Nutrition needs change as we age

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Nutrition needs change as we age

Let’s think about it. Does a two-year-old have the same nutritional needs as a 34-year-old would have, or even a 73-year-old? Do you think that each of these age groups has the same appetite for food? Do certain foods tend to bother different age groups more?

While generalizations regarding the types and amounts of food that are offered to older adults should not be made, caregivers need to be sensitive that older adults may have some unique problems. Listed below are some of the special dietary needs that may be observed in older adults, and the considerations to be given in assisting people in coping with these conditions.

Decreased sensation of taste, smell or vision
What you could do: Present food attractively on the plate, add a garnish whenever possible. Check the menu to see that there is a good use of color. Food should be well seasoned. Provide adequate lighting without glare.

Diminished appetite and/or ability to feed one’s self
What you could do: Provide foods that are dense in calories (many calories in small volume). Try to offer meals and snacks when the person’s appetite is the best. Check medication to determine its influence on appetite. Allow adequate time to eat. Provide appropriate utensils/feeding devices, if needed.

Diminished thirst sensation
What you could do: Offer fluids at temperatures most accepted by the person. Many prefer beverages without ice. Determine beverage preferences. Offer fluids frequently instead of waiting for someone to say he or she is thirsty.

Dental disease or poorly fitting dentures
What you could do: Many people without teeth are capable of chewing whole food. If someone can eat green beans, it is not necessary to mash or puree them. Offer fluids frequently during the meal.

What you could do: Provide high fiber foods often. Emphasize intake of raw and cooked fruits and vegetables, whole grain cereals and breads. Offer water frequently. Encourage physical activity.

Lactose intolerance, osteoporosis
What you could do: Many elderly are less tolerant of milk and dairy products. Small amounts of dairy products at a time, or eating dairy products with other foods, may be better tolerated. Try special milk products such as lactaid drops, lactaid milk, fermented dairy products such as buttermilk or yogurt

Decreased iron intake
What you could do: Encourage intakes of high iron foods with high vitamin C foods for improved absorption. Some high iron foods include deep green vegetables, red meats, iron fortified cereals.

Arthritis and or special disabilities
What you could do: Provide “easy to open” or opened containers. If overweight, encourage weight loss to reduce discomfort. Provide finger foods when appropriate. Provide foods in appropriate consistency. Obtain special eating utensils, cups, plates, and bowls, for those who need it. If necessary, consult an occupational therapist to help determine appropriate eating utensils.

What you could do: Immobility increases risk for obesity, constipation, osteoporotic changes, pressure sores. Encourage physical activity to the extent possible.

Need for socialization
What you could do: Encourage dining in a group setting. Select compatible table mates. Provide a stimulating dining environment that is comfortable and conducive to conversation.

Hearing impairment
What you could do: Be patient. Face the person when speaking. Use effective communication skills by speaking clearly.

The ins and outs of fiber

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The ins and outs of fiber

What happened to oat bran?

Remember just a few years ago there was so much excitement over oat bran? Just like fashion, it has gone “out of style.” People wanted to think that oat bran would cure everything, including high cholesterol levels. Many people failed to promote oat bran for what it really is – a good source of fiber.

What is fiber?

Fiber comes from the part of the plant that our bodies cannot digest. There are two types of fiber – soluble and insoluble. Soluble fibers are found in dried peas and beans, lentils, oats, carrots, bananas, apples, oranges and other fruits and vegetables. Soluble fibers are like a sponge. Once they enter our bodies, they swell and form a gel. They tend to make us feel full longer and may help to lower blood sugar and blood cholesterol levels. Insoluble fibers include foods such as wheat, corn and other bran products, broccoli, cauliflower, green beans, potatoes and peaches. Roughage is another name for insoluble fibers. It moves food quickly through the bowel to help prevent constipation.

Why eat a high fiber diet?

One of the greatest benefits of a high fiber diet is that it prevents colon cancer. People need to eat between 20 to 35 grams of fiber daily. Most Americans eat about half this amount.

Tips on adding more fiber:

  • Add fiber to your diet gradually. Too much fiber all at once can cause diarrhea and bloating.

  • Choose one or two servings of whole grains every day. Whole grains may include whole wheat bread or muffins, who grain or bran cereals.

  • Eat at least three to five servings of vegetables and two to four servings of fruit every day.

  • Eat dried peas or beans two or three times per week. This includes foods like split peas, kidney beans and garbanzo beans.

  • Drink at least eight glasses of liquids every day.

  • Eat a variety of foods like whole grain breads and cereals, fruits and vegetables every day.

