so here in the BRC we require that Standard Operating Procedures are accompanied by face-to-face training. This is provided by someone with a qualification in the area or by someone with extensive experience in making the measurements. Training is followed by a short competency assessment and performance is monitored and maintained using annual refresher sessions. If you require any extra information, clarification or are interested in attending a training session, please contact Dr Kesta Durkin (k.l.durkin@soton.ac.uk). This document has been prepared from Version 1 of the BRC Standard Operating Procedure for using the Seca medical Body Composition Analyser validation test kit. It was approved in December 2014 and the next review date is set for December 2016. The version number only changes if any amendments are made when the document is reviewed. Page 1 of 8 NIHR Southampton Biomedical Research Centre NIHR Southampton Biomedical Research Centre Procedure for USING THE SECA mBCA VALIDATION TEST KIT BACKGROUND The Seca mBCA (medical Body Composition Analyser) analyses body composition using the Bioelectrical Impedance methodology. Bioelectrical Impedance is a method used to obtain impedance values generated by different components of the body in response to a small electric current. In order to be confident that the Seca mBCA machine is working correctly it must undergo monthly validation checks. A record of which is kept in the Seca mBCA validation folder in the Bod Pod and Body Comp room (WC205A) in the NIHR Wellcome Trust Clinical Research Facility (CRF). PURPOSE To ensure the correct validation procedure for the Seca mBCA machine, within the BRC. SCOPE This procedure applies to any individual performing the monthly validation checks on the Seca mBCA machine, within the BRC RESPONSIBILITIES It is the responsibility of the individual to use this procedure when performing monthly validation checks on the Seca mBCA machine and they will be responsible for reporting and recording the outcome of the validation test in the validation test folder held in the Bod Pod and Body Comp room (WC205A). Page 2 of 8 NIHR Southampton Biomedical Research Centre PROCEDURE 1. Switch the laptop, printer and Seca mBCA machine on at the wall sockets. 2. Get the SECA Wireless Dongle (figure 1) out of the box file and plug into a USB port on the laptop. The box file is on the bottom on the workstation desk next to the printer and is labelled "Seca mBCA". Figure 1. Seca wireless dongle 3. Turn on the Seca mBCA machine by pressing the on/off button on the bottom left corner of the display panel. 4. Do not touch any part of the equipment during this process as you will interfere with internal set-up calibrations. 5. Wait until the start screen is displayed. It should say 0.00 in centre of the screen as it will not be registering any weight. 6. Switch on the laptop and log in with your UHS login details. 7. Click the "SECA medical software" icon on the computer desktop to open the Seca mBCA software program. 8. It will ask for a username and password. This will be supplied to you after training. During the training session the trainer will use their log in details. 9. Enter the user name and password that has been assigned to you. 10. Position the components of the Test kit on the equipment in the following order. a. Position one small cylindrical test weight on each foot electrode (figure 1). It does not matter which one goes on which electrode but the end with the hole in the centre needs to be face-up. Page 3 of 8 NIHR Southampton Biomedical Research Centre Figure 1. b. Clip the red and black clips to contact the hand electrodes on each side of the machine, in the positions shown in figure 2. Make sure the red clips are at the front (figure 2). Figure 2. Page 4 of 8 NIHR Southampton Biomedical Research Centre c. Connect red leads in the "hand leads" bag to the red clips and black leads in the "hand