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PLANETS texture modified recipe book

Description: A texture modified recipe book for patients with cancer of the oesophagus or stomach A texture modified recipe book for patients with cancer of the oesophagus or stomach Contents Introduction 3 Patient stories 4 From the dietitian 8 From the Chef 9 Purée food 10 Purée breakfast recipes 12 Purée soups 16 Purée main meals 20 Purée side dishes 30 Purée desserts & snacks 34 Drinks & supplement recipes 38 Soft & bite sized diet 40 Soft & bite size breakfast recipes 42 Soft & bite size main meals 46 Soft & bite size side dishes 54 Soft & bite size desserts & snacks 56 Introduction This recipe book aims to provide you with a selection of easy to prepare, high calorie and protein recipes of a suitable purée or soft texture that may be helpful during chemo or radiotherapy or following surgery for oesophageal or stomach cancer. The recipes in this book will make larger portions than you may be able to manage, so you will be able to divide them into several smaller portions. Each recipe will indicate if it can be stored in the fridge or frozen. Ensure you defrost food thoroughly and cook through. What is texture modification? A texture modified diet will contain carefully selected foods of an appropriate consistency which can be more easily managed if you are struggling with swallowing or pain on eating, or healing following surgery. Food fortification In order to help minimise weight loss, especially when you may only be able to manage small portion sizes it can be helpful to ‘fortify’ your food to maximise its nutritional content. • Avoid foods labelled as ‘diet’ or ‘light’ and choose full fat dairy products. • Add extra butter, cream, evaporated or condensed milk to increase calories. • Add fortified milk to drinks and foods. (see recipe below) Fortified milk recipe • 1 pint (approximately 600ml) full cream milk • 4 heaped tablespoons (60g) skimmed milk powder 1. Add milk powder to a small amount of milk and mix to a paste. 2. Gradually add the remaining milk. 3. Store in the fridge and use instead of normal milk. 2 3 Patient stories The following are advice and tips are from patients with oesophageal or stomach cancer who have followed a purée and soft & bite sized diet... Gordon Oesophagectomy August 2018 Early in 2018 I was diagnosed with cancer of the oesophagus. I had three cycles of chemotherapy after which in August 2018 I underwent an oesophagectomy at Southampton General Hospital. Initial foods by mouth consisted of purée foods including scrambled egg and soups. I was initially also receiving the bulk of my nutrition through a Jejunostomy feeding tube, which was weaned down and stopped in February 2019. I was provided both in hospital and at home with high calorie/protein supplements in the form of Fortisip. We (my carer was an active participant in finding an acceptable diet, a situation I would consider as being almost essential) then tried various commercial varieties such as ‘Complan’. For the first few weeks after leaving hospital I didn’t feel thirsty at all and again my carer became concerned that I would become dehydrated. Given the restricted room available for food intake in my re-arranged insides there was always a tussle for space between solids and liquids and we could not settle on a highly nutritious solution to meet both requirements. As soon as I was able to eat almost anything – I still have difficulty digesting pastry ten months after the op – I started to eat quantities of cheese, puddings and cream. We have now resorted to supermarket sourced ‘protein bars’ such as ‘Nature Valley’ and ‘Graze’ that I munch between the three traditional meals. I also ‘graze’ on nuts, biscuits and fruit. To start with I lost weight, going from 68.5kg down to 63.3kg at the end of April. Since then it has stabilised and we hope to perhaps gain another kilo or two. Not too much because, according to the NHS chart, for someone of my height it is an ‘ideal weight’. I think now, ten months down the track, we are getting things right. A typical daily intake for me is as follows: Breakfast: Coffee, cereal (not too much sugar), toast with a spread of some sort, fruit juice. Lunch: Possibly left-overs from last evening’s meal, eggs in a variety of ways, cheese on toast, soup, a sandwich followed by a piece of fruit. (continued over) 4 Evening meal: A whole variety of dishes; roasts, casseroles, stir fry, salads, curries usually followed after an hour or so by a dessert. All those meals are of very small portions – though getting bigger all the time, some days better than others – so in between meals I have snacks comprising a range of protein bars, biscuits, fruit and cashew nuts by the handful. It seems to be working.I’m feeling stronger all “ ” the time, exercising and enjoying life! Janice Oesophagectomy May 2019 I had an oesophagectomy in May 2019 so I am currently almost 5 months post-op. I won’t lie, up to a month ago I found the whole eating and dietary issues frustrating. A lot of that was down to my impatience in accepting that recovery was going to take a good year or more. However, in the last few weeks, I feel I’ve finally ‘cracked it’ and found a regime that works for me. The day before being discharged from hospital my daughter visited and, between us, we ‘brainstormed’ a list of foods that could be, or were already, puréed. Armed with an extensive list, my daughter shopped for all the items including some baby food containers. She filled the containers with some prepared meals and left them stacked in my fridge and freezer ready for my return. I can’t tell you just how much that helped in the early days at home. Not having to worry about what to prepare and eat to start with was a blessing. Luckily, my husband was happy to see to himself so I could concentrate on my own needs. Some of the foods I stocked up with were: • Tinned custard, semolina and variety of soups. • Potatoes, butternut squash, and carrots. • Whole milk, cream, strong cheese, eggs, creamy yoghurts, butter and ice cream. • Salmon, white fish, skinless sausages. • Jelly cubes (for milk jellies). • Cheese sauce granules, gravy granules and dried milk (for making the fortified milk). • Weetabix and instant porridge. (continued overleaf) 5 5 • Some