Growing Up Healthy is a handout

for each child age and stage (0-6)

that parents receive through their

public health nurse at child health

clinic (CHC) appointments. It has

been available for years

but the recent editions

are exciting resources!

This latest revision to

the Growing Up Healthy

series is a multidisciplinary effort

from many—Ministry of Health,

public health nursing, nutrition,

speech and language, health pro-

motion, First Nations & Inuit

Health, dental health, psychology

and the Prevention Institute

among others.

Growing Up Healthy offers advice on

many infant and child concerns as

well as tips for parents. Included are

sections on nutrition, sleep, play,

pee & poop, feeding, bath time and

so on. There is also a QR code that

links to the entire series of handouts

and websites for more information.

The review of Growing Up Healthy

brought experts together regularly

to debate topics and consider the

most recent national guidance. Its

strength is the collaboration that

created these client centred

resources.

The foundation for nutrition content

are many evidence based technical

documents including, Nutrition and

Growth Assessment Manual for Infants

and Children 0-5 (NAMIC) and Nutrition

for Healthy Term Infants 0-6 months

and 6-24 months.

NAMIC is a resource developed by

the early childhood nutrition

committee (ECN) of the Public Health

Nutritionists of Saskatchewan. It

provides population based

statements and is a technical

nutrition manual to

support public

health nursing and

other health

professionals.

Nutrition for Healthy Term Infants is a

Health Canada document for health

professionals outlining evidence-

informed principles

and recommendations.

Provinces, territories &

health organizations

use it as a base to develop feeding

guidelines for parents and

caregivers in Canada.

There has been a concerted effort

to review all the standards and

statements for child health in the

last few years to ensure that there

is consistency between national

recommendations, NAMIC, CHC

protocols and all related materials.

NAMIC (2009) is currently under

revision and CHC protocols have

been revised and piloted. In 2014,

this exciting work will be rolled

out!

Work to develop early childhood

guidelines and statements

continues to be collaborative.

Many groups and professions

work to review and develop

position statements and

guidelines that are evidence based

and best practice. (Also visit the

Canadian Pediatric Society, which

has professional resources and see

Caring for Kids for parent info).

NAMIC and the CHC Nutrition &

Growth Protocols have the same

messages. Both are informed by

science, best practice and client/

professional needs. The work

offers consistent messaging

throughout the province. There is

information about growth (height

& weight), milestones (being able

to sit, walk, talk), eating behav-

iours and client based resources

that support parents and families

to raise healthy children.

For Growing Up Healthy handouts go to: www.health.gov.sk.ca/early-childhood-development

NUTRITIONNUTRITIONNUTRITION UPDATEUPDATEUPDATE A newsletter for professionals

Volume 16 Issue 1 March 2014

Developed by the Public Health Nutritionists of Saskatchewan

Child Health Clinics (CHC) support parents and caregivers of children 0-5 years of age by providing a family centred approach to caring for and raising healthy children.

Growing Up Healthy

Routine skin or blood testing before a

first ingestion is discouraged. There is a

high risk false-positive results, which is

confusing and may lead to unnecessary

dietary restrictions.

The recommendations apply to all babies

including those defined as high risk* for

allergy. If an infant has a confirmed food

allergy, it is recommended the caregiver

consult with a health care provider.

* High risk defined as: a first-degree relative

(parent or sibling) with a diagnosed allergic

condition such as atopic dermatitis, a food

allergy, asthma or allergic rhinitis.

Q Should children under 2 years

of age have plant-based beverages?

A Soy, rice, almond, or coconut and

other plant-based beverages are NOT

recommended for children under two

years of age. These are not intended for

consumption by children under two.

Plant-based beverages may or may not be

fortified with important nutrients, such as

calcium and vitamin D, but none contain

the amount of nutrients the infant and the

toddler requires.

These beverages are often low in protein

and fat and high in manganese. This can

result in insufficiency and deficiency for

energy and/or protein; retarded growth;

fat and muscle wasting; or developmental

delay.

Soy or rice beverages can be introduced

after the age of two but toddlers this age

are still growing/developing so caregivers

still need to ensure children are offered a

wide variety of healthy foods. Plant-based

beverages do not replace the nutrition in

cow milk; they are not milk. Only soy is a

milk alternative for those 2 years and

older in Canada’s Food Guide.

Call a Registered Dietitian...

if you need an alternative to breast milk,

commercial infant formula, or whole cow

milk and if children are fed vegetarian or

vegan diets to ensure that their nutritional

needs are met!