leads" bag to the black clips over the hand electrodes (figure 3). The attachment side of the clips needs to face outwards and the larger pin end of the leads must be pushed through the hole and the screw mechanism used to tighten the lead in place. Leave the other end of the leads to dangle for the moment. Figure 3. d. Make sure the sets of red and black leads and the Reference Unit are out of the case and then place the case on its end on to the machine (figure 4). Double check you are using the Reference Unit do NOT use the Test Unit. Leave all the other components in the box. Figure 4. e. Now use the other set of red and black leads. f. Take two red leads from the "foot leads" bag and connect one to each of the cylindrical weights on the ball of the foot electrodes (figure 5). Page 5 of 8 NIHR Southampton Biomedical Research Centre g. Take two black from the "foot leads" bag and connect one to each of the cylindrical weights on the heel of the foot electrodes (figure 5). h. Place the Reference Unit on top of the case and connect the other end of the two red and two black leads plugged into the weights, into the corresponding coloured positions at the person's foot-end of the image on the Reference Unit (figure 5). Figure 5. i. j. Now take the dangling opposite end of the red leads for the hands that you previously connected to the red clips and connect the dangling free end to the corresponding coloured positions at the person's head-end of the image on the Reference Unit (figure 6). Do the same for the black leads (figure 6). Figure 6. Page 6 of 8 NIHR Southampton Biomedical Research Centre 11. Set-up of the test kit is now complete. Check that your set up matches that shown in figure 6. 12. Work with the machine now as if you are measuring a participant 13. The weight should read the weight of the test kit (5.8kg). Press hold to fix the weight. 14. Enter a height value of 1 meter and then press the BIA button on the right of the display panel. 15. Carry out the measurement by performing the long (75 second) test. This requires you to make sure that all the boxes are ticked (including the "raw data for impedance" box) when you are viewing the screen shown in figure 7. Do not touch the machine whilst the measurement is in progress. Figure 7. 16. When the measurement is complete, press "continue". 17. When asked to enter "Activity Level" enter the value 1.5 and then press "confirm". 18. On the screen that requests the patient details: For First Name, enter "3" and for Surname enter "VALIDATION" 19. When this has been entered press "search". 20. Enter user PIN when requested. 21. Wait until the machine has completed the patient search and when VALIDATION 3 has been found, press "confirm". 22. Press "save". 23. Open the file on the laptop and obtain navigate to the "Raw Data for Impedance" section. Select "Right Half of Body" and check the results at 5 and 50kHz fit within the required limits. Page 7 of 8 NIHR Southampton Biomedical Research Centre Raw Data Measurements Zre (50kHz) re (50kHz) Rre (50kHz) Xcre (50kHz) Zre (5kHz) re (5kHz) Rre (5kHz) Xcre (5kHz) Target Value 524.9 (+/-1) 0.0? (+/-0.1?) 524.9 (+/-1) 0.0 (+/-1) 524.9 (+/-1) 0.0? (+/-0.1?) 524.9 (+/-1) 0.0 (+/-1) 24. Record the results on the Seca mBCA Validation Record Form in the blue folder labelled Seca mBCA Validations in the Bod Pod and Body Comp room in the CRF (WC205A) 25. If there are any problems and the results are not within the specified limits repeat the test twice more. If the problem persists, please report the problem to the SCBR Operations Manager and clearly mark the machine "Do not use" so that it is not used again before repair/recalibration. 26. Shut down the laptop and the mBCA machine. 27. Completely dismantle the validation kit set-up and return all the components to the box. Page 8 of 8
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Gentle low FODMAP diet - patient information