baby foods that I used as a base e.g macaroni cheese that I just added more grated cheese to. • Smoothies I thought the easiest food to eat would be mashed potato enriched with an egg, milk, butter and cheese but I actually found it quite difficult to swallow so stuck to the butternut squash instead (still with everything added). Keeping hydrated was difficult as I’m not a great drinker anyway. You definitely need to drink a good 30 mins before or after food and not at the same time. I kept a jug of fortified milk on the go and used it for cereal, jelly and frozen milk lollies (using Nesquick). I did find that my taste buds changed and I struggled with dairy products in particular. Moving on to soft foods after 4 weeks was bliss. I was so bored with puréed food by that point. I was losing weight but was expecting that and hoped that the loss would slow down with a more varied diet. I still wasn’t keen on the sweet dairy products although I kept trying various yoghurts and desserts. I must say I did spend a lot of money on food but also wasted a large amount of food as well! I eat anything that could be mashed with a fork and found stronger flavours worked for me. • Cottage pie • Spaghetti Bolognese • Tagliatelle • Vegetable curry • Skinless sausage casserole • Cheese omelette with thin cut ham added My ‘go-to’ snacks included: cheese and crackers, buttery cheese straws, mini Babybels, tiramisu, spicy crisp puffs e.g Cheetos. Trying to keep a small portion of food warm enough for the 30 mins needed to eat it was a problem. I overcame it by buying a child’s wide-necked food thermos flask. It certainly kept the food at a reasonable temperature. After a couple of months, I was able to move on to a normal, varied diet. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. My portions have increased considerably and I enjoy stir-fries, curries, roast dinners, fry-ups – you name it and I’ll try it. The only thing that I don’t cope with very well is red meat but everything else is fine. I make sure I chew everything thoroughly but it did take some time to realise when I’d eaten enough. Sometimes, that last spoonful was one too many and it would stick in my throat. It would go down eventually but it’s uncomfortable at the time. 6 My taste buds are getting back to normal and I now enjoy chocolate, cream cakes and some desserts again. I always keep a couple of ready meals in the fridge (Marks and Spencer do a range designed for a smaller appetite). I snack on things like crisps, peanuts, cashew nuts, fruit loaf, crumpets, waffles and fruit and nut chocolate bars. At my last weigh-in I had gained over 2kilos so I know the only way is up now and I’m feeling very positive about the future. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. 7 7 From the dietitian… We have worked closely with our patients in producing this recipe book to help support you after surgery or during chemo/radiotherapy when you may find your appetite is very low. The recipes are designed to maximise the calorie and protein content, which will help you to better maintain your weight. Eating small portions regularly every few hours over the day can help, as well as serving small portions of food on a side plate or in ramekins so that it doesn’t look too overwhelming. Dietitian, Sarah Davies Don’t feel you have to make everything from scratch, you can often buy foods of an already appropriate texture from supermarkets, for example pots of custard or smooth soup to save you time. Several online ready-made meal companies can deliver good quality meals that have a range of suitable textures, including ‘mini’ or ‘petite’ ranges for smaller portions, which you may find helpful if you are feeling too tired to cook. Choose ‘purée’ or ‘soft and bite sized’ ranges according to which stage of diet you are on. If you require further advice or are worried about your weight or diet please ask to be referred to a dietitian. We hope you find this book helpful! 88 From the Chef… It’s really inspiring for me to read the positivity within the patient stories and learn about the different food plans that have worked for each individual. I can fully appreciate a lack of desire to get creative in the kitchen, especially post surgery, though along with some great existing recipes already in this book, I have put together some of my own that will hopefully encourage you to think positively about food and flavours. There will obviously be days where you may wish to simply blitz up a can of pre prepared soup though if feeling adventurous it would be a pleasure to learn that any of my recipes have been given a run through! Please do enjoy! Blender advice To get a really smooth consistency to your food it is really important that you use a powerful blender. I personally find the Ninja range superb & at an affordable price range. They have some great models from around £49.99 and are available from most supermarkets or it’s worth looking online for a good deal. If your blender fails to create the desired smooth texture, you can pass it through a fine sieve afterwards and discard any ‘lumps’. If the consistency of the food is a little dry, simply add a little extra water whilst blending. Chef, Gary 9 Purée foods 10 What is a purée diet? • A purée diet should be smooth throughout without any bits, lumps, skins or shells. • Food can be puréed using a blender or food processor. • Food can also be sieved to ensure there are no lumps. • Food should be puréed separately so there are individual portions of each food on the plate. This helps to retain the taste and colour of each item and makes it more appealing. • Add additional liquids to blend such as gravy, milk or stock. • Enhance flavours by adding sauces such as smooth mustard, curry powder, soy sauce or lemon juice. Suggested purée meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Purée cinnamon porridge Nourishing coffee Purée scrambled eggs Supplement drink Salmon Mousse Glass of milk Cream of chicken soup Supplement drink Purée shepherd’s pie Nourishing malt drink Purée rice pudding 1111 Purée breakfast recipes 12 Cinnamon Porridge • 25g porridge oats • 175g full fat milk • ¼ teaspoon of cinnamon • 1-2 tablespoons of full fat Greek yogurt to serve 1. Put the porridge oats in a saucepan, pour over the milk and sprinkle in a pinch of salt. Bring to the boil and simmer for 4-5 minutes, stirring from time to time and watching carefully that it doesn’t stick to the bottom of the pan. 2. Or you can try this in a microwave. Mix the porridge oats, milk and a pinch of salt in a large microwave-proof bowl, then microwave on High for 5 minutes, stirring halfway through. Leave to stand for 2 minutes before eating. 