NUTRITION UPDATE Page 2

Q What does DOR - division of

responsibility mean?

A Division of responsibility is a term

coined by Ellyn Satter and is used to talk

about infant and child feeding.

The basics are that parents are responsible

for offering food - it is adults who choose

what to buy and serve on the family table.

Babies and children decide what they eat,

how much they eat and if they eat all from

what YOU put on the table. Simply, this is

baby led feeding.

Infants and children know when and how

much to eat. When hungry, they are good

at showing us - from birth! Hand sucking,

restlessness, open mouth, reach for breast,

lean forward/toward food and reaching for

food. They also show when they are full

or not interested; they lean back, turn their

head away, push the spoon away or close

their mouth.

Children may choose not to eat but adults

still need to set structure and boundaries.

It helps avoid mealtime battles. Do not be

a short order cook - children choose from

the meal on the table. It is best not to push

or withhold food, bribe or to use food as a

reward regardless of age.

Infants and children learn about food and

feeding from parents, siblings and family

members. Encourage, offer, allow choice,

let children self feed and include them in

food prep and table setting as appropriate.

Be calm and firm. Offer family foods and

children will learn to eat from the family

food choices. Enjoy mealtime and if you

have questions call your local dietitian or

nutritionist.

Q What are the recommendations

for allergy prevention in infants?

A Food allergies can occur when the

immune system mistakes a particular food

as harmful. Once a person develops a food

allergy, allergic reaction occurs each time

that food is consumed. Tolerance can be

built and children do outgrow some food

allergies, especially if the allergy started

before age 3.

What are the recommendations?

The Canadian Paediatric Society and the

Canadian Society of Allergy and Clinical

Immunology recommend the following to

prevent allergy in infants, including those

considered at high risk*

Pregnancy

Eat a variety foods and include peanuts

eggs, milk, and other potential allergens

during pregnancy. Avoiding a specific

food does not prevent allergy in infants

and children.

Restricting foods or food groups can

lead to maternal undernutrition. The

potential harm to a developing infant

may be significant.

Breastfeeding

There is no need for moms to restrict

foods while breastfeeding. There is no

evidence to show this prevents allergic

conditions in babies.

Breastfeed exclusively for the first six

months of life.

Continue to breastfeed as solid foods

are introduced. The longer a mother

breastfeeds, the better protection for

baby.

Introducing Solid Foods There’s no reason to delay introduction

of potential allergens. A delay of those

foods may actually increase the risk of

developing a food allergy.

A variety of foods including fish, eggs

and nut/peanut products can be offered

starting at about 6 months.

Offer these foods regularly (several

times a week) to build and maintain

immune tolerance.

Ask a NutritionistAsk a Nutritionist

Learning to eat includes: seeing what adults eat looking at food smelling food and touching food tasting and spitting tasting and swallowing eating one bite and stopping changing his mind about what he likes

NUTRITION UPDATE Page 3

World Breastfeeding Week

August 1-7, 2014 (October in Canada)

World Breastfeeding Week (WBW) was started in 1992 by

the World Alliance for Breastfeeding Action (WABA) and is

a global strategy to promote breastfeeding. It is celebrated the

week of August 1-7 each year, to commemorate the Innocenti

Declaration. It now involves more than 170 countries and is

endorsed by UNICEF, WHO, FAO and IPA. In Canada we

celebrate the event annually during the first week of October.

The theme this year “Breastfeeding: A winning Goal - for

Life!” asserts the importance of increasing and continuing

the protection, promotion, and

support for breastfeeding

Objectives in 2014 are to call

attention to the importance of

STEPPING UP the actions to

protect, promote and support

breastfeeding as a key stone

intervention at the population level and in primary care. It is

also important to stimulate interest among young people to

see the relevance of breastfeeding in today's changing world.

www.waba.org.my

Canadian Paediatric Society Position Paper

Dietary Exposures and Allergy Prevention

in High-risk Infants

Infants can try all foods as early as 6 months!

The Canadian Paediatric Society (CPS) published its position

statement (December 2012) on allergy prevention in high-risk

infants. This position statement summarizes the changes to the

allergy prevention guidelines for those who are not fully aware

of them. This statement also complements current anticipatory

guidance offered to families in public health.

Infants may eat peanuts, eggs and other potential food

allergens as early as six months.

Allergies have become common in Canada and many daycares,

preschools and childcare centres have banned peanuts. It was

thought that delaying the introduction of certain ‘trigger’ foods

would help prevent food allergies. Instead, research has found

that food allergies actually went up with that recommendation.

