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Nutrition Therapies

Patients often ask what they can or shouldn't eat for many common symptoms and situations. Here are suggested ways food can be used to troubleshoot common questions.

    • Encourage frequent meals and snacks

    • Encourage energy-dense foods and beverages, such as nuts and seeds and their butters, soy products, avocados, vegetable oils, and fortified plant milks and yogurts

    • Reduce dietary fiber, if necessary, by using some refined grain products, peeling fruits and vegetables, and straining legumes

    • Offer a larger variety of foods, particularly pairing with foods well-liked, to increase intake

    • Encourage monitoring of dietary intake. Online personalized calculators may be useful to educate on nutrient needs (e.g., “DRI calculator for health professionals” (USDA))

    • For infants, evaluate breastfeeding and formula feeds (e.g., frequency, duration of feeds, amount, formula preparation)

    • Ensure adequate hydration

    • Consider formula use and preparation (e.g., improper mixing) and dietary changes (e.g., formula change, abrupt switch from breastmilk, the introduction of complementary foods)

    • Evaluate fiber intake as both excessive or inadequate intake may contribute to constipation. Not all fibers are effective for constipation in children, and some (particularly insoluble fiber) can exacerbate it. Thus, a gradual and individualized dietary adjustment should be based on stool consistency and symptoms (e.g., gas, pain, bloating).

    • A slow increase of fiber along with fluids may be helpful for some children with low intake. Add small amounts (less than 5g/d) of extra fiber gradually to the diet along with extra fluids up to the RDA (14g/1000 kcal/d for persons 2+yrs; 12-23 mo-olds up to 19 g/d)

    • Low/slow fermentable fiber foods (FODMAP) may also help reduce GI symptoms (see Monash University for details)

    • Consider small amounts of 100% apple, pear, or prune juice for osmotic laxation (e.g., 2-4 oz for infants older than 4 mo; under 4 mo give 1 oz per age in months (e.g., 3 oz for a 3-month-old)

    • Evaluate behaviors associated with stool withholding in children (e.g., readiness to be toilet trained, public bathroom avoidance)

    • Evaluate supplement and medication use (e.g., iron); chelated iron supplements, lower doses, or higher doses QOD may reduce side effects.

    • Offer plenty of fluids; ORS may be needed and zinc may be helpful with extended diarrhea duration

    • Provide frequent, small meals

    • Offer foods the child is willing to eat; it is not necessary to withhold foods (or only give the BRAT diet) as this may reduce nutrient intake

    • Avoid greasy, spicy, hyperosmotic, caffeinated, and possibly lactose-containing foods & beverages (sugary drinks, full-strength juices, sugar alcohols like sorbitol, milk, and tea)

    • As diarrhea subsides, a very slow return to consuming adequate dietary fiber with adequate fluids may help to restore gut health

    • Although some, but not all, studies have shown beneficial effects of supplements with probiotics on acute diarrhea in children, there is a lack of broad consensus for specific probiotic strains and doses. Thus, current data limits the systematic administration of probiotics to children.

    • Offer smaller, more frequent meals/ snacks Trial bland, dry, starchy, or salty foods to curb nausea

    • Avoid strong odors, greasy, and high-fiber foods

    • Keep hydrated; encourage ORS when necessary

    • Eat a snack before getting out of bed in the morning (e.g., during pregnancy)

    • Focus on energy-dense foods (e.g., tofu, avocados, nut butters) and possibly electrolytes (e.g., fruits and vegetables are high in potassium and magnesium)

    • Trial limiting/avoiding high-fat foods, mints, chocolate, tea, and carbonated beverages

    • Eat slowly and chew well; for infants, interrupt feedings for more frequent burping

    • Rise slowly from supine to sitting or standing, and avoid jostling infants after feeds

    • Hold infants upright 20-30 minutes after feeds; for older children and adults, sit upright 2-3 hours post meal