3. Stir through the cinnamon and drizzle with Greek yogurt to serve (you can thin this down with some more milk if needed). Storage: Refrigerate Weetabix, Peanut Butter & Banana Smoothie • ½ a banana • 2 tablespoons of smooth peanut butter • Approximately 250ml full fat milk • 1 Weetabix biscuit (or shredded wheat) 1. Slice the banana into the blender. 2. Add the peanut butter and 3 tablespoons of the milk. 3. Blend together until well combined. 4. Crush the Weetabix into the mixture. 5. Add the remaining milk and blend until smooth. Storage: Refrigerate 13 Purée Scrambled Eggs • 2 eggs • 6 tablespoons of single cream or approximately 60ml of full fat milk • Butter 1. Lightly whisk the eggs, 6 tbsp of single cream or full fat milk and a pinch of salt together until the mixture has just one consistency. 2. Heat a small non-stick frying pan for a minute or so, then add a knob of butter and let it melt. 3. Pour in the egg mixture and let it sit, without stirring, for 20 seconds. Then stir with a wooden spoon, lifting and folding it over from the bottom of the pan. 4. Once cooked through, place eggs in your blender and blend until smooth (you may need to add a little more milk to give the correct consistency). Storage: Refrigerate Fruity Greek Yogurt Smoothie • 250ml Full fat Greek yogurt (or pineapple flavoured Greek yogurt) • 50ml full fat milk • ½ a banana • 30g fresh or frozen mango • 30g fresh, tinned or frozen peach slices 1. Place the yogurt and fruit into the blender and mix until smooth (if using frozen fruit you may need to let this defrost for a few moments to make it easier to blend). 2. Add additional milk to thin down as required. Storage: Refrigerate 14 15 Purée soups All soups can be kept in the fridge for 1-2 days or frozen 16 Cream of Chicken Soup • 2 tablespoons of olive oil • 600ml chicken stock • 1 medium onion, chopped • 175ml double cream • 1 medium leek, thoroughly washed and chopped • A pinch of pepper • 2 large chicken breast fillets (chopped) 1. Heat the oil in a pan, add the onion and cook until softened. 2. Add the leek and cook for a further 5 minutes. 3. Add the chicken, stock and seasoning and bring to the boil for 2 minutes then reduce to a simmer. 4. Allow to simmer for 25 minutes until the chicken is cooked through. 5. Add the cream then blend until smooth. Lamb and Vegetable Soup • 2 tablespoons of olive oil • 800ml vegetable stock • 400g lamb mince • 150ml full fat milk • 1 medium onion, choppe d • 120g skimmed milk powder • 3 large carrots, peeled & cho ppe d • 100ml double cream • 1 medium potato, peeled & chopped 1. Heat the oil in a pan and add the lamb and onion and cook for 5 minutes, breaking up the lamb into small pieces. 2. Add the carrot and cook for 10 minutes until soft. 3. Add the potato and stock and bring to the boil, then reduce to a simmer for a further 30 minutes. 4. Combine the milk with the skimmed milk powder then add to the pan with the cream and season. 5. Blend the soup until smooth. 17 Pea and ham soup • 2 tablespoons of oil • 1 medium onion, chopped • 1 medium potato, peeled and finely chopped • 400ml vegetable stock • 600g frozen garden peas • 100g cooked ham, finely chopped • 300ml full fat milk • 100g skimmed milk powder • 30g parmesan 1. Heat the oil in a pan and add the onion. Cook for 5 minutes until soft 2. Add the potato and stock and season. Boil for 15 minutes until the potato is soft. 3. Stir in the peas and ham and cook for another 10 minutes 4. Mix the milk with the skimmed milk powder and then add to the soup along with the parmesan. 5. Blend the soup until smooth and then sieve to ensure all pea shells are removed. Seafood chowder • 1 tablespoon of olive oil • 1 medium onion, finely chopped • 1 tablespoon of plain flour • 2 small potatoes, peeled and finely chopped • 600ml fish or vegetable stock • 300ml full fat milk • ½ teaspoon of grated nutmeg • 170g salmon, chopped into small chunks • 150g cod, chopped into small chunks • 60ml single cream • 200g frozen prawns (thoroughly defrosted) 1. Heat the oil in a saucepan and add the onion. Cook for 5 minutes until soft, then add the flour and cook for a further 2 minutes. 2. Add the potatoes and stock and bring to the boil for a minute then turn down to a simmer and cook for around 15 minutes until the potatoes are soft. (continued over) 18 3. Add the milk and nutmeg with the salmon and cod and cook for 5 minutes. 4. Add the cream and prawns and simmer for 5 minutes until cooked through. 5. Blend the soup until smooth. Sweet potato and lentil soup • 3 tablespoon of olive oil • 1 large onion, finely chopped • 10g minced ginger (or ginger paste) • 10g minced garlic (or garlic paste) • 600g sweet potatoes, peeled and finely chopped • 200g dried red lentils • 400g tin of coconut milk • 800ml vegetable stock • 100ml double cream • 120g skimmed milk powder 1. Heat the oil in a saucepan then fry the onions, garlic and ginger for 5 minutes. 2. Rinse and drain the lentils. 3. Add the sweet potatoes, lentils, coconut milk and stock and simmer for 30 minutes until the potatoes are soft. 4. Mix together the cream and skimmed milk powder then add to the soup. 5. Blend until completely smooth (you may need to sieve the soup to ensure the lentils are completely blended). 19 Purée main meals 20 Salmon Mousse • 125g smoked salmon • 50g cream cheese • 25g crème fraiche • The juice of ½ a lemon 1. Place all of the ingredients in your blender and combine until smooth. 2. Season with salt and pepper to taste and serve. Storage: Refrigerate Fish Pie • 2 skinless and boneless white fish fillets (approximately 200g) • 2 skinless and boneless smoked haddock fillets (approximately 200g) • 400ml full fat milk • 50g butter • 3 heaped tablespoons of plain flour (50g) • A pinch of nutmeg 1. Put the fish in the frying pan and pour over the milk. 2. Bring the milk to the boil then reduce and simmer for 8 minutes. 