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At what age should I introduce solid foods?

At what age should I introduce solid foods?Feeding child

The American Academy of Pediatrics (AAP) currently recommends gradually introducing solid foods when a baby is about 6 months old.1

**Always consult your metabolic healthcare professional before introducing new foods or changing your child’s low protein diet.

How do I know if my baby is ready to eat solids?

The following tips may help2

  • Is your baby’s tongue-thrust reflex gone or diminished?
    This reflex prevents infants from choking on foreign objects, but also causes them to push food out of their mouths. Ask your pediatrician or metabolic dietitian.
  • Can your baby support his/her own head?
    To eat solid food, an infant needs good head and neck control and should be able to sit up unassisted in a high chair.
  • Is your baby interested in food?
    A 6-month-old baby who stares and grabs at your food at dinnertime is clearly ready for some variety.

What should I know about first foods?

Until now your baby is only used to liquids so it is essential that the first foods offered are a smooth, runny purée. First solids should be bland, easy to swallow and easy to digest. Your baby can progress to a thicker purée once they become used to the runny texture.

What types of food should I offer?

Check with your metabolic dietitian which foods are best for your baby.  Most parents begin with rice cereal mixed with formula and gradually introduce other foods. Homemade purées are inexpensive and easy to make. Fruit and vegetables can be cooked in a small amount of water until soft and then puréed using a hand blender or food processor. Ready-to-eat first foods and baby cereals are also available in the grocery store. Once you have introduced single purees to your baby you can try mixing different combinations for variety e.g. sweet potato and carrot, or apple and pear.

How much should I give my baby to eat?

At first, only offer very small amounts (about 1-2 teaspoons at a single meal). Gradually more food can be offered. When your baby is taking a reasonable amount of solids at a single meal (about 6-10 teaspoons) you can introduce solids at a second meal in the day and then at a third.

Suitable Low Protein Baby Foods2

6-8 Months Old

  • Apple sauce
  • Very small pieces of soft fruit
  • Some cereals
  • Soft cooked vegetables such as carrots or squash

9-12 Months Old

FRUITS

Fresh

  • Wash thoroughly.
  • Remove skins and seeds.
  • Cut into small, bite-size pieces or thin sticks (i.e. quarter grapes).
  • At one year, include unpeeled ripe fruits, berries, pears and nectarines.

Frozen/Canned

  • Look for fruits packed in their own juices.
  • Avoid fruits canned in heavy syrup.
  • Frozen fruits are soothing to teething gums.

Dried

  • Pitted or seedless prunes, apples, apricots, peaches, and dates.
  • Avoid raisins, which can cause choking.

Examples: Apple, Apricot, Avocado, Banana, Berry Grape, Kiwi, Mango, Melon, Nectarine, Orange, Papaya, Peach, Pear, Plum.

VEGETABLES2

Vegetables can be served hot or cold, but all will need to be cooked.

Fresh

  • Wash thoroughly.
  • Raw vegetables are difficult to chew, swallow, and digest.
  • Cook until tender and easily pierced with a fork.
  • Cut into small pieces, long thin strips, or grate.

Canned or Jarred

  • Be careful of the amount of sodium, choose low sodium if possible.
  • Rinse the can or jar before opening.
  • Can be served directly from the can, cut to appropriate size.

Frozen

  • Must be cooked until tender and cut to appropriate size.

**Be sure to discuss PHE or protein tracking an your child’s daily allowance prior to proving any new foods.

References:
1. American Academy of Pediatrics Web Site. Web. 03 Mar. 2010. http://www.aap.org/
2. Eat Right Stay Bright. Guide for Hyperphenylalanemia. L Bernstein and C Freehauf. Chapter 1. Pages 56-58

Eating Out on a Low Protein Diet

Although it can be easier to prepare low protein meals at home, this can restrict your work and social activities. Fortunately, many eating places are beginning to realize that an increasing number of people follow “special diets”.