  • Eating more than 50 to 60 grams of fiber a day may interfere with your body’s ability to absorb vitamins and minerals. So don’t overdo a good thing.

The calcium connection

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The calcium connection

All nutrients are important for good health at any age, but some have special importance for older adults. For example, inadequate calcium has been linked to osteoporosis, a condition in which bones become weak and brittle. The exact cause of osteoporosis is not known. Several nutrients in addition to calcium are involved.

Some scientists believe that women need to get adequate amounts of calcium throughout life. Milk, yogurt, cheese and other dairy products are the best sources of calcium. Some dark-green leafy vegetables, canned fish eaten with the bones (sardines and salmon) and tofu also provide calcium.

To absorb calcium, your body needs vitamin D. Vitamin D is added to most fluid milk. It can also be made by your skin when exposed to sunlight. Dietary supplements of vitamin D are usually not necessary. Your doctor should advise you on your need for additional vitamin D. If your doctor recommends supplements, she should tell you how much you should take.

In addition to getting adequate calcium and vitamin D it is important to note that moderate exercise that places weight on your bones, such as walking, helps maintain and may even increase bone density and strength in older adults.

Who is at risk for osteoporosis?

Anyone can get osteoporosis, but women are at greatest risk, especially white women who are thin, fair-skinned and small in build. Aging itself, extreme immobility and genetics, as well as smoking and drinking alcoholic beverages, are believed to contribute to the risk for osteoporosis.

Loss of calcium from the bones increases in women after menopause, when levels of the hormone estrogen decrease. Estrogen replacement therapy can be prescribed by a doctor to help decrease bone loss after menopause. Because estrogens may have negative side effects in some women, the decision to take estrogen should be made by each woman with the help of her doctor.

Milk is the most obvious and popular source of both calcium and vitamin D, but some people don’t drink it and need to consider other ways to get calcium.

Some people have trouble digesting lactose, the sugar occurring naturally in milk.

If you have trouble digesting milk:

  • Drink milk that has had lactase added or add it yourself. Lactase is an enzyme that breaks down milk sugar. It can be purchased at many drugstores.

  • Drink only a small amount of milk at a time.

  • Eat yogurt or cheese. Lactose has been partially broken down in these foods.

  • Try cooked foods made with milk such as soups, puddings or custards.
    If you don’t like milk, eat more of other foods with calcium, such as:

  • foods made with milk or cheese

  • tofu, a soy product that is sometimes made with calcium sulfate (check the label); 1/2 cup (four ounces) of tofu made with calcium sulfate has about the same amount of calcium, protein and fat as one cup of whole milk.

  • dark-green leafy vegetable, such as kale, collards and broccoli

  • tortillas made with cornmeal that is fortified with calcium; the label may state that the cornmeal is processed with lime, or may list the cornmeal as “masa harina”

  • canned or dried fish with edible bones, such as salmon and sardines.

Source: Food Facts for Older Adults , U.S. Department of Agriculture

Adult Nutrition

Child & Adult Care Food Program

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Adult Nutrition
General Information



Baby foods with DHA may not be served as part of reimbursable meal

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Baby fruits or vegetables with DHA may not be served as part of a reimbursable meal

The Mountain-Plains regional office of the USDA has issued a clarification that certain baby foods containing DHA (docosahexaenoic) cannot be served as part of a reimbursable meal in child nutrition programs. DHA is an omega-3 fatty acid that may be added to commercially prepared fruits or vegetables. USDA Memo CACFP-687 states:

“The source of DHA in some lines of baby food products, such as Beech-Nut First Advantage Sweet Potato Soufflé or Tropical Blend, is egg yolk. These DHA-added products combine fruits or vegetables with dried egg yolk, heavy cream, rice flour, vanilla extract and other ingredients. They are not labeled or marketed as desserts, but they contain similar ingredients that may not be appropriate for an infant young than 8 months of age. Introducing these “dessert-like” ingredients into an infant’s diet at an earlier age could result in a food sensitivity or a food allergy.

“Although DHA-added products cannot contribute to the infant meal pattern, they may be served as additional foods to infants 8 months of age or older. Since they contain several ingredients, additives, or extenders that could cause allergic reactions, we recommend that the center, the provider or the school check with the infant’s parent or guardian before serving them.”

Tips for Infant Feeding

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Tips on infant feeding

Good nutrition is essential to the rapid growth and development that occurs during a baby’s first year. Providing babies with the right foods promotes good health and gives them the opportunity to enjoy new tastes and textures as they establish good eating habits. Positive and supportive feeding techniques allow babies to eat well and to develop healthy attitudes toward themselves and others.

