Notes from ‘The Road to Toddlerhood’, a one-day symposium for health professionals

Posted on Friday, October 25, 2013 by

Everyone quite obviously was looking forward to a great day. ‘The Road to Toddlerhood’ is a full day nutrition symposia hosted at Massey University’s Albany Campus. The anticipation of quality probably based on it actually being the 7th in this series of one day symposia.  The day saw several themes becoming popular points of discussion both on and off stage (during the breaks). These included toddler feeding strategies, food allergies and intolerances and eating psychology from pregnancy to toddlerhood.

The day started with Pam Von Hurst (lecturer in Human Nutrition at Massey University), introducing Professor Paul McDonald to the stage. Recently arrived at Massey to be the PVC College of Health, he welcomed attendees and speakers to the nutrition symposia. McDonald shared an inspiring perspective on where nutrition is heading.  He acknowledged the impact that social networks play in individual nutrition levels. He is looking forward to more research being conducted in relation to “Socially transmissible nutrition patterns” and no doubt also harnessing and creating correct patterns. He wants to help break bad nutritional cycles. Currently the network effect seems to currently automatically favor unhealthy eating. The key to changing he forecast is for health professionals to work collectively to combat this worrying trend. How will knowledge be transferred and managed over time? Good questions, ones that research is yet to answer. It seemed that he felt new Communities of Practice will emerge to cope with these new forms of change management and technology. How and what messages people share, needs to aid society generally but also support the need and value of professional medical advice.

The first speaker was Dr Halima Maulidi, a Developmental Pediatrician from North Shore Hospital. Her topic was ‘Normal Development’. She seemed to continue the theme that McDonald had started; health professionals need to empower patients. She suggested that the role of a health professional was in part surveillance. Specifically this needs to empowerment to maximize patient independence.

Emily Jones spoke next. Jones works as a Clinical Educator, Speech Language Therapy at Massey University. She has worked in Australia and New Zealand. Jones topic today was ‘The development of feeding skills from birth to toddlerhood’. She tackled an issue common to many households; fussy eating. She suggested being mindful of the physical environments while children consume food. Things like distractions (like TV?), cues and patterns.

At the last minute Shannon Brothers filled in for Dr Jan Sinclair who is the Paediatric Allergist from Starship Children’s Hospital. Brothers used Sinclair’s presentation on ‘Food Allergies and Intolerance’s. There was a lot of amazing content, some we seemed to breeze over for the sake of time. Hopefully there will be another opportunity to hear Sinclair speak at another event. Brothers however did a great job. There were lots of thought provoking facts. For example: 1, Israel and France have remarkably low levels of their populations with food allergies. 2, Fish allergies can in fact be air borne. 3, a historical food allergy reaction level unfortunately doesn’t necessarily correctly indicate future reaction intensity (for the better or worse). In fact, 1/3 experience a significantly different reaction compared to a recent reaction. Brothers also spoke about it now accepted that immunological responses (allergic reactions) can be delayed up to 2 hours (up from an hour). This means that the reaction peeks within 2 hours. This issue of timing seems to be one of the key differences between an allergic reaction and intolerance’s or sensitivities (which take longer to peek). She referred attendees to ACCIA for allergic reaction plans for their patients. There was a small discussion about ‘hospital challenges’ and Serum Testing (ssIgE), for working out tolerance levels.

Katrina Pace, Dietitian at Massey University gave a presentation on ‘Negotiating the Road of Allergies, Intolerance’s and Nutritional Adequacy’. She “breathes her profession due to having a family with some rather interesting adverse reactions to food”. Pace talked about the ease of availability relating to information to do with dietary issues. However, the issue is that it’s not nearly as ‘easy’ to correctly or safely interpret and sustainably implement dietary matters. Many just don’t realize the risk that their self-diagnosis or their lifestyle choice can have. For example, symptoms can be similar for multiple allergens. They may illuminate a food group that may appear to help the symptom, but may actually hide the real issue. This can cause hidden issues to compound. Pace reminded attendees that from 3 months of age, allergy testing can be conducted. One of the key takeaways was the importance of introducing diverse food types whilst children are 4-6 months. It doesn’t matter that they don’t consume much. One of the benefits is that they have had exposure to the substance while hopefully still being breast fed.