Many of the larger restaurant chains state that they will try and cater for customers on a special diet whenever possible. To get further information from a particular company contact their Customer Service helpline or check their website.

RESTAURANT TIPS

  • Try and give advanced notice to the restaurant whenever possible
  • When explaining your diet, try not to get caught up in a long list of “I can’t have” foods
  • Offer a few ideas of possible dishes you can eat and recipes if necessary
  • Ask if you can bring in your own low protein products such as pasta or pizza bases if this is suitable

EATING ON THE GO
1. Cafes/sandwich shops

Small cafes that make things up from scratch can prove useful (especially if they get to know you!).  Ask if nutritional information is available to find out ingredients /protein content of items.

Possible snack ideas

-Salad
-Fruit
-Tomatoes on toast*
-Chips*
-Jacket potato* and butter

2. Fast food outlets

Some larger, well known fast food chains, provide nutritional content leaflets  for customers in the shop or online access nutrition information.

Possible snack ideas

-Salad (if available)
-Chips*
-Onion rings*
-Hash browns*
– Most veggie burgers are NOT suitable, as they are high in protein.

3. Cafeterias at work or school

Some cafeterias can be quite flexible so it is worth asking if they can cook or re-heat some of your low protein foods. If the cafeteria food choices are limited it may be easier to take a packed lunch in.

Possible snack ideas

-Salad/vegetables
-Fruit
-Baked Potato (avoid mashed potato as it is likely to contain milk)
 *Weigh out as usual

Note: Each condition may vary in tolerance for specific foods that contain protein, even if low in protein. Always speak with your metabolic dietitian or healthcare provider before adding new foods or changing your metabolic diet in any way.

Exploring Exotic Fruits and Vegetables

Exploring Exotic Fruits and Vegetables

You can tell summer is approaching by the increased variety of fruit and produce at your local supermarket. Exploring new fruits and vegetables can add excitement and variety to a low protein diet. Most fruits and vegetables are naturally low in protein and can be included in meal plans that limit phenylalanine or other amino acids.

Many fruits and vegetables we consume today were once considered exotic, but are now readily available. By exploring new items, you can open the door to new low protein foods, recipes and improved nutrition. Fruits and vegetables are a good source of fiber and other nutrients needed to maintain a healthy diet. Below are some of our favorite fruits and vegetables that can spark your culinary imagination, increase fiber intake and add a new twist to an ordinary low protein meal.

Star Fruit (Carambola) 1 medium (91g) Protein 0.9g PHE 33.7mg LEU 70mg Fiber 2.5g Kcal 28
Star Fruit, also known as Carambola, is a juicy tropical fruit grown in Thailand and throughout Southeast Asia. It is also grown domestically in Hawaii and Florida, so it is readily available at your local grocery store. This exotic fruit is both fun and nutritious. When you slice through the yellow shiny skin, it resembles a 5 pointed star and is packed with fiber and vitamin C. Add it to a fruit salad or enjoy it sliced for a sweet, crisp, and refreshing low protein snack.

Figs. 1 medium (50g) Protein 0.4g PHE 9mg LEU 17mg Fiber 1.4g Kcal 39
Figs are a great way to add flavor and fiber to a meal. Figs are sweet in taste and can be diced and tossed into a salad or made into a spread to add flavor and excitement to low protein bread or scones. Besides the delicious, sweet taste, one medium fig contains 1.4 grams of fiber, an abundance of minerals and only 9mg of PHE. They can be found fresh in season or dried all year round.

Jicama. 1 cup (130g) Protein 0.9g PHE 20mg LEU 33mg Fiber 6g Kcal 49
Jicama is an often forgotten low protein food. It is a root vegetable that is native to Mexico and Central America. It has a crisp texture and when sliced open resembles a raw potato, but with much less PHE. Complete a summer meal with sliced Jicama, chili powder and a splash of lime juice for a crunchy side dish at your next barbeque. Check out Celebrity Chef, Bobby Flay’s recipe for Jicama Slaw that can be found on the food network website at www.foodnetwork.com.

