Busy Kiddos and Busy Families
Nutrition Series
By: Emily LaRose, MS, RD, CNSC, CSP, Dietitian at Children's Hospital of Los Angeles
It’s the final week of our National Nutrition Month series! I have really enjoyed working on these posts as a resource for all of the HLHS families out there. In this last post, I am going to review some of the feeding guidelines used after the Fontan operation, and I am going to cover some nutrition tips for older kiddos. As promised, I’m also including a couple of recipes for the whole family to enjoy! The postings I make on this site are my own personal opinions and do not reflect the opinions or views of Children’s Hospital Los Angeles.
Busy Kiddos and Busy Families
Before I get into talking about family nutrition, I wanted to comment on another topic that is specific to our HLHS kiddos: nutrition after the Fontan. I’ve shared some of what we expect and how we provide nutrition for neonates, infants, and toddlers including some centers’ goal weight for the Fontan. After the Fontan, however, some centers have different ways that they may modify a kiddo’s nutritional plan.
Immediately following this third surgical palliation, some hospitals restrict sodium, others restrict fat, most restrict fluids, and some centers do a combination of all of these to prevent some of the post-op complications (including chylothorax) and to facilitate recovery. These restrictions are often temporary, but they can be very important.
At CHLA, we restrict fluids while kiddos are in the hospital after the Fontan. We also put all of our kiddos on a low fat diet for the first six weeks (or so) after their operation. The thought is that by restricting fat, we’re trying to minimize the likelihood of a kiddo developing a chylous effusion (where fat leaks into the space around the lungs) that can sometimes happen because of surgery and pressure changes in the chest.
With the low fat diet, we usually have to acknowledge that kiddos may lose a little bit of weight but, because it’s such a short amount of time, weight loss shouldn’t be too significant. We spend time with families helping to problem solve meals so they have the confidence they need to make low fat foods at home. Again, this modification is usually temporary so once the cardiologist gives a family a thumbs up to resume a normal diet, there aren’t usually any lasting restrictions.
For kiddos on tube feedings, different formulas may be used after the Fontan as well. Tube feeding changes are very individual and can be addressed by your child’s dietitian or medical team.
Once a kiddo is back on his regular diet, we encourage a variety of foods including fruits and veggies, healthy fats, and lean proteins. Some kids do have higher than average nutrition needs so strategies for weight gain can be used but, for the most part, kiddos with HLHS post-Fontan should be following the same general nutrition guidelines as the rest of us.
What about a heart healthy diet?
The idea of a heart healthy diet comes up a lot for our kiddos with heart defects. When we think of a traditional ‘heart healthy’ diet, we think of adults with heart disease risk factors, but having a diet focused on whole foods and healthy fats can be healthy for all of us.
In the years following the Fontan, our goal remains to keep kids healthy and growing. When we think about what a heart healthy diet looks like, a few things come to my mind:
After age two or so, kids don’t need the saturated fats from whole milk anymore so at that point many kids can transition to lower fat or fat free milk.
Healthy fats can come from fish, olive oil, nuts, seeds, avocados, and other non-animal sources. It’s a great idea to get some mixed fats into your family’s diet… and, no, fried foods are not a good source of healthy fats even if a vegetable fat is used.
Don’t overdo it on cheeses and animal fats. Sure, cheese, eggs, and meats can be healthy because they provide protein, vitamins, and minerals, but eating too much of these foods is not good for anyone.
Stay away from heavily processed foods. Processed foods often have a lot of sodium, may have trans fats, and usually don’t offer a whole lot of true nutritional benefit even if the label suggests otherwise.
Eat fresh fruits and veggies! It’s not new or surprising, but providing your family (and kiddos) with a colorful variety of fresh fruits and veggies will provide them with more than just vitamin C and fiber. Plants have a variety of antioxidants that we’re still learning about and most research has said that taking a supplement is not as beneficial as eating food.
We’re busy… what can we do to keep the whole family eating well?
Even with the best of intentions, all of our nutrition and diet goals can be quickly derailed in our busy day-to-day lives. Home cooked meals become fast food burgers and frozen lasagnas for a lot of families. Many parents report that they just don’t have time to cook , don’t know how to cook, or feel that cooking at home is too expensive.