Parents and child care providers face special challenges and opportunities during a baby’s first year. The information that follows will help you make appropriate feeding decisions as the baby changes and develops.

Child care providers and parents should communicate frequently to coordinate what babies are being fed while in child care with what they are fed at home. By doing this, the best care for the babies can be assured.

Developmental Stages

During the first year, babies develop the ability to chew. As their digestive tracts mature, they become able to handle a wide variety of foods. At the same time, babies progress from needing to be fed toward feeding themselves. As babies mature, their food and feeding patterns must continually change.

A baby’s developmental readiness determines which foods should be fed, what texture the foods should be and which feeding styles to use. All babies develop at their own rate. Although age and size often correspond with developmental readiness, these should not be used as sole considerations for deciding what and how to feed babies. It is important to be aware of a baby’s individual development so that you know the appropriate food and texture to serve and the appropriate feeding style to use at each stage.

Each baby is an individual. Babies always do best if they are supported in progressing at their own rate.

Breast Feeding

Breast milk is the optimal food for babies. It is the only food a baby needs during at least the first four to six months of life and it continues to be an important source of nutrition for the first year. Mothers who are breast feeding their babies should be encouraged to continue to breast feed when returning to work, if they desire to do so. Babies who are breast fed may be bottle fed expressed breast milk while at day care; be breast fed by their mothers at the day care site, or receive infant formula while at day care.

Breast milk must be refrigerated or frozen until you are ready to give it to the baby. If frozen, thaw it in the refrigerator. Shake the bottle of breast milk to mix it before you give it to the baby. Warm the bottle by holding it under running water for a few minutes until the milk feels warm to the touch. Heating breast milk on a stove or in a microwave oven is not recommended.

Infant Formula

Iron-fortified infant formula is the best food for the baby when the baby is not being breast fed or when a supplement to breast feeding is needed.

Commercially prepared iron-fortified infant formula is specially formulated to have the right balance of nutrients and to be easily digested by the baby. For a baby who is not breast fed, iron-fortified infant formula is the only food a baby needs for at least the first four to six months of life, and it continues to be an important source of nutrients for the baby’s first year.

Infant formula must be stored properly to keep it safe for the baby to consume. Canned formula must be refrigerated after opening. Use all of the formula out of one can before opening another. If opened formula has been left out of the refrigerator for more than one hour, throw it away.

Powdered formula is the least expensive and is easy to transport. Once reconstituted, handle the same way as liquid formula.

Warm a bottle by running hot tap water on it or let it sit in a pan of hot water. Do not use the microwave oven. The formula can get very hot even if the bottle only feels warm. Some babies have been badly burned.  Sprinkle a little formula on your wrist to see how hot it is. If it is too hot, run the bottle under cold tape water and then check it again.

Bottle Feeding

Always hold an infant while feeding from a bottle. Propping the bottle can cause ear infections. Also, you may not notice if the baby chokes.

Babies will take different amounts of breast milk or formula at different feedings. They know how much to take. You just need to learn what things the baby does to say “I’m hungry” or “I’m full.” Be sure to throw out the leftovers in each bottle.

Always wash and rinse the bottle and nipple carefully before using them again. Use a bottle brush. Bottles shaped like bears and clown are difficult to clean. Use plain ones.

A little spitting up is normal. If you are worried about how much a baby is spitting up, you may be feeding too much at one time or you may need to try a different formula. Be sure to burp the baby gently several times during each feeding to prevent spitting up.

Baby bottle tooth decay can occur when babies are allowed to fall asleep with their bottles in their mouths. The production of saliva decreases when the baby falls asleep and the teeth are not cleansed properly. The sugar in the milk or juice can cause serious tooth decay. To prevent baby bottle tooth decay:

  • Feed only formula, breast milk, milk or water from a bottle.

  • Never put water sweetened with honey or sugar in a bottle.

  • Never put fruit juice, sodas, iced tea or other sweetened drinks in the bottle.

  • Offer the bottle only at feeding time, not at nap time.

  • Do not use a bottle of cold juice to soothe a teething baby’s gums. Instead, offer a clean rattle or teething ring that has been cooled in the refrigerator.

Starting Solids

Wait until at least four months to start solids. The baby should be able to sit up and push food to the back of his mouth to swallow. If a baby cannot do these things, he is not ready for cereal. Never put cereal in the baby’s bottle. It does not aid sleep and feeding solids too early can lead to overfeeding and/or allergies.

Foods with a single ingredient should be introduced, one at a time, in small amounts. If there are adverse reactions to the food, it can be eliminated and reintroduced when the baby is older and the digestive system is more developed and tolerant.

