Transitions…

You don’t have to tell me that change is hard. I have trouble eating something different for breakfast each day; I’m the queen of routine. The last few weeks have been especially difficult at home; So much so that we needed to put our heads together to figure out the reason for the increase in whining, tantrums, regression, and just plain cruel behavior. Once we started reflecting, we realized how many changes the kiddos have incurred in the last month. They have started to independently get dressed (picking out clothes to putting them on), wiping themselves, saying goodbye to Pull-ups at naps, starting swimming lessons at a new location, and the biggie- bidding Uncle JD farewell as he continuous his academic and professional journey in Chicago.

IMG_2355 (1)

What is it about change and transition that is so hard?

We are creatures of habit and change takes more energy, especially emotional and mental energy. Pediatric behavioral specialists believe the primary reason is because it requires that we stop something we enjoy and feels comfortable, in order to, do something very different that we need to do and may not want to do. Many of the negative consequences related to transition, even simply transitions like leaving the park or putting away a toy, require intense emotional management. Since strong emotions like anger, anxiety, frustration and sadness require practice to explore and manage; young children simply haven’t had the time or experiences to learn how to do it well. Our youngsters often look to us- their parents and caregivers- for tips on managing transitions; if we throw tantrums, they will, too. I often catch myself whining, complaining and throwing a pity-party from time-to-time and this negativity is as contagious as the common cold. I try to remind myself that like most things in life, prevention is the best medicine.

How can we help?

Create boundaries with freedom. We all know that people thrive in routine; perhaps because we have the comfort of predictability. I have found that if I set boundaries, create a structured schedule or routine and then grant freedoms within the structure, the kiddos flourish. For example, we eat and sleep at the same times every day but, what we do between these marker-activities is up to the children. Another example, we enjoy four different food groups at every meal: Protein, Grain/Starch, Vegetable and Fruit, but the V5 get to collectively- or individually- decide what we eat.

Prepare for change. We often give several countdowns to transition such as 15-minutes until clean-up time or 5 more minutes in the bath tub. If we’re at the park, they also always know that they get “one-more-thing” and after the last thing, we head to the car. These countdowns are more difficult with big changes, such as moves, starting school, surgeries, etc. From my perspective, you don’t want to start mentally preparing children too early where it can breed anxiety but also want to allow for adequate time to process. Any suggestions from our readers?

Transition Tunes. Life can be better as a musical. Certain activities lend themselves to a soundtrack such as cleaning up toys (clean-up song playlist); we love Daniel Tiger’s Clean, Pick-up, Put-away song. We also sing songs as we head upstairs for nap. We are always open to new tunes, so send them our way.

Visual Cues. It often amazes me how disoriented our children are to the days of the week. Nana B created a color chart for us which has a color for each day of the week. Each of the V5 has their own color and thus their own day. We try to celebrate each day by wearing the color of the day:

  • Lucky Lily Green Monday
  • Cool Blue Dude Tuesday
  • Purple Princess Bella Wednesday
  • Red Rosie Thursday
  • Orange-You-Glad-You’re-The-Only-Boy Friday
  • “Play-doh Rose” Pink Saturday
  • K-Mae Yellow Sunshine Sunday

It truly lends itself to a colorful wardrobe and the children have learned the days of the week. Frank also added little pictures of Nana, Uncle JD, himself and I to the chart so they would know who their primary caregiver was for the day. This was uber-helpful and cut-down on the number of questions each day.

Consistent Consequences. This is a difficult strategy for us. We have our go-to consequences based on our stoplight approach:

  • Green Light: you get a smiley at the end of the day. After three smileys, you get to pick from the prize bucket.
  • Yellow light: Verbal warning and a 2-minute time out
  • Red light: 2-minute time out and lose a toy

But, what happens when they earn several red lights? Or, the caregiver becomes so weary that they can’t keep up and thus be consistent. This is where we struggle. When the number of bad choices outweigh the good, it is tough to remain positive and thus reward the good choices with verbal praise, stickers, etc. I think this is when it’s necessary to let the little lights shine and truly make a big deal out of the good choices so, they can encourage more good choices but also fuel positivity so we all don’t become frowny brownies.