Nutritional benefits aside, there have been a number of studies that have proven that home cooking is usually much more affordable than eating fast food or frozen meals. While I’m a believer that almost anything can exist in a well-rounded diet, I also believe that we should make an effort to eat well most of the time. So what can busy parents do to prevent frequent trips through the drive through?
Plan ahead and shop with a list: Planning a weekly menu can help cut back on grocery shopping time, save money, and prevent food waste. While you’re at the store, it’s also helpful to focus most of your shopping on the perimeter of the store where there are fewer processed foods.
Cook ahead: If you have a few hours once a week to devote to cooking ahead, your food plan can be made much easier. In our house, we spend Sunday afternoons making pasta sauce, roasting veggies, and making meals like beans, lasagna, or enchiladas that can be frozen or refrigerated and reheated for another night during the week when there’s less time to cook.
Get kids involved in cooking: Even young kids can help knead dough, add ingredients to a bowl, or sprinkle salt on a dish. Kitchen tasks can change as kiddos get older and can handle more responsibility. Including kids in cooking makes often them more open to trying new foods that they helped prepare!
Let kids pick out a fruit or veggie at the store: For some parents, bringing kiddos to the grocery store or farmers market and allowing them to pick a new fruit or veggie is a good way for the whole family to try something different. Again, encouraging (and allowing) kids to get involved can be a great way to get them excited about food, eating, and cooking.
What about recipes?
Historically, recipes have come from cookbooks, magazines, friends, and family members, but in the age of the internet, there are even more resources available. The key is finding a few that provide recipes that match your cooking skill level and that you can trust for reliability.
Cookbooks: The Essential Vegetarian by Diana Shaw (now out of print) and How to Cook Everything (by Mark Bittman) are a couple of my favorites. I always figure that it’s easy to make a vegetarian meal non-vegetarian… and Mr. Bittman’s book really does include almost everything.
Websites: I find it helpful to use magazine sites like Bon Appetit, Cooking Light, and Saveur all of whom have kitchens where recipes are well tested prior to publication. I also like the ‘Photograzing’ section of the Serious Eats website (www.seriouseats.com) for finding inspiration. While the pictures provide links to other websites and blogs that may or may not contain recipes, I find it to be like window shopping- I may not buy what’s in the window, but it may inspire me in some other way.
I grew up cooking Southern food alongside my parents, grandparents, aunts, and uncles so, like many others, I have a collection of family recipes that I like to refer to. I also went to culinary school (and have my B.S. in Culinary Arts Nutrition). Because of my cooking family and education background, I cook by inspiration and by feel more than by recipe (but that’s not how I started!).
When I bake I rely on recipes, and I try to keep note what works and what doesn’t. The Joy of Baking website (www.joyofbaking.com by Stephanie Jaworski) is a great go-to site for me. I especially love that all of the recipes have weight measures since when I bake cakes and things, I use a scale.
As promised, I wanted to include a couple of recipes for the whole family so here goes. To give a little bit of background, I have been making various kinds of ‘pockets’ for a few years. I really like that they can be frozen for a quick lunch or dinner on the go. It’s also really easy to make different sizes for your young kiddos (just like an empanada, calzone, or other savory stuffed pastry). I usually fill them with veggies, but you could add meat, chicken, or just about anything else.
Sweet Potato Pockets - With an Indian Flare
For those with kiddos on a low fat diet, I would suggest this first recipe since it can be made with fat free yogurt and fat free milk. Because this is an essentially fat-free dough, it can be a little chewy, but I like it. You can substitute some of the flour for whole wheat if you’d like and, of course, the fillings can be changed to whatever you like. Kids can help mash, mix, and fill these little pastry pockets… though you may end up with a mess. Have fun and feel free to get really creative!
Makes ~10 pockets
Ingredients:
For the pastry dough:
2 ½ cups flour (plus more for rolling out the dough)
½ cup non-fat plain yogurt
½ cup non-fat milk
½ teaspoon salt
For the filling:
1 pound of sweet potatoes, peeled and steamed/roasted
½ cup wilted spinach, cooked or frozen and drained
½ cup peas, cooked or frozen
½ teaspoon salt
Pepper to taste
¼ cup fresh cilantro, chopped (optional)
½ teaspoon of mild curry powder (optional)
2 tablespoons of pepper jelly (optional)
Preparation:
Preheat the oven to 400 degrees.Line a baking tray with parchment paper or a silpat baking sheet.