Infant cereal is usually the first food given. Vegetables and fruit are next. Then add meats and eggs (yolks only, until the baby is one year old), one at a time, to the infant’s diet. After each new food is introduced, watch for signs of allergy.

Infants are being exposed to new tastes and textures. They may reject a new food at first because it is different. Try the food again. As with older children, it may take up to 10 tries to get a food accepted. Be careful not to convey your own food dislikes to the baby. Let the baby try it and decide.

Drinking from a Cup

Use a small plastic cup. Hold the cup yourself and let the baby sip from it. Don’t fill the cup all the way. Be patient. Drinking from a cup is very different from sucking on a nipple.

Once the baby is proficient with the cup, there is no need for a bottle. A baby who has been slowly weaned from the bottle is usually ready to give it up. 

A Healthy Future

Your efforts to develop healthful eating habits in infants will be well rewarded. Starting out with good nutrition helps assure bright, healthy futures for children.

More on feeding infants

Questions and Answers About the Nutritional Content of Baby Food

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Questions and Answers About . . .

The nutritional content of processed baby food

What is the goal of infant nutrition?

The goal of infant nutrition is to promote optimal growth and development by providing a variety of nutritious foods. Babies need to be gradually exposed to a variety of tastes and textures geared to their developmental level.

Are infant nutritional needs the same as adult needs?

No. Infants have their own unique nutritional and developmental needs. Adult dietary guidelines for fat, protein, fiber, sugars and other nutrients should not be applied to infants and young children.

Are processed baby foods as nutritious as home prepared baby food?

Yes. As part of the infant diet, processed baby foods provide balance and variety with a carefully controlled and consistent nutrient content.

Is home prepared baby food safe?

Yes, as long as it is correctly prepared from carefully selected foods. Good clean work areas are very important to prevent accidental contamination. Home prepared baby food should be steamed, then thoroughly mashed with a fork or a food processor. Parents need to be cautious of feeding foods that cannot be mashed by the gums as these present a choking hazard.

Why is water added to baby food?

Water helps make the food the appropriate consistency for the developmental stage of the infant who will eat it. Initially a baby’s food should be liquid enough to be sucked from a spoon. Babies need water for growth and should have a good intake of fluids every day, especially in hot, humid weather.

Are starch fillers used in baby food?

Starches are easily digested carbohydrates, which may be present in baby foods in the form of flour (corn, wheat, rice), tapioca or rice. Whether added or a component of food, starches provide an important source of calories for growing infants. Food starches also help to moderate flavor and control texture. The Food and Drug Administration has determined that food starches are safe and suitable for use in baby foods, and requires that they be listed on the food label.

Why is texture important?

Texture plays an important role in providing developmentally appropriate challenges for the infant. Lumpier foods introduce chewing skills by helping the infant to learn and master the up-and-down and side-to-side motions of chewing and the manipulation of the tongue to guide foods.

Source: International Food Information Council

Cow’s Milk Removed from Infant Meal Pattern

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USDA removes whole milk from the infant meal pattern

Cow’s milk has been eliminated from the infant meal pattern in the Child and Adult Care Food Program. Meals containing cow’s milk and served to infants under one year of age are no longer reimbursable. Breast milk or formula must be included in all reimbursable meals for infants under one year of age.

The regulatory changes were effective December 15, 1999, but to allow for transition, USDA has provided the following timeline:

Centers and home providers may continue serving whole cow’s milk in lieu of breast milk or iron-fortified infant formula to any child between 8 months of age and one year of age who is already receiving cow’s milk on or before December 15, 1999. No child between 8 months of age and one year of age may be served cow’s milk in lieu of breast milk or iron-fortified infant formula in a reimbursable meal after April 14, 2000.

Child care facilities must offer at least one infant formula which meets CACFP requirements if infant meals and snacks are claimed for reimbursement. A parent or guardian may elect to decline the offered infant formula and supply another infant formula or breast milk. They also must indicate when their infant is ready for the other meal component(s).

Meals with breast milk are reimbursable

Meals containing only breast milk provided by parents (which could include breast milk produced by a wet nurse) are reimbursable from birth through seven months. Meals containing only formula provided by parents are NOT reimbursable. Meals containing formula provided by parents, served to infants four months of age or older, may be claimed for reimbursement when the other meal components(s) (optional or required) are supplied by the child care facility.

Whole milk recommended between ages 1 and 2 years

Meals containing whole milk instead of breast milk or infant formula are not eligible for reimbursement. Whole milk has been removed from the CACFP infant meal pattern. The decision to introduce whole milk should be made in consultation with the parents. It is strongly recommended that whole milk be served between the child’s first birthday until the child’s second birthday.