IMG_2184

Catch Quality Zzzz’s. Quality, routine sleep is definitely good medicine for physical, mental and emotional health. Life can get in the way of adequate sleep but it is well worth shifting priorities to achieve it.

 

Trick, Treat, or Teaching Opportunity

Halloween can be a scary time for more reasons than the goblins and spooky ghosts. Halloween seems to kick-off the season of treats beginning with the tempting sweets that line the grocery store aisles. Many parents dread Halloween due to the amount of candy that their child drags home after a long night of trick-or-treating.  However, I am looking forward to this teaching opportunity.

img_1380

Many of you know that food, nutrition and overall wellness are near and dear to my heart. I love equipping and empowering people in their health pursuits… especially my children. Trick-or-treating is a great time to teach moderation. There is a growing body of research that encourages families to mark no food as forbidden. Ellyn Satter encourages parents to help their children to, “Learn to manage sweets and to keep sweets in proportion to the other food [they] eat.” Moderation can be a difficult concept to grasp, but it is a lesson worth learning. According to research, treat-deprived children often end up weighing more later in life due to hoarding forbidden foods. I appreciate these findings but also recognize that these lessons need to be age-appropriate.

At three years young, my kiddos still are led by their frontal lobes (aka Impulsivity) therefore, we have tailored the moderation conversation to one of “wants” versus “needs” and “wants” have a time and a place. Since candy and sweets are unnecessary “wants,” my children have never had any. We don’t have any in the home so, if they encountered a candy bar on the street they wouldn’t know what it is. This is intentional because I know the power of sugar and I also know the consequences. Sugar is a sweet and silent killer that is a great contributor of morbidity and mortality around the world. Because of this I often associate excess sugar with excess alcohol or even smoking. As parents, we are guides and guardians for our children. We are blessed with the opportunity to guard their hearts, minds, bodies and souls until they are able to “digest” the media and message and then tasked with helping to guide them through this muddy world.

This does not mean my children will never have the pleasure of candy; recall those that are deprived often become the secret hoarders. Instead, we will continue to be intentional about when, where, why and how we introduce these types of foods and experiences. I also feel led to set others up for success that is why we will continue to be the weirdo house on the street that does not handout candy, but rather an allergen free snack. There are also a host of other food and non-food alternatives including…

Non-Food Alternatives:

  • Stickers
  • Glow sticks
  • Play dough
  • Rings
  • Toothpaste/Floss/Toothbrush
  • Pencil/Erasers
  • Seasonal Post-it’s
  • Bubbles

Food Alternatives:

  • Gum
  • Granola Bars
  • Pretzels/Crackers
  • Popcorn or Puffed Corn

So, with moderation in mind may the force be with you as we forge into the season of sweets and continue to guard and guide our children in the days to come!

Double Time

It’s double time!  For those bandies and musicians or Tae-bo pros out there, you know this means it’s time to pick up the pace.

During the 2nd trimester, from weeks 15 to 20, babies double in size. So, you can imagine that the nutrient needs of both mom and babies alsoescalate. There are a variety of methods to determine how many calories are ideal during pregnancy. There are estimated energy requirement equations, some just say 300 extra calories and 30 extra grams of protein per day, and others encourage moms to add 500 calories per fetus and 25g protein. I, personally, think it is best to consume the amount of calories that promotes the ideal weight gain per week. For a mom of high order multiples it is 2.0-2.5 lbs. per week.

I was able to gain this at 3,000 Calories per day during the first trimester. This was a true blessing because with the nausea there was no way I was going to get to the original 5,000-calorie estimation. During weeks 13 to present, I have watched this weight gain slow-down, so I know it’s time to bump up the kCals. I really was quite surprised that there were not any meal plan examples- that I could find anyway- on the Internet. My best resource was in Dr. Barbara Luke’s book, “When you’re expecting twins, triplets, or quads.” This is where I derived the information regarding calorie and food group goals. Since there seems to be a gaping whole on the World Wide Web, I thought I’d go ahead and fill it.

Below you will find recommendations for calories, macronutrients (carbs, protein and fat) and suggested food group goals during pregnancy. While this information is targeted at high order multiple pregnancies, it is of course applicable to any pregnancy.