Pace discussed the important role nutritionists and dietitians pay in their patients’ lives. Always, always test before eliminating. Even seemingly obvious allergens based on patient history! The answers sometimes surprise. There is power in having correct and current information on which to base your recommendations. It is equally important to fully educate the patient. Nutrients lost with the eliminated food group, need to be sourced from elsewhere. The example given was milk allergies. Ensuring their rice milk is fortified with calcium may not be obvious to the patient unless it is pointed out. It is worth while also pointing out other sources of calcium like almonds, broccoli, tofu etc. Aside from these alternative food lists Pace encouraged attendees to give their patients details regarding support groups. We know it can be tough and isolating living with medically based dietary requirements. There is also value in giving attention to educating parents about being proactive about play-dates, birthday parties and eating out. One of the websites she recommended was www.allergy.org.au (for posters).

The afternoon sessions were chaired by Lindy Thomas, a Physiologist from Massey University. The first speaker she introduced after lunch was Dr Cath Conlon. Conlon lectures in Human Nutrition at Massey University. The topic she discussed was ‘Avoiding Fussy Eating’. The presentation challenged the audience to educate/remind parents that “language is important and labels are dangerous”. Regarding language, for toddlers she recommended open-ended questions relating to food actually aren’t as effective as giving ‘this-or-that’ type choices. They have to eat one but which, is their choice.  Regarding labels, yes they may be ‘fussy with food’ but saying it in front of them encourages it to continue. No need to continue to remind them. A balanced nutritional diet for children is the responsibility of the parent. However delegates may need to encourage parents to give their child opportunity to ‘try’ things more. Let them explore new tastes, texture even environments without the pressure of eating it all.

Thomas then introduced Linda Chard who is a Clinical Psychologist at Starship Children’s Hospital in Auckland who seemed to almost pick up where Conlon finished. The presentation was called ‘Who is in the driver’s seat? – Parenting styles and strategies’. The main thought was that families (especially parents) need to accept the role their own nutritional intake has on their children’s nutritional patterns – both now, and later in life. Parents need to reinforce desired outcomes by personally demonstration. Contexts have consequences. Chard mentioned findings now indicate more calories/nutriments are absorbed when food is eaten at meals, rather than at snakes. Recommended reading about this was French Kids Eat Everything by Karen Le Billon. Le Billon had fussy kids. The book is about her experience visiting relatives in France with her young family in tow, while realizing that ‘French kids had a different relationship with food’. Snacking less and welcoming the opportunity to ‘try’ new things. It has been added to our own ‘must read’ list! It was also mentioned that physical and social environments play an important part to nutrition. Physical cues like a highchair or dining table need to represent calm and enjoyable experiences which are centered on food.

The next speaker was from Starship Children’s Hospital too. Kim Herbison is a Paediatric Dietitian and she spoke on ‘Food-based strategies to improve nutritional status of toddlers’. Herbison agreed with the importance of social in nutrition. In her opinion “food is socially transmitted”. Her very practical presentation had recommendations to help parents decide what, when, how and where they feed their children. But that is OK to let the child decide how much. Many parents say this is difficult because, how do you know when they have had enough? Herbison said it’s often less then we realize. Her tips were using visual cue of everyday items like an iPhone.

For example for toddles:
1/3 of an iPhone is enough red meat or pate
2/3 of an iPhone is enough cheese, chicken or egg
1 iPhone is enough fish, lintels or baked beans

For young children Herbison recommends iron rich foods should be amongst the first they eat. To help this be absorbed consume dairy at different meals.

The last speaker for the day was lecturer Claire McLachlan a Professor of Childhood Education at Massey University. Her presentation was very informative. The topic was ‘The role Early Childhood Education Centres in the development of nutrition and physical activity in toddlers’. In the 3 years early childhood teachers spend in training, they literally have one single hour of teaching assigned to nutrition! Shocking, especially considering how many provide snakes and noon meals. The centres have regulations and SOP’s, but often these are about recording what is provided and accessibility to water. Some may detail that food must have a healthy heart tick. This news seems to amplify the earlier presentations. That the nutritional messages of health professionals need to not only reach the families they work with, but extend into the communities at large too. Hopefully the technology and Communities of Practice that Professor McDonald mentioned will be able to assist the likes of our Early Childhood Centres soon. From our perspective it is scary to think they are so ‘uneducated in nutrition’ considering the percentage of young children who live with food allergies.

I believe the key takeaways from ‘The Road to Toddlerhood’ full day nutrition symposia included feeding practices, parent styles and evidence for emerging best practice. We would recommend attendance to similar events, the quality of the presentations was very high and the content presented in ways which would make it easy use.

Note: The above discussion is based on notes written as a delegate at the symposia and is not intended as advice. We recommend you speak to a medical professional about unique dietary needs.