3. Lift the fish onto a plate and strain the milk into a jug to cool. Flake the fish into large pieces in a baking dish. 4. Melt the butter in a pan, stir in the flour and cook for a minute over a moderate heat. Take off the heat then pour in a little of the milk from the jug and stir until blended. 5. Continue to add the milk gradually, mixing well until you have a smooth sauce. Season with nutmeg and pepper to taste. 6. Add to a blender with the fish and blend until smooth. 7. Layer in a small dish with creamy mashed potato on top (see recipe in side dishes section). 8. Heat the oven to 200°c and bake for 30 minutes. Storage: Refrigerate or freeze 21 Mediterranean inspired chicken & chorizo casserole chickpea - spinach - fresh basil This recipe is inspired by big Mediterranean flavours. The strong flavours from the chorizo flavour the whole dish and make it a pleasure to eat. The recipe will give a generous 4 - 6 portions though likely more for smaller appetites. • 100g diced chorizo • 200g diced chicken thigh • 1 onion, diced • 1 stick celery, diced • 1 carrot, diced • 1 tin of chick peas, drained • 2 tins chopped tomatoes • 200g baby spinach leaves, washed • Handful fresh basil • Juice of one lemon • Salt and pepper Gary’s 1. Start with a hot pan and colour the chorizo on all sides (no need for any oil) 2. Add the chicken and stir in - cook for a few minutes 3. Add the onion, carrot and celery - cook for about 5 more minutes over a gentle heat (lid on) 4. Add the tinned chickpeas and tomatoes - bring to the boil and simmer for 30 minutes, stirring occasionally 5. Add the baby spinach and fresh basil 6. Add salt and pepper and lemon 7. Blend until smooth 8. Enjoy 22 Mild red lentil & butternut squash curry coconut - lime - lemongrass This simple recipe is for a mild curry with Asian flavours. You can replace the squash with chicken if desired but I personally love a vegetarian curry and you get plenty of calories from the coconut milk and the red lentils. You can omit the chilli if wanting a milder version or add one or two extra in. Again, allows for 4 - 6 generous portions. • 1 butternut squash, diced • 1 onion, diced Gary’s • 4 cloves garlic, crushed • 1 inch fresh ginger, grated • 1 stick lemongrass, diced • 1 green chilli, de-seeded • Juice of two limes • Bunch fresh coriander • Teaspoon mild curry powder • Dash of fish sauce • Teaspoon turmeric • 200g red lentils • Two tablespoons soy sauce • Coconut oil for cooking 1. In a hot pan, heat the coconut oil and add the garlic, ginger, lemon grass and onions - sweat for a few minutes 2. Add the squash, chilli and curry powder - cooking for 5-10 minutes until starting to soften (keep lid on) 3. Add the coconut milk and bring to the boil - simmer for twenty mins 4. Meanwhile, boil the red lentils in 400ml water for five minutes with the turmeric (the water should evaporate whilst they cook) 6. Add the cooked lentils (drained) into the sauce 7. Add the lime juice, fish sauce and soy sauce 8. Blend until smooth 9. Enjoy 23 Vegetarian ‘Shepherd’s pie’ puy lentils - butter beans - root vegetables minted gravy Very fond of vegetarian food?..... I’ve included this recipe which works really well with the lentils replacing the meat. Plenty of flavour from the vegetables and served with buttery mash and additional gravy, it’s a real treat. • 200g puy lentils (cooked) • 1 onion, chopped • 1 stick celery, chopped • 1 carrot, chopped • 1/2 small swede, chopped • 4 cloves garlic, chopped • 1 tin butter beans, drained • Tablespoon tomato purée • Teaspoon dried mint • Teaspoon dried mixed herbs • Salt and pepper Gary’s 1. In a hot pan, sweat the onions with the dried herbs for a few minutes 2. Add the other vegetables and cook for a further ten minutes (lid on) 3. Add the tomato purée and red wine 4. Add the lentils and butter beans 5. Add the Worcester sauce and salt and pepper 6. Add the gravy 7. Simmer for 30 minutes 8. Blend until smooth adding a little extra water or gravy if necessary 9. Serve with the mash and extra gravy 24 Mash Ingredients • 40g potato, diced • 100g butter • Salt and pepper • Dash grated nutmeg (optional) • Teaspoon Dijon mustard 1. Bring the potatoes to the boil and simmer for 20 minutes until soft 2. Drain and beat with a whisk until smooth - avoid using the blender which will break down all the starch, causing loss of the natural texture we all love in a good mash. As long as it’s given a good beat with a sturdy whisk it will become smooth or you can use a ricer, putting through twice. 3. Add salt and pepper, butter and mustard Chef Gary’s Top Tips Invest in some reusable tubs. They are great for portioning and storing food when batch cooking. You can then prepare food ahead of time and freeze for when you need something that’s quick, healthy and nutritious. Purée down tinned rice pudding for a quick dessert that is packed full of calories. When the texture is one dimensional it’s so important to add flavour to keep you interested and looking forwards to mealtime. A little extra salt, sugar or lemon juice can go a long way. As long as you can purée them to a fine texture, add fresh herbs to any recipe to give dishes extra flavour. Basil is great with tomato based dishes and coriander pairs brilliantly with coconut or curried recipes. As you move forwards, by using the pulse on the blender, you can leave some texture in the dishes. All my recipes can of course be left ‘unblended’ if catering for other family members or friends. 25 Minced beef • ½ tbsp sunflower oil • 30g onion (finely chopped) • 30g carrots (finely chopped) • 100g minced beef (or substitute for Quorn mince) • 1 tablespoon of tomato purée • 200ml beef stock • 2 tablespoons of Worcestershire sauce 1. Heat the oil in a medium saucepan and soften the onions and carrots. 2. When soft, add the minced beef and cook until browned. Then add the tomato purée and Worcestershire sauce and fry for a few minutes. 3. Pour over the stock and then simmer for 30-40 minutes. 4. Place the mixture into a blender and blend until smooth. Serve into small portions. Ideal with mashed potato or purée vegetables (see sides section). Storage: Refrigerate or freeze Shepherds’ pie • 350g minced beef (or substitute for Quorn mince) • 2 tablespoons of olive oil • 1 small onion, chopped • 100g mushrooms (optional) • 2 medium carrots, peeled and chopped • 2 tablespoons of tomato purée • 350ml beef stock • 50g butter • 50g flour 1. Heat the olive oil in a pan and add the onions and soften. 