    • Consider thickening foods, if necessary, for chronic reflux (e.g., formula, breastmilk)

    • Rinse mouth with water, baking soda dissolved in water, or brush teeth after vomiting to protect teeth

    • Consider vitamin B6 supplements, ginger, and acupressure, as they may be helpful, particularly during pregnancy

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    • Legumes (e.g., beans) and some vegetables (e.g., asparagus) can be a source of excessive gas production during digestion.​

    • Using cooking practices, such as soaking legumes and discarding the soaking water before cooking, can reduce oligosaccharide content that causes gas

    • Gradually introduce limited amounts of legumes and other foods that may cause gas and bloating

    • Focus more on low-FODMAP diet foods to help reduce fermentable carbohydrates in the diet (see Monash University for details). Examples:

    • Low FODMAP: lentils, edamame, tempeh, tofu, soy & almond milk, broccoli, eggplant, green beans, carrot, zucchini, tomatoes, peanuts, walnuts, cantaloupe, kiwi, oranges, gluten-free pasta, quinoa, rice, corn

    •  High FODMAP (limit/ increase slowly): kidney beans, peas, milk, asparagus, artichokes, cauliflower, mushrooms, garlic, onions, cashews, pistachios, apples, cherries, wheat, rye, barley

    • Determine the types of foods that are best tolerated (e.g., lentils, soy)

    • Suggest eating slowly and chewing well

    • Explore other sources of flatus, such as carbonated beverages

    • Explore antiflatulent medications

    • Consider other sources of protein, iron, and zinc if legume consumption is limited

    • Don’t pressure, praise, or punish. The long-term goal is to teach children to be independent with food.

    • Allow the child to decide what and how much they want to eat. Let them learn how to respond to their hunger signals and never force them to finish their plate.

    • It can take offering food 10 times or more before a child will accept it. Continue to offer a variety of foods with repetition, especially with different textures as this is a primary reason for refusal.

    • Give choices of different foods to try. Let the child decide which one to try.

    • Mix new foods with foods already well-liked

    • Try freezing small bites of different foods (to avoid food waste)

    • Involve the child in the planning and preparing of food (e.g., shopping, mixing ingredients)

    • Continue to offer the same foods as the family and avoid reacting to refusal/conflict. Be firm, consistent, and patient

    • Consider if snacking throughout the day may be reducing hunger and subsequently limiting nutrient intake at meal times

    • Share the video, “Tips for Feeding Picky Eaters: American Academy of Pediatrics (AAP)” 

    • Encourage a healthy whole-foods, plant-based diet as it may help promote weight loss, help to keep weight off, and prevent obesity

    • Focusing on diet quality rather than focusing on weight may improve patient reception

    • Educate parents on growth chart percentiles and trends to encourage growth monitoring

    • Online personalized calculators may be helpful to educate the child/parent on nutrient needs (e.g., “DRI calculator for health professionals” )

    • Encourage parents to model eating healthful foods and exercising regularly, communicate the principles of healthy eating, and avoid conversations about dieting around children

    • Suggest stocking the kitchen with healthy foods and limiting the availability of processed foods high in calories and low in nutrients. Place healthy foods front and center in the refrigerator, cabinets, and counters to make them the easy choice.

    • Encourage water and limit sugary drinks

    • Avoid using food as a reward (e.g., ice cream, candy). Instead, consider other non-food items, such as visiting a park or going to the movies

    • Educate on reading labels/menus & portion sizes. It can be easy to overeat, especially in restaurants

    • Discourage eating out of the bag, carton, or box because it encourages overeating. Instead, serve a reasonable portion and put the package away.