Calories goals may vary from 3,000-5,000 Calories per day, and I recommend watching your average weight gain from week-to-week to be sure you are getting enough. The composition of these Calories is important and different than the recommendations for the average American. Typically, it is recommended to consume a daily diet composed of 50-55% calories from carbohydrate, 15-20% calories from protein and 25-30% calories from fat. However, during pregnancy with super twins it is recommended to consume 40% of calories from carbohydrate, 40% calories from fat and 20% calories from protein. The reduction in calories from carbohydrate, I presume is to decrease one’s risk of gestational diabetes, which is much higher in pregnancies with 3 or more. Per Dr. Luke, this breaks down to the following:

Nutrients

3,000

3,500

4,000

4,500

Protein

 150g

176g

200g

225g

Fat

 133g

155g

178g

200g

Carbohydrate

 300g

350g

400g

450g

Food Groups

Servings per day

Lean Protein

4

5

5

6

Dairy

4

8

10

12

Grains

8

10

12

12

Fat

5

6

7

8

Fruit

7

7

8

8

Vegetables

4

4

5

6

This type of meal plan is quite different than my pre-pregnancy diet, so my typical pattern is a bit different. For example, prior to pregnancy I ate very little dairy and meat/poultry and the majority of my protein came from beans, peas, lentils, whole grains, and fish. It has been easiest for me, and my mild lactose intolerance, to add the lean meats versus 8-10 servings of dairy per day.  Also, before pregnancy I ate a lot of veggies and not so many fruits, so I continue to consume only 2-3 fruits per day and 8-plus servings of vegetables.

As mentioned previously, I have been consuming 3,000-3,500 Calories per day so I decided to share a few meal plans, or as RD’s call them “Typical days” to help make these recommendations real.  There are a few original high calorie, high protein recipes in the meal plans that I will add later. If you’re interested check back because I will be adding a recipe section to my blog. Also, I did not comment on the variety of supplements that I believe are a crucial safety net, so look out for that content coming soon!

Day 1

(3,065 Calories: 316g Carb, 92g Fat, 175g Protein)

Breakfast

  • Breakfast Taco Dip
    • ½ tsp Olive Oil
    • 1 Organic Egg
    • ½ Avocado
    • 4oz 0% Plain Greek Yogurt
    • Lentil Loaf (Recipe coming soon)
    • 2 Hard Shell Tacos, broken into chips
    • Up Your MassBanana Smoothie (Recipe coming soon)

AM Snack

  • Fruit and Yogurt Parfait with Granola
    • ½ cup Fresh berries
    • 1 cup Low-fat Vanilla yogurt
    • ¼ cup Nutty Granola

Lunch

  • Turkey and Avocado Sandwich
    • 2 slices Homemade Whole Wheat Bread
    • 3 oz Oven-roasted Turkey Breast*
    • ½ Avocado
    • 1 cup Fresh Spinach
    • 2 Clementines
    • ½ Cup Baby Carrots

PM Snack

  • Oat and Nuts Cereal
    • 1 ¼ C Oat Cereal
    • 1 C Unsweetened, Organic Soy Milk
    • ¼ C Roasted Pepitas
    • ¼ C Slivered Almonds

Dinner

  • Basil Mac & Cheese (Recipe coming soon)
  • 12 medium shrimp, cooked
  • 1 C Asparagus Spears
  • Skinny Cow Ice Cream Sandwich

Evening snack

  • PowerBarHarvest Peanut Butter Chocolate

Day 2

(2,993 Calories: 319g Carb, 94g Fat, 171g Protein)

Breakfast

  • 4 Up Your MassBanana Nut Pancakes (Recipe coming soon)
  • 1 C Unsweetened, Organic Soy Milk

AM Snack

  • Cinnamon Raisin Bagel with 1oz Cream Cheese
  • 1 C 2% Milk

Lunch

  • 1 Large Baked Potato with Lentil Loaf, melted Cheese stick and 2 Tbsp Salsa
  • 1 C Asparagus spears
  • 1 C Fresh Pineapple

Dinner

  • ¾ C Cooked Quinoa with 1 tsp Olive oil
  • 4oz Organic, Skinless Chicken Breast
  • 1 C Steamed Zucchini Squash
  • Skinny Cow Ice Cream Sandwich