2. Add the mince and brown through. (continued over) 26 3. Add the mushrooms and carrots. Cover with a lid and leave to cook on a medium heat, stirring regularly. 4. Make a roux sauce by melting the butter in a separate pan. Using a whisk add the flour and whisk well until combined. 5. Add the beef stock a little at a time to the roux, still mixing well to make a thick sauce. 6. Add this sauce with the tomato purée to the beef mixture and stir well. 7. Transfer to the blender and mix until smooth. 8. Place in a small dish and top with creamy mashed potato (see side dishes section). 9. Bake in the oven for 15-20 minutes until cooked through. Storage: Refrigerate or freeze Purée chicken • 100g of diced chicken breast • 1 small onion chopped • 100ml chicken stock • ½ a chopped leek • 1 tablespoon of chicken gravy granules • 1 teaspoon of oil 1. Heat the oil in a pan then add the onion, leek and chicken and cook through. 2. Add the chicken stock and simmer for 15 minutes. 3. When cooked, add the gravy granules then transfer to the blender and blend until smooth. Ideal to serve with creamy mashed potato. Storage: Refrigerate or freeze 27 Macaroni cheese • 3 tablespoons of butter • 350g of pasta (penne or spiral pasta) • 1 teaspoon garlic paste • 1 teaspoon mustard • 3 tablespoons plain flour • 500ml full fat milk • 250g cheddar cheese • 50g grated parmesan 1. Boil the pasta until cooked then drain and set aside. 2. Meanwhile melt 2 tablespoon of butter in a saucepan. 3. Add the garlic paste and English mustard and cook for 1 minute. 4. Stir in 3 tablespoons of plain flour and cook for 1 more minute. Gradually whisk in 500ml of the milk until you have a lump-free sauce. 5. Simmer for 5 minutes, whisking all the time until thickened. 6. Take off the heat and stir in the cheddar and parmesan. 7. Add the pasta then blend with the sauce until smooth. Add extra milk if you need to thin the mixture down. Storage: Refrigerate 28 Red lentil Dahl • 250g red lentils • 1 teaspoon turmeric • A pinch of salt • 2 tablespoons sunflower oil • 1 teaspoon cumin • 1 medium onion, finely chopped • 50ml cream 1. Put the lentils in a pan of 800ml of water and bring to the boil. 2. Add the turmeric and salt and simmer uncovered for 15 minutes. Stir occasionally until the lentils have broken down completely to a purée (the consistency of a smooth thick soup). 3. Heat the oil in a separate pan and add the onion. Cook for 5 -10 minutes until soft. 4. Add the onion, cumin and cream to the lentils then blend until smooth. Storage: Refrigerate or freeze 29 Purée side dishes 30 Creamy mashed potato • 6 medium potatoes, peeled and chopped into chunks • 60g butter • 100ml double cream 1. Place the potatoes in a pan and cover with cold water 2. Bring to the boil then cover with a lid and reduce to a simmer for 20 minutes until the potatoes are soft. 3. Drain the remaining water, add the cream and butter and gently heat. 4. Mash the potatoes or beat. Storage: Refrigerate or freeze Hint: Try adding cream cheese or mustard to give extra flavour Cauliflower cheese • 150g cauliflower florets • 1 level tablespoon of cornflour • 2 tablespoons of full fat butter or olive oil spread • 150ml full fat milk • 30g cheddar cheese, finely grated 1. Wash the cauliflower then steam for 8-10 minutes until soft. 2. To make the sauce combine the flour, butter and milk in your blender. 3. Transfer into a microwaveable container and microwave for 45 seconds then stir through. 4. Microwave for another 15-30 seconds until the sauce starts to thicken then stir in the grated cheese. 5. Combine the cauliflower and sauce in the blender until smooth. Add additional milk if required. Storage: Refrigerate or freeze 31 Sweet potato and carrot purée • 250g carrots, chopped • 250g sweet potato, chopped • 1 tablespoon of garlic purée • 25g butter 1. Put the sweet potato and carrots into a pan of boiling salted water and cook for around 15 minutes until soft. 2. Drain the vegetables then stir through the garlic purée and butter. 3. Blend until smooth. Storage: Refrigerate or freeze Hint: You could also try adding 100g parsnip Butternut squash purée with ginger • 1 butternut squash, halved lengthways and deseeded • Olive oil • 4cm piece of fresh root ginger, peeled and finely grated • 3 tablespoons of butter • 2 tablespoons of double cream or crème fraiche • Nutmeg (optional) 1. Preheat the oven to 200°c 2. Rub a little olive oil into the cut side of the butternut squash then roast in the oven on a baking sheet for around 45 minutes or until soft. 3. Scoop out the flesh with a spoon and set aside (discard the skin) 4. In a pan melt 2 tablespoons of butter and add the ginger and cook for 5 minutes. 5. Place the cooked squash and ginger in the blender and blend thoroughly until smooth. 6. Return to the pan and add the remaining butter and nutmeg if you are using this. Stir through the cream or crème fraiche. Storage: Refrigerate or freeze 32 Purée ratatouille • 50g aubergine • 50g courgette • 40g red or yellow pepper • 2 tablespoons of olive oil • 200g passata • 1 small onion, finely chopped • 30g mushrooms • ½ garlic clove peeled and crushed • 1 tablespoon of red wine vinegar • 50ml single cream (optional) 1. Heat the oil in a casserole dish or saucepan and cook the onions and garlic on a low heat for 10 minutes until soft with the lid on. 2. Add the peppers, aubergine and courgettes. Season with salt and pepper and cook for a further 20 minutes with the lid on. 3. Pour in the passata and red wine vinegar and cook for another 5 minutes without the lid 4. Transfer to your blender and blend until smooth. Stir through the single cream to add additional calories before serving Storage: Refrigerate or freeze 3333 Purée desserts & snacks 34 Banana dessert • 1 medium banana, peeled and sliced • 10g ground almonds • 1 teaspoon maple syrup • 2 tablespoons double cream • 20g skimmed milk powder • 1 teaspoon vanilla extract 1. Freeze the banana slice for at least 2 hours 2. Blend the frozen banana, almonds, maple syrup, cream, skimmed milk powder and vanilla extract into a creamy smooth texture. Add some extra milk if it is difficult to blend Storage: Refrigerate or freeze Rice pudding • 