Rather than avoiding peanuts, fish, and eggs until an infant is

older, CPS recommends parents introduce and include these

foods right from the time infants start solids at about 6 months.

It is important however, that once these foods are introduced

they be offered to the child on a regular basis (several times a

week); given how the immune system works, regular frequent

oral ingestion helps maintain immune tolerance.

CPS also advises against avoiding milk, eggs, peanuts or other

foods while pregnant or breastfeeding; there is no evidence that

avoiding foods during pregnancy or breastfeeding helps prevent

allergy in children either. If a mother does have a diagnosis of a

specific food allergy, then she would have to avoid that food for

her own health and she can talk to a Registered Dietitian to help

plan a healthy diet. There are risks to health for avoiding foods;

maternal undernutrition or potential harm to the unborn infant.

CPS statements: www.cps.ca

Parent handouts and information: www.caringforkids.cps.ca

March is Nutrition Month

“Simply Cook and Enjoy!”

Nutrition Month 2014 aims to show Canadians

that eating healthy at home does not have to be complicated.

During the month of March, Registered Dietitians, your food

and nutrition experts, serve up practical advice and delicious

recipes to help bring home the message that healthy eating is

simply the best!

The national Nutrition Month campaign is brought to you by

Dietitians of Canada http://nutritionmonth.ca

TIP:

Engage kids from a young age. You

will be surprised at how capable they

can be, from cracking eggs to tossing

salads to working pizza dough.

Nutrition Month website is brought to

you by the Dairy Farmers of Canada

www.dairygoodness.ca

NUTRITION UPDATE Page 4

Contributors for this issue include members of the Early

Childhood Nutrition Committee of the Public Health Nutritionists of Saskatchewan Working Group:

Johanna Bergerman Tracy Bielinski Audrey Boyer

Chelsea Brown Danielle Campbell Jadwiga Dolega

With assistance from consultants Laura Matz

Eunice Misskey Naomi Shanks

This newsletter is distributed three times annually to health

professionals, educators, community leaders and others.

It is designed to provide up-to-date nutrition information and highlight

important initiatives and resources.

We welcome letters and contributions from our readers.

Please send correspondence to:

Jadwiga Dolega Public Health Nutritionist

Early Childhood Committee Chair

Provincial Nutrition Newsletter Committee

NAMIC 2013 The Early Childhood Nutrition Committee (Public Health

Nutritionists of Saskatchewan) are currently updating the

Nutrition and Growth Assessment Manual for Infants and

Children 2009.

This professional resource is being revised to include the

WHO growth chart standard and the most recent literature.

This edition will also include an updated 2-5 years section.

Watch for information from the public health nutritionist in your health region.

BREASTFEEDING ON THE WORLDWIDE AGENDA

UNICEF published a report called Breastfeeding on the Worldwide

Agenda. This report reflects on why strong scientific evidence

about the benefits of breastfeeding has not translated into political

and donor commitments at the global level and in high burden

countries.

In developing countries, scientific evidence suggests breastfeeding

of infants under the age of one could prevent a million deaths of

children under the age of five. Despite the evidence, global breast-

feeding rates remain low with only 36% of children under 6 months being exclusively

breastfed.

Findings from a landscape analysis identified 3 main issues: the lack of a common agenda

with a shared vision of change, a significant gap in leadership and ineffective advocacy

and communication.

The report finds that for most organizations breastfeeding features more strongly in policy

and strategic frameworks than in actual programming and implementation.

A global initiative is needed to address these issues. Such an initiative needs to focus on

advocacy, leadership, and social mobilization.

The report is on the WHO website on the East Asia and Pacific page. www.unicef.org/eapro

Link to the report: www.unicef.org/eapro/breastfeeding_on_worldwide_agenda.pdf

Resource Corner

Local Contact:

Melanie Warken, B.Sc., R.D.

Public Health Nutritionist

Five Hills Health Region

(306) 691-1536

melanie.warken@fhhr.ca

https://twitter.com/MelanieWarken

WHO Growth Chart Training Program WHO Growth Chart Training Program is an evidence-based,

self-learning package for health practitioners. A collaboration

of: Dietitians of Canada, Canadian Paediatric Society, College

of Family Physicians of Canada, Community Health Nurses of Canada, the National

Aboriginal Health Organization, and the Canadian Obesity Network.

The program is free and contains five modules. Each module takes about 45-60 min-

utes to complete at a time, place, and pace convenient for the individual.

Education credits are available. See Dietitians of Canada website: www.dietitians.ca