To prepare the dough, combine flour, yogurt, milk, and salt in a mixing bowl. Gently mix with a fork until it comes together to make a ball of dough. Cover with plastic wrap and allow the dough to rest in the refrigerator.
Prepare the filling by mashing the sweet potatoes with the back of a fork then folding in spinach, peas, salt, and cilantro. You can add black pepper, curry powder, and pepper jelly if you’d like. Taste the filling and adjust the seasoning as desired.
Remove the dough from the refrigerator and divide into about 10 pieces (or more if you’re making smaller pockets). Press or roll each piece of dough into a six inch circle. Add about ¼ cup of filling to each round of dough. Fold the dough in half (into a half moon shape) and fold the edges in or press the edges with a fork to seal them.
Bake the pockets for 20 to 25 minutes or until lightly browned.
A few notes: You could swap out the sweet potatoes for butternut squash or even roasted cauliflower. I do usually add all cooked items to the pockets so that the filling is soft and so that they don’t leak a lot of liquid while they cook. One of our favorites is to make this dough and fill it with wilted spinach, feta cheese, onions, and dill for a little Greek influence. If you’re not following a low fat diet, you can brush the outside with a little olive oil to help the pockets brown in the oven.
Chicken and Black Bean Pockets - Tex-Mex Style
For those who aren’t on a low fat diet, I love the following dough recipe for savory pastries. It does have butter in it so there is some saturated fat but when you break it down into servings, the amount of butter per person actually isn’t too much. I also love the flavor of the olive oil in the crust (and it’s even better with some pepper added to it if your family likes). These are fun to make with kids since there is plenty they can do to help out. And you really can fill these with anything!
Makes ~10 pockets
Ingredients:
For the pastry dough:
1 cup flour (plus more for rolling out the dough)
1 cup cornmeal
5 tablespoons of butter, very cold
¼ cup olive oil plus extra for brushing
1 teaspoon salt
Cold water
For the filling:
1 cup cooked chicken (ground, shredded, or diced chicken is fine)
½ cup black beans, cooked or canned
½ cup corn, frozen or roasted
½ cup salsa
¼ cup fresh cilantro, chopped
Chopped onions (optional)
Shredded cheese (optional)
Preparation:
Preheat the oven to 400 degrees. Line a baking tray with parchment paper or a silpat baking sheet.
To prepare the dough, combine the flour, cornmeal, and salt in a mixing bowl. Cut the butter into small pieces and blend into the flour mixture until it looks like a coarse meal. Gently stir in olive oil. Gradually add cold water until the dough comes together enough to make a ball. Cover the dough and allow it to rest in the refrigerator for at least 30 minutes.
Prepare the filling by mixing all of the ingredients together in a mixing bowl. Taste the filling and adjust the seasoning as desired.
Remove the dough from the refrigerator and divide into about 10 pieces (or more if you’re making smaller pockets). Press or roll each piece into a six inch circle.
Add about ¼ cup of filling to each round of dough. Top the filling with cheese if you’d like. Fold the dough in half (into a half moon shape) and press the edges with a fork to seal them.
Brush the tops of the pockets with a little olive oil. Bake for 20 to 25 minutes or until lightly browned.
A few notes: These are easy to make vegetarian with added veggies or more beans (and without chicken). You could also swap out the chicken for another kind of meat if you’d prefer. This is also a great way to use leftover chicken if you have some in the fridge! I’ve also been known to use this dough to make a larger vegetable pie rolling it out to fit a 9” spring form pan and filling it with all sorts of things.
I have really enjoyed writing these posts for Sisters by Heart; I am honored to have been included in your National Nutrition Month blog series. I hope that the information I have provided has clarified how we think about nutrition for kiddos with HLHS as they grow. All kiddos are different so, as I’ve mentioned, if you have questions or need help with your little one’s nutrition, let your medical team know. I wish you all the best, and Happy Cooking!
Thank you so much, Emily, for all of your fantastic nutritional advice! All of us here at SBH, and the families we serve, have so appreciated your insights!