    • Encourage eating mindfully: eat slowly and pay attention to hunger and satiety

    • Encourage awareness of satiety and to stop eating when no longer hungry

    • Encourage exercise

    • Older children should be physically active for at least 1 hr/d; preschool-aged kids need 3 hours

    • Find activities they like, such as sports, dance, biking, or martial arts, to promote enjoyable exercise

    • Include the family in fun physical activities can also encourage active lifestyles

    • Describe the relationship between maternal weight gain and infant outcomes to encourage a healthy weight trajectory

    • Encourage food intake based on individual patient needs

    • Consider stressing diet quality and nutrient adequacy rather than weight

    • Encourage a wide variety of foods to gain adequate nutrients

    • Explore foods that can replace restricted foods

    • Consider supplements where necessary

    • Provide resources, such as a lactation specialist, National Breastfeeding Helpline (1-800-994-9662), and WIC’s breastfeeding webpage

    • Focus on health and not weight.

    • Educate on healthy growth trajectories and expected body changes during adolescence (e.g., “Adolescent development explained”)

    • Ask reasons for the specific type of diet consumed; if severely restricting food or fad dieting for appearance, for example, further examination of possible eating disorder development and consultation with behavioral specialists may be necessary.

    • For more information, see the National Eating Disorders Association's Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics 147, e2020040279 (2021).

    • If severely reducing calories, explain its ineffectiveness for long-term weight loss and how it can cause nutrient deficiencies; refocus the conversation on health and growth.

    • Encourage parents to help the child navigate social media and other unrealistic images.

    • Encourage parents to be good role models (e.g., no dieting/ dieting talk in front of children)

    • Express the importance of food variety in obtaining needed nutrients

    • Encourage meal planning tools, such as the USDA’s Healthy Eating for Vegetarians , and vegan food guides, like The Vegan Plate, and The Plant Plate.

    • Encourage mild-flavored foods, especially if vegetables are not liked

    • Promote the exploration of different food preparation techniques to improve taste and food variety (e.g., roasting vs. boiling vegetables)

    • Explore more healthful foods available when not at home and ideas to plan/pack meals & snacks

    • Consider supplement needs

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    • Provide community resources, such as food pantries, SNAP, WIC, and United Way’s 211 call center

    • Encourage the use of home-cooked foods as they can be less expensive than prepared foods

    • Encourage the use of in-season, canned and frozen fruits and vegetables and bulk whole grains (vs. packaged); note that canned and frozen produce is as nutritious (and sometimes higher in nutrients as they are processed immediately at harvest) than fresh produce

    • Encourage meal planning and ways to reduce food waste

    • Explore inexpensive ways to increase the amount of food and nutrient content of meals, such as adding beans or tofu to dishes

    • Athletes that are weighed as part of their sport (e.g., wrestlers) or who are historically encouraged to have low body weight (e.g., ballet) may need education and encouragement to maintain a healthy weight and growth trajectory

    • Educate that nutritional needs of most athletes are similar to other children with regular physical activity, but high-performance athletes often need extra energy and protein

    • Encourage a variety of complex carbohydrates, protein, and healthy fats as fuel for muscles and cells

    • Online personalized calculators may be helpful to educate the child/parent on nutrient needs (e.g., “DRI calculator for health professionals”)

    • Energy-dense foods, such as tofu, nuts, seeds, and their butters, & avocados can help some people to meet calorie requirements

    • Reducing fiber may be necessary for some people who consume a high amount of whole plant foods to ensure adequate energy and nutrient intake

    • Encourage good sources (or supplements) of iron, vitamin B12, vitamin D, calcium, and other “key” nutrients described herein; a healthy athlete can get protein and most other nutrients they need from foods without taking supplements

    • Discourage the use of performance-enhancing supplements and encourage evidence-based resources for information on supplements, such as the National Center for Complementary and Integrative Health and the Office of Dietary Supplements.

    • Encourage adequate hydration, especially during very cold and warm weather:

      • 1-2 hours before the event: ~12-22 oz of beverages

      • events lasting longer than 60 minutes: replace electrolyte and carbohydrate losses with fluids

      • after the event: ~ 16-22 oz (2-3 cups) for every pound of weight lost

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