Kiwi Fruit. 1 medium (76g) Protein 0.8g PHE 21mg LEU 43mg Fiber 2.6g Kcal 46
Kiwi Fruit is a good example of an exotic fruit that has become more available in local food markets. Also known as Chinese Gooseberry, once native to China, Kiwi is now grown in New Zealand, Israel, Italy and domestically in California. This little green fruit makes a great addition to fruit salads and can be diced and tossed over greens to add flavor to a salad.

Mango. 1/2 cup (83g) Protein 0.4g PHE 14mg LEU 26 Fiber 1.5g Kcal 54
Some call mango the king of tropical fruits. We call it a great low protein snack. Mango can range in colors but all have a sweet, soft texture when ripe. You can be creative with this fruit and add to low protein rice, splash with spicy seasonings or chop into a salad.

The following recipe was created by Chef Birch DeVault, MEd, Department Chair of Culinary Arts at Johnson & Wales University, Denver, CO

JICAMA AND MANGO SALAD

NUTRITION:
Per Serving: 1/8th recipe Protein: 1.4g PHE: 37mg LEU: 53mg Kcal: 125

Ingredients:

  • 2 small (730g) jicama, peeled, cut into julienne strips
  • 3 cups (495g) mango, peeled, sliced
  • 1 each (14g) jalapeno, seeded, diced fine
  • 1 each (80g) red onion, peeled, minced
  • 1 clove (3g) garlic, minced
  • 1.5 fl oz orange juice
  • 1 fl oz lemon juice
  • 2 each (152g) kiwi, peeled, sliced
  • 2 tablespoons (27g) olive oil
  • To Taste salt and pepper
  • 1/2 cup (8g) cilantro – chopped

Method of Preparation:

  1. Mix garlic, orange and lemon juice, cilantro and olive oil. Season with salt and pepper.
  2. Add remaining ingredients, toss lightly.
  3. Divide in 8 servings and Enjoy!

Click here to view More Low Protein Recipes

Nutrition information obtained from the following sources: USDA nutrient database; Low Protein Food List for PKU by Virginia Schuett; The Food Processor, ESHA Research; MSUD Foodlist, Emory University; Manufacturer’s packaging. Household measurements are approximate, for greater accuracy use a gram scale.

What is PKU?

What is PKU?

If you have PKU or your child with phenylketonuria is older, you may think this is a silly question, but even though you are living with and managing this metabolic condition on a daily basis, you may not completely understand what PKU is or be able to explain it to others.

There are some terms that you may or may not be familiar with. Learning these key terms will help you better understand or better explain why you follow a special low protein diet.

Art: In “medical terms’ Phenyketonuria (PKU) is an autosomal recessive genetic disorder that results in incomplete phenylalanine metabolism.

But in “REAL TERMS” what does this mean?

Let’s break it down:
Autosomal: a chromosome other than an X or Y sex chromosome
Recessive: a trait that appears only when a gene has been inherited from both parents
Genetic: hereditary characteristic that you get from your parents
Disorder: an abnormal condition
Phenylalanine: an essential amino acid (must be consumed, the body doesn’t make it) commonly referred to as “PHE”
Metabolism: the process in which your body breaks down particular substances

So in REAL TERMS:
PKU is an inherited genetic disorder that prevents the full breakdown of phenylalaine.

Did you know: (image) When phenylalanine builds up in the blood it is excreted in the urine as phenyketones. That is how this condition became known as PhenyKetonUria or PKU for short.


Posted by: Sandy Simons, MA, RD, CHES

Sandy is a Registered Dietitian and Certified Health Education Specialist. She received her graduate training at Columbia University’s Teacher College in New York. She has been working on the industry side of metabolic nutrition for the past 11 years and is often seen at patient events around the country. This post is also found in a book written by Sandy with the help of others titled: My PKU Toolkit: A Transition Guide to Adult PKU Management.