Description: This factsheet explains what FODMAPs are and what a gentle low FODMAP diet involves.
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Recipe book - For toddlers who need to make the most of every mouthful

Description: 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
Url: /Media/UHS-website-2019/Docs/Services/Child-health/DietaryAdvice/Recipe-book-For-toddlers-who-need-to-make-the-most-of-every-mouthful.pdf

Press release: Southampton expert says home genetic testing kits "shouldn't be used for healthcare decisions"

Description: A leading doctor based at Southampton's university hospitals has warned against the use of home genetic testing kits and called for more regulation of, and engagement with, the industry.
Url: /AboutTheTrust/Newsandpublications/Latestnews/2019/October/Press-release-Southampton-expert-says-home-genetic-testing-kits-shouldnt-be-used-for-healthcare-decisions.aspx

Eating after bowel surgery - patient information

Description: Patient information factsheet Eating after bowel surgery After bowel surgery, it may take a while to return to your normal diet. To begin with, you may experience loose and/or more frequent bowel movements. It is also common to have a reduced appetite. This factsheet is about simple changes to your diet that can help with these issues. If you have a colostomy or ileostomy, there is separate written information available. Lower fibre diet For the first four to six weeks after bowel surgery, we recommend that you follow a lower fibre diet (also known as a lower residue diet). These foods are easier to digest while your bowel is healing. After this period, you should gradually reintroduce higher fibre foods one small item at a time. It is not advisable to follow a lower fibre diet in the long term, unless specifically suggested by your doctor or dietitian. The table below shows what a lower fibre diet includes. Lower fibre foods (recommended) Bread, pasta, White versions of these products, such rice and as white bread, pasta, rice, tortilla potatoes wraps, couscous, crisps and potatoes without skins Breakfast Rice Krispies, cornflakes, Special K, cereals Coco Pops, frosted flakes and porridge Snacks Fruit and vegetables Any biscuits, cakes, crackers or sweets that do not contain dried fruit, nuts or seeds Well-cooked vegetables without skins, such as broccoli, cauliflower, peeled root vegetables, courgettes, aubergines or squash Higher fibre foods (to avoid) Brown versions of these products, such as wholegrain, seeded or granary bread, whole wheat pasta, brown or wild rice, and potato skins Weetabix, Shredded Wheat, bran flakes, Crunchy Nut, fruit and fibre, granola and muesli Biscuits, cake, crackers or sweets containing dried fruit, nuts or seeds Raw vegetables Fruit and vegetables for which the skins cannot be removed (such as peas, sweetcorn and oranges) Fruits without skins, such as bananas, melons, peeled apples or pears, tinned Fruit and vegetables that are stringy, or pureed fruit such as celery, green beans and rhubarb Soft salad products, such as avocado, peeled cucumber, round lettuce, baby Fruits containing large seeds, such as spinach, and skinned and deseeded pomegranate or passion fruit tomatoes Dried fruit www.uhs.nhs.uk Patient information factsheet Protein sources Meat, fish, eggs, tofu, Quorn, nut butters and hummus All dairy and dairy alternative products If you have diarrhoea � Follow a lower fibre diet and limit fruit and vegetables to one portion at a time. A portion is a small handful. � Try to stick to regular meal times. � Limit caffeine, fizzy drinks and alcohol. You could try decaffeinated alternatives. � Limit fruit juice and smoothies to a small 150ml glass per day. � Limit high fat foods such as takeaways or fried foods. � Limit spicy foods. � Limit artificial sweeteners. If you have a reduced appetite Fortify your food with extra oil, butter, cream and cheese so that every mouthful provides more nutrition. For example: - add double cream to soups and stews - fry or roast food with extra oil - add grated cheese to mashed potato and pasta dishes - put butter on boiled vegetables or roast them in oil - add sugar to your hot drinks and breakfast cereals Have small, regular and high energy snacks. Nutritious snacks could be: - cheese and biscuits - full fat yogurt - toast or bread with thick layer of full fat spread - cake, biscuits or puddings - full fat milkshakes or hot drinks - shop-bought, meat-based snacks, such as sausage rolls, chicken drumsticks or scotch eggs � � � � � Try ready-made meals if you do not feel like preparing food. Try to eat more at times when your appetite is better. Avoid `diet', `light' or `low fat' foods and drinks. Avoid drinking before you have a meal (this can make you feel full). Try getting some fresh air and gentle exercise such as walking to help stimulate your appetite. Nuts, seeds, beans, lentils and chickpeas If you continue to have difficulties with your appetite, weight or bowels, please speak to your GP or your surgical team. If you need a translation of this document, an interpreter or a version in large print, Braille or on audio tape, please telephone 023 8120 4688 for help. Version 1. Published May 2019. Due for review May 2022. 2262 www.uhs.nhs.uk
Url: /Media/UHS-website-2019/Patientinformation/Digestionandurinaryhealth/Eating-after-bowel-surgery-2262-PIL.pdf

Oesophageal manometry test for rumination syndrome - patient information

Description: This factsheet explains what an oesophageal manometry test to check for rumination syndrome is and what it involves, so you know
Url: /Media/UHS-website-2019/Patientinformation/Tests/Oesophageal-manometry-test-for-rumination-syndrome-3725-PIL.pdf

Dietary advice for jejunocolic anastomosis - patient information

Description: This factsheet explains jejunocolic anastomosis and the dietary changes you may need to make because of this.
Url: /Media/UHS-website-2019/Patientinformation/Digestionandurinaryhealth/Dietary-advice-for-jejunocolic-anastomosis-3195-PIL.pdf

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Press release: Southampton expert says home genetic testing kits "shouldn't be used for healthcare decisions"

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