120g pudding rice • 700ml full fat milk • 50g sugar (or swap for sweetener) • 200ml cream • 1 teaspoon of vanilla extract • ½ teaspoon of ground cinnamon • 75g ground almonds • A pinch of salt • 100g skimmed milk powder 1. Blanch the rice in a pan of boiling water for 3 minutes 2. In another pot mix 600ml of milk with the sugar, cream, vanilla extract, cinnamon and salt and bring to the boil 3. Add the blanched rice and ground almonds and simmer for 30 minutes, stirring occasionally 4. Combine with the remaining 100ml of milk and skimmed milk powder 5. Blend until completely smooth and then serve into small portions Storage: Refrigerate 35 Vanilla custard • 1 pint of full fat milk • 55ml single cream • 1 vanilla pod or ¼ teaspoon of vanilla extract • 4 egg yolks • 30g caster sugar • 2 level teaspoons of cornflour 1. Bring the milk, cream and vanilla to simmering point gradually over a low heat. 2. Remove the vanilla pod if used. 3. Whish the egg yolks, sugar and cornflour together in a bowl until well blended. 4. Pour the hot milk and cream mixture into the egg mixture, whisking all the time with a balloon whisk. 5. Return to the pan and stir over a low heat until thickened. Storage: Refrigerate Spiced pear (ideal with the vanilla custard) • 2 pears, peeled, cored and cut into small chunks • A small pinch of cinnamon • A splash of full fat milk 1. Steam the pear for 8-10 minutes until tender. 2. Transfer to the blender and add a splash of milk and cinnamon and blend until smooth. 3. Can be frozen into ice cube trays. Storage: Refrigerate 36 Lemon mousse • 150g lemon curd • Zest of ½ a lemon • 150ml of double whipping cream 1. Put two-thirds of the lemon curd in a large bowl with the zest and cream. 2. Beat with an electric whisk until it holds its shape. 3. Dribble over the rest of the lemon curd, marbling the curd as you add it. 4. Transfer into small pots or glasses. Cover with clingfilm and freeze for 30-40 minutes until set. Storage: Refrigerate 37 Drinks and supplement recipes 38 Nourishing malt drink • 150ml full fat milk • 1 heaped tablespoon milk powder • 3 teaspoons of malted drink powder such as Ovaltine or Horlicks • 2 tablespoons cream Nourishing coffee • 150ml full fat milk • 1 heaped tablespoon milk powder • 1 teaspoon coffee powder • 2 tablespoons of cream Chocolate mocha pots • 1 teaspoon of coffee granules dissolved in a splash of boiling water • 25g butter • 100ml of chocolate Fortisip • 200g plain chocolate broken into chunks • 50g Muscovado sugar (or swap for sweetner) 1. Place all of the ingredients in a small pan and stir gently over a low heat until it has fully melted 2. Pour into small espresso size cups and allow to cool 3. Transfer to the fridge to set Cappuccino • 1 sachet of instant cappuccino mix • 110ml of hot water • 1 bottle of neutral of mocha flavoured Fortisip 1. Put the water, cappuccino mix and Fortisip in a saucepan. Mix well and heat gently until at serving temperature Fortisip milk jelly • 1 packet of blackcurrant or raspberry jelly • 400ml of Strawberry Fortisip • 100ml boiling water 1. Cut the jelly into cubes and place in a bowl 2. Add the boiling water and stir until the jelly is dissolved 3. When cooled slightly, add the Fortisip 4. Mix thoroughly and transfer to small containers and leave in the fridge to set What is Fortisip? You will initially be prescribed high calorie supplement drinks such as Fortisip Compact Protein. This will help you to maximise your nutritional intake. They are available in 8 flavours through your GP: vanilla, strawberry, banana, mocha, peach/mango, berries, neutral, and hot tropical ginger. They can also be frozen into ice cube trays or ice lolly moulds. 3399 soft & bite sized diet 40 What is a soft and bite sized diet? • A soft diet should be of fork-mashable consistency and require some chewing. • Avoid crunchy, sharp foods with skins and doughy foods such as bread. • Continue to aim for small regular meals and snacks over the day. Suggested soft and bite size meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Overnight oats Fortified cappuccino Pancakes and crème fraiche Supplement drink Salmon fish cakes Glass of fortified milk Flapjack Supplement drink Beef casserole with pepper mash Nourishing malt drink Tiramisu 41 Soft & bite sized breakfast recipes 42 No-bread eggs benedict • 1 ripe avocado, destoned • 2 slices of ham or smoked salmon • 2 eggs • 2 tablespoons mayonnaise • 1 teaspoon mustard • 2 teaspoons white wine vinegar 1. Bring a saucepan of water to the boil 2. Scoop the avocado flesh into a bowl and season with salt and pepper. Mash with the back of a fork and leave to one side 3. Once the water is boiling carefully crack in the eggs and poach at a gentle simmer for about 4 minutes until the yolk is still runny 4. While the eggs are poaching make the hollandaise sauce. Whisk together the mayonnaise, mustard and vinegar with 3 tablespoons of warm water 5. Once cooked layer the ham or salmon with the mashed avocado then top with poached eggs and spoon over the sauce Storage: Refrigerate Overnight Oats • 120g rolled oats • 120ml full fat Greek yogurt • 220ml full fat milk • ½ tablespoon honey or maple syrup (or sweetener) • 1 teaspoon vanilla extract To make ‘coconut latte’ overnight oats substitute full fat milk for 170ml coconut milk, do not use vanilla extract and instead add: • ½ teaspoon ground cinnamon • 60ml brewed coffee 1. Place all of the ingredients into a large glass container and mix well 2. Put the top on the container & refrigerate for at least 2 hrs or overnight Storage: Refrigerate 43 Potato waffles You will require a waffle iron • 300g peeled potatoes, chopped • 2 tablespoons butter • 1 onion, finely chopped or grated • 1 garlic clove finely chopped • 30g plain flour • 2 eggs 1. Boil the potatoes in a pan of water for around 15 minutes or until soft 2. Meanwhile melt the butter in a pan over a medium heat. Add the onion and garlic and cook until soft 3. Preheat the waffle iron according to the manufacturer’s instructions 4. Drain the potatoes when cook then combine with the onion mixture, flour, eggs and season with salt and pepper. Mix in a large bowl until well blended 5. Scoop the batter into the waffle iron and cook until golden brown Storage: Refrigerate Hint- Ideal to serve with scrambled egg, ham, mushrooms