 

Day 3

(3,710 Calories: 367g Carb, 154g Fat, 176g Protein)

Breakfast

  • Stuffed Baked Potato
    • 1 Large Baked Potato
    • ½ tsp Olive Oil
    • 1 organic Egg and 1 Egg white
    • 1 Melted Cheese stick
    • ¾ C Kidney Beans
    • ¼ C Salsa

AM Snack

  • ¼ C Dried Fruit
  • ½ C Almonds and Pumpkin seeds, mixed
  • 1 C Organic Skim Milk

Lunch

  • ¾ C Pasta with ½ C Meat Tomato Sauce and ¼ C Melted Mozzarella Cheese
  • 1 C Steamed Spinach
  • 1 Banana
  • 2 Tbsp Peanut Butter

PM snack

  • 1 Whole Wheat Pita
  • ½ C Original Hummus

Dinner

  • 5 oz Salmon with ¼ C Avocado Salsa
  • 1 C Wild and Brown Rice
  • 1 C Steamed Broccoli

Evening Snack

  • 1 ½ C Neapolitan Ice Cream**

* I try not to consume deli meat, so this was a baked turkey breast. I do reheat any lunch meat/protein that I bring as a food safety precaution.

** When you want to promote glycemic (blood sugar) control, eating sweets and desserts alone is a no-no. However, if the dessert is consumed within 1 hour of a meal or healthier snack, typically the blood sugar response is more favorable.

Written by: Cassie Vanderwall, MS RD CD CDE CPT

Eating for…Six

“Let food be thy medicine and medicine be thy food.”  -Hippocrates

Food-Is-Medicine

This is a statement I passionately believe in. Medicine is defined as “the science or practice of the diagnosis, treatment and prevention of disease,” and thus nutrition is also the science of the diagnosis, treatment and prevention of disease.

This is especially true when educating and counseling persons with chronic diseases, such as diabetes, high cholesterol, high blood pressure, kidney disease and the list goes on and on. Tweaks in what these persons eat on a daily basis can dramatically improve their disease state.

Many of you are probably waiting for the link to pregnancy, well here it comes. While I continue to believe in the power of nutrition, my view of food has shifted during pregnancy. I believe food during pregnancy is very similar to food for the elite athlete; it is its most basic form- fuel.

While dietary quality is of the utmost importance during both pregnancy and athletics, but quantity often is slightly more important. I have been intrigued by the amount of energy (Calories) required to grow and sustain life, let alone 2, 3, or 6 at one time.  The average adult woman needs approximately 1600 Calories per day and the average adult male needs nearly 2000 Calories per day. These amounts of course vary depending on an individual’s metabolism, body composition and daily physical activity. But, the average woman pregnant with one child needs approximately 300 additional Calories per day beginning in their 2nd trimester. However, this is not the case with multiples. This additional energy requirement starts in the 1st trimester and quickly escalates with each fetus:

  • Twins: 3,500 Calories
  • Triplets: 4,000 Calories
  • Quads: 4,500 Calories
  • Quintuplets: 5,000 Calories

One may be jumping for joy at this amount, because it’s like Thanksgiving everyday! Unfortunately, when you add in morning sickness, indigestion and limited belly capacity, this feat requires a bit of creativity.  Again, it is important to remember that quality is a close second to quantity and thus the type of Calories consumed is also very important.

The average dietary composition is 50-55% Carbohydrate, 25-30% Fat and 15-20% Protein. During pregnancy, this also shifts to approximately 40% Carbohydrate, 40% Fat and 20% Protein. Fat, primarily from unsaturated sources high in omega 3’s, like DHA, is critical for neurological development. Protein is known as the building block for life and food sources that maintain a complete amino acid profile, animal-based proteins, are ideal. The percentage of carbohydrates decreases during pregnancy, and my assumption for this decrease is two-fold: 1) To account for the increases in necessary fat and protein and 2) To limit edema, or swelling and bloating. Carbohydrates tend to pack on water has they are stored and extra L.B.’s from fluid tend to be unappreciated, especially later in pregnancy.