or a combination of toppings 44 Pancakes with banana and crème fraiche • 55g plain flour • 1 egg • 100ml full fat milk • 25g butter • 1 banana • Crème fraiche • Handful of raspberries or blackberries (optional) 1. Sift the flour with a pinch of salt into a large mixing bowl 2. Make a well in the centre of the flour and break in the egg 3. Whisk together and gradually add the milk until a smooth consistency 4. Melt 25g butter in a pan and add half of this to the batter mix and whisk in 5. Get the pan very hot with the remaining butter, then turn down to a medium heat 6. Add about 2 tablespoons of batter to the ban and tilt the pan to completely cover in the batter and thin 7. Cook the pancake on each side until golden but not too crispy 8. To make the fruit purée spoon the berries into a sieve and push through to remove any pips. Serve with crème fraiche Storage: Refrigerate 45 Soft & bite sized main meals 46 Salmon fish cakes • 4 medium potatoes, peeled and chopped into small pieces • 350g skinless and boneless salmon, flaked • Zest of 1 lemon • 1 tablespoon plain flour • 15g fresh chives, finely chopped • 1 medium egg • 30g grated parmesan • 2 tablespoon olive oil 1. Preheat the oven to 180°c 2. Put the potato pieces in a pot of boiling water and cook for 10-15 minutes until soft 3. Drain and mash the potato and allow to cool 4. Add the flaked salmon, lemon zest, flour, chives, egg and parmesan to a large bowl 5. Mix with the mashed potato until well combined 6. Divide the mixture into 8 cakes and shape 7. Place on a baking tray and brush with olive oil 8. Cover with tin foil and bake for 10-15 minutes until cooked through Storage: Refrigerate or freeze Smoked fish chowder • 450g smoked haddock fillet • 170g carrots, peeled and • 60g butter finely chopped • 1 onion, finely chopped • 150ml single cream • 2 tablespoons plain flour • 230g potatoes, peeled and finely chopped 1. Boil 1 litre of water in a saucepan then reduce to a simmer and cook the haddock for about 10 minutes until tender. (continued overleaf) 47 2. Drain the haddock and keep the water to use as stock later 3. Flake the haddock removing any skin and bones 4. Heat the butter in a pan and add the onion and cook until soft 5. Stir in the flour and cook for a minute then gradually add the water back as stock. Bring to the boil stirring constantly 6. Add the potatoes and carrots and simmer for 10 -15 minutes until tender 7. Stir in the flaked fish and cream. Season and serve Storage: Refrigerate Salmon curry • 1 tablespoon olive oil • 1 small onion, sliced • 2 garlic cloves, crushed • ¼ chilli, deseeded and sliced finely • 1 teaspoon milk curry powder (or medium if preferred) • 1 tin salmon or approximtely 200g fresh salmon fillet • 1 spring onion, chopped • 2 tablespoons tomato purée • Boiled brown rice 1. Heat the oil in a pan over a medium heat. Add the onion and garlic and cook until soft 2. Add the chilli and cook for another minute 3. Add 5 tablespoons of water and stir then turn down the heat to a simmer for 5 minutes until the water evaporates 4. Add the tin of salmon, spring onion, tomato purée and salt and pepper 5. Simmer until cooked and soft then serve with a small amount of cooked rice Storage: Refrigerate or freeze 48 Pesto chicken • 1 tablespoon olive oil • 2 small chicken breast fillets, sliced • 1 garlic clove, crushed • 1 tablespoon green or red pesto • 200ml crème fraiche • 10 cherry tomatoes • Boiled rice or pasta 1. Heat the olive oil over a medium heat. Add the chicken and cook for 405 minutes until brown on all sides 2. Immerse the cherry tomatoes in boiling water for a few seconds then carefully remove and peel off the skin 3. Add the onion, garlic, pesto and peeled tomatoes. Cook for 5 -10 minutes stirring continuously 4. Ensure the chicken is tender and fully cooked then stir in the crème fraiche 5. Serve with cooked rice or pasta Storage: Refrigerate 49 Beef and Swede Casserole • 2 tablespoons olive oil • 2 onions, finely chopped • ½ celery stick, sliced finely • 500g diced braising beef • 700ml beef stock • 500g swede, peeled and diced • 300g potatoes, diced • 3 thyme sprigs • 1 bay leaf • Mashed potato to serve 1. Heat the oil in a saucepan or casserole dish 2. Fry the onions and celery for a few minutes until turning brown 3. Add the beef and brown all over for 3-4 minutes 4. Add the stock, swede, potatoes, thyme and bay leaf. Bring to the boil then reduce the heat 5. Simmer for an hour or transfer to a slow cooker if preferred 6. Cook until the beef is tender then remove the thyme and bay leaf before serving Storage: Refrigerate or freeze Moussaka • 500g potatoes, peeled • 3 tablespoons olive oil • 1 red onion, sliced finely • 500g lamb mince • 2 garlic cloves, crushed • 1 teaspoon mixed spice • 500g carton of passata • 2 aubergines, sliced finely • 300ml crème fraiche • 150g grated cheddar 1. Boil the potatoes whole for 20 minutes until soft then drain and allow to cool 2. In another pan add 2 tablespoons of olive oil and fry the onion until softened 3. Add the lamb and fry for 5 minutes until cooked 4. Add the garlic, mixed spice and passata & bring to a simmer 5. Heat the oven to 200°c 6. Warm a new pan over a high heat and add a little oil. Cook the aubergines on each side 7. Once cool slice the potatoes into thick slices 8. In an ovenproof dish layer the potatoes, then aubergines, then a layer of lamb mince mixture and repeat until all of the ingredients are used, ensuring an aubergine layer is on top 9. Spread the crème fraiche over the top and sprinkle with cheddar 10. Bake in the oven for 10 minutes or until the top is golden Storage: Refrigerate or freeze 50 51 Vegetarian lasagne • 1 red pepper, deseeded and cut into chunks • 2 courgettes, sliced • 1 small aubergine • 2 garlic cloves • 1 red onion, finely chopped • Olive oil • 250g Quorn mince • 1 tablespoon Worcestershire sauce • 1 tin tomatoes • 1 teaspoon oregano • 450ml full fat milk • 25g butter • 40g plain flour • 70g cheddar • 30g parmesan • 120g lasagne sheets 1. Heat the oven to 220°c 2. Put the peppers, courgettes, aubergines, half the garlic and half the onion into a roasting tin. Season and drizzle with olive oil then roast for around 30 minutes until tender 3. Heat 2 tablespoons of olive oil in a pan and add the remaining onion and garlic and fry for a few minutes until soft. Add the Quorn mince, Worcestershire sauce, tomatoes and oregano and simmer for 5 minutes 4. In a separate pan put the milk, butter, flour and seasoning. Heat and whisk until thickened and smooth. Stir in the cheddar and parmesan 5. Layer the Quorn mince mix, roasted vegetables, lasagne sheets and cheese sauce alternately in an ovenproof dish 6. Cook for around 40 minutes at 200°c until golden Storage: Refrigerate or freeze 52 Swedish meatballs • 250g mince beef • 1 garlic clove, chopped • ½ onion, finely chopped • ½ egg • 2 tablespoons chopped fresh parsley • Olive oil • 1 tablespoon butter • 20g plain flour • 250ml beef stock • 120ml cream • 1 teaspoon Worcestershire sauce • Pasta (tagliatelle or penne) 1. To make the meatballs mix together the beef, garlic, onion, egg and parsley in a bowl. If the mixture is very thick add a little more egg 2. Using a tablespoon roll out meatballs from the mixture 3. Heat oil in a pan over a medium heat and add the meatballs and cook for about 10 minutes until browned, turning occasionally. 4. Remove the meatballs and leave to cool on a paper towel 5. To make the sauce melt the butter in a pan and whisk in the flour until golden brown. Slowly whisk in the beef stock and cook until thickened 6. Add the cream, Worcestershire sauce and season with salt and pepper. 7. Add the meatballs and coat in the sauce then sprinkle with parsley. 8. Boil the pasta in water until soft then serve with the meatballs Storage: Refrigerate or freeze 53 Soft & bite sized side dishes 54 Spinach mash • 500g potatoes, peeled and chopped • 100g spinach • 60ml single cream • 20g butter 1. Boil the potatoes in a pan of water until soft 2. In a separate pan steam the spinach leaves until wilted. When cool squeeze out excess liquid 3. Blend the spinach with the butter until almost smooth 4. Mash the potato in a large bowl then stir in the spinach purée and cream Storage: Refrigerate or freeze Pepper mash • 1 red pepper, quartered with seeds removed • 500g potatoes, peeled and chopped • 60ml single cream • 20g butter 1. Roast the pepper under a hot grill, skin side up until it blackens. 2. Leave to cool then peel the skin from the pepper then blend until smooth 3. Meanwhile boil the potatoes in a pan of water until soft 4. Mash the potato in a bowl then stir in the butter, cream and pepper purée Storage: Refrigerate or freeze Hint: You could use the purée side dish recipes within this book and mash with a fork rather than blend completely 55 Soft & bite sized desserts & snacks 56 Hummus and butter biscuits For the biscuits: For the hummus: • 160g plain flour (whole wheat or white) • 1 tablespoon sugar • Pinch of salt • 80ml water • 4 tablespoons unsalted butter • 1 400g tin of chickpeas • 1 small clove of garlic • 1 tablespoon tahini • 1 lemon • Olive oil 1. Preheat the oven to 200°c 2. Line a baking sheet with parchment paper 3. Put the flour, sugar and salt in a food processor 4. Add the butter and blend until the butter is fully incorporated 5. With the mixer still running, add the water and blend until it forms a smooth dough 6. Once smooth remove the dough from the blender and divide into 4 equal pieces 7. Lightly flour the work surface then roll each dough piece into a large triangle, turning frequently to stop it sticking to the surface 8. Use a pizza cutter or knife to cut into approximately 3cm squares. 9. Place onto the baking sheet and cook until lightly browned for about 10 minutes 10. To make the hummus; drain the chickpeas and add to the blender. Peel and add the garlic and tahini with a good squeeze of lemon juice and 1 tablespoon of olive oil 11. Season with a pinch of salt and blend until smooth. Add extra lemon juice or a splash of water if needed Storage: Refrigerate hummus, store biscuits in an airtight container 57 Tiramisu • 600ml double cream • 175g pack sponge fingers • 250g mascarpone (full-fat) • 25g dark chocolate • 5 tablespoons golden caster sugar • 2 teaspoons cocoa powder • 300ml strong coffee (2 tablespoons coffee granules in 300ml boiling water) 1. Put the double cream, mascarpone and caster sugar in a large bowl and whisk until completely combined 2. Pour the coffee into a shallow bowl and dip in the sponge fingers a few at a time for a few seconds until nicely soaked but not too soggy 3. Grate the dark chocolate coarsely 4. In a large dish form alternating layers of sponge fingers, then a layer of cream mixture and topped with chocolate and cocoa powder. Repeat until all the ingredients have been used up Storage: Refrigerate for up to 2 days Flapjacks • 115g rolled oats • 55g butter • 200g no added sugar, seedless Jam (try fig, apple or pomegranate) • Dark chocolate for drizzling 1. Heat the oven to 180°c 2. Melt the butter and jam in a large pan over a gentle heat 3. Add the oats and stir until well combined 4. Press into a greased square tin or cake tin 5. Bake in the oven for 25-30 minutes until brown 6. Melt some dark chocolate and drizzle over the flapjack to serve 7. Once cool cut into small pieces 58 Apple sponge pudding • 2 large cooking apples, peeled and cored • 85g caster sugar (or swap for sweetener) • 3 tablespoons cold water • ½ egg • Finely grated zest and juice • 1 teaspoon baking powder of 1 lemon • 65g plain flour 1. Quarter the apples and place in a saucepan with
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Url: /Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Suppressing-your-breast-milk-supply-after-giving-birth-2907-PIL.pdf

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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

Your non-invasive ventilation (NIV) device: A40 Pro - patient information

Description: This factsheet explains how to use and care for your A40 Pro non-invasive ventilation (NIV) device safely at home.
Url: /Media/UHS-website-2019/Patientinformation/Respiratory/Your-non-invasive-ventilation-NIV-device-A40-Pro-3631-PIL.pdf

Your non-invasive ventilation (NIV) device: Lumis 150 - patient information

Description: This factsheet explains how to use and care for your Lumis 150 non-invasive ventilation (NIV) device safely at home.
Url: /Media/UHS-website-2019/Patientinformation/Respiratory/Your-non-invasive-ventilation-NIV-device-Lumis-150-3630-PIL.pdf

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