Overall, we know that nutrition is an individualized science and all of the energy goals have to be adapted to the individual. I believe the best outcome for measuring a person’s nutrition during pregnancy is maternal weight gain. Future mom’s of multiples are to gain an average of 2-2.5lbs per week beginning with week one, so that by 30 weeks mama has gained nearly 80lbs. Maternal weight gain is highly associated with fetal growth and gestational age, which we know are the two variables that often influence fetal complications.

So, for you “bump” lovers out there I will be sure to post a pic or two in the coming weeks along with some updated ultrasounds. Until then, hang tight…patience is a virtue (lol). And, for you nutrition geeks and foodies out there, much like myself, there will certainly be future posts on nutrition tips and meal planning for mom’s of multiples.

Five Buns in my oven

Written by: Cassie Vanderwall, MS RD CD CDE CPT

Woes and Wishes of the First Trimester

The first trimester poses something new with each week. The two-week wait presents great anticipation of finding out whether you have been part of the miracle of conception, as well as, the opportunity to strengthen your patience. In week three and four you begin to realize that your body is certainly not your own. As your blood volume begins to increase your heart rate, blood pressure and respiratory rate all tend to also increase, which left me exhausted and out of breath. It is amazing how nature has a way of slowing down even the busiest of all the bees. Then, come the GI (gastrointestinal or belly) woes. Bloating, indigestion and the beloved “morning” sickness all of which can be attributed to the hormones that are bouncing around like Flubber. My biggest woe has certainly been “morning” sickness, which for me has been 24/7 nausea.  I am very grateful that everything has stayed down, because we know every nutrient counts. I’d love to take a moment to share my tried and true tips for nausea.

The Do’s and Do Not’s of Morning Sickness

  • Do take 60-100mg of extra vitamin B6 everyday.
  • Do get your hands on ginger chews and ginger tea.
  • Do have your own stash of seltzer water and salty snacks on your person at all times…in your purse, car, desk, bag and table next to your bed.
  • Do get fresh air. For me, there was nothing like taking a walk around the block.
  • Do try a cold cloth on your forehead and back of neck.
  • Do stay hydrated with ice cold water.
  • Do purchase Seabands…they rock.
  • Don’t eat really fatty or smelly foods. The high fat foods take a long time to digest which delay transit time. Smelly foods (spicy foods, fish, etc) can trigger the nausea center in your brain, which usually doesn’t end well.
  • Don’t become constipated. If you can help to keep that train running you will prevent the intestinal traffic jam that can cause a nasty back-up. Focus on whole grains and fruits and vegetables that you can tolerate.
  • Don’t eat foods that don’t sound good. Food aversions are odd to me. Foods you love can quickly become foods that you cannot even think twice about. Don’t force it, save them for later because this too shall pass.
  • Don’t wait until you are hungry to eat. Establish a meal pattern, such as every 2-3 hours. An empty stomach is not your friend.

Alright, thank you for entertaining my list. Hopefully, some of you find it helpful. Onto a few more woes and wishes. During week 8, my nausea began to subside, which was scary for me because up until that point that’s how I knew I was not alone. My greatest fear at this point remains miscarriage. So, I am highly cognoscente of my signs and symptoms. This fear only escalated during week 9, this is a warning that if you’re grossed out by lady talk skip on to the next paragraph.  During week 9, I started spotting. It is really frightening to bleed during pregnancy, because I immediately think Aunt Flow has come for a visit and she doesn’t visit pregnant folks. I called my docs and they assured me that as long as it is not accompanied by cramping or back pain and does not increase in flow that everything is alright. I’ve heard a variety of reasons for bleeding during pregnancy, including:

  • Implantation
  • Placenta Formation and Attachment
  • Blood clots created during placenta formation
  • Bursting of blood vessels
  • Uterine growth and contractions

My plan is to keep a close eye on things and make a follow-up to ensure that everything is alright, so please be praying for this.

My greatest wish at this point is to make it to 32-34 weeks miscarriage free because I know at that point my babies have the best chance of a handicap free life.  I also hope and pray that I can create the ideal environment in my belly for their growth and development.

All of these woes and wishes, hit me pretty hard on the way to work yesterday. Then, I was blessed by a song on the radio; “I need you now, how many times” by Plumb. Amazing song and exactly what I needed to hear.  I hope it inspires you, too!

Written by: Cassie Vanderwall