Infant formula is defined as any iron-fortified formula intended for dietary use solely as a food for normal, healthy infants; excluding those formulas specifically formulated for infants with inborn errors of metabolism or digestive or absorptive problems. Infant formula, as served, must be in liquid state at recommended dilution.

Some infants consume, on average, less than the minimum serving of breast milk established for their age group. Consequently, if the full portion of breast milk is offered to an infant who does not consume that much, some of the breast milk may be wasted. Since breast milk is provided in very limited quantities, as much as possible should be conserved. USDA is permitting providers to serve less than the minimum regulatory serving of breast milk to infants who regularly do not consume that amount of breast milk.

However, if the full portion is not initially offered, the provider must offer additional breast milk if the infant is still hungry. USDA emphasizes that this provision is being adopted solely in recognition of the needs of some infants and the desire to avoid wasting already limited quantities of breast milk. Under no circumstances can providers offer less than the stipulated minimum serving of infant formula or other components of the infant meal pattern.

Meal providers must take care to ensure that breast milk is stored and handled properly to prevent possible tainting or spread of disease. In particular, all breast milk given to the provider should have a label stating the child’s name, and providers must make sure that each child receives only the breast milk supplied by its mother.

Source: U.S. Department of Agriculture, Food and Nutrition Service, Mountain Plains Region

Infant Feeding – Reminders

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Infant menus – important reminders

More and more child care centers are claiming meals served to infants under one year of age on the Child and Adult Care Food Program. There are a few things to keep in mind to make sure that these meals are eligible for reimbursement.

During the first year of life, good nutrition is important to the rapid growth and development of an infant. Nutritional needs are based not only on the foods essential for health and growth but also on the infant’s developmental readiness to accept these foods.

The infant meal pattern for the CACFP divides the infant’s first year into three age groups. These three groups allow for flexibility based on the infant’s rate of development and appetite. The amounts shown in the Infant Meal Pattern chart are the minimum portions that must be offered to meet CACFP requirements. Some infants may have progressed to larger servings and additional foods. It is important to coordinate what the infants are being fed at home with what they are being fed in child care.

The Infant Meal Pattern allows for a gradual introduction of solid foods and encourages breast-feeding or formula feeding up to the first birthday. The texture and amount of the feeding should be consistent with the age of the infant. For physical, mental and emotional growth, infants need foods that are rich in nutrients. Foods such as strained meat, fruit, vegetables, iron-fortified dry infant cereal, iron-fortified infant formula, and breast milk provide the maximum amount of vitamins and minerals for growing babies. Commercial foods such as combination or mixed baby foods are not creditable because water often is listed as the first ingredient, and it is difficult to determine from the ingredient label the actual amounts of the food components in the product.

Parents will also provide important information to help in feeding their babies. Communicate frequently with the parents so that foods served at home will coordinate with foods served in care. This assures the best care for the babies.

Formula Must Be Offered

Child care facilities must offer at least one infant formula which meets Program requirements if infant meals and snacks are claimed for reimbursement. A parent or guardian may elect to decline the offered infant formula and supply another infant formula or breast milk. They also must indicate when their infant is ready for the other meal component(s). Sample forms to be used for this purpose are available from Nutrition Services. These records must be kept on file.

Meals containing formula or breast milk provided by parents, served to infants 4 months of age or older may be claimed for reimbursement when the other required meal component(s) are supplied by the child care facility. Refer to chart regarding reimbursable infant meals.

The decision to introduce whole milk should be made in consultation with the parents. Whole milk has been removed from the CACFP infant meal pattern. Juice should not be offered to infants until they are ready to drink from a cup. Drinking juice from a bottle can promote tooth decay. Never prop a bottle or give a bottle to a baby during nap time. This can cause choking as well as tooth decay and ear infections.

Heating bottles in a microwave oven is not recommended because uneven heating can occur and burn the infant’s mouth.

Infant Record Keeping Requirements

A record documenting the amount of food offered at each meal and snack must be completed for each infant whose meals are claimed for reimbursement. Presently, centers have the option of using either an Individual Infant Meal Record or a Daily Infant Meal Record, both of which are available from Nutrition Services.

download infant production records here

Important to Remember

Iron-fortified infant formula and iron-fortified dry infant cereal must be served unless there is a statement from a medical authority documenting a medical condition requiring a substitution.

Full-strength 100% fruit juice may be given at snack for infants eight months of age and older.

If three meals in one day are being claimed for an infant, at least one must be a snack.

Meals must meet the CACFP Infant Meal Pattern for all infants under one year of age in order to be claimed for reimbursement. For example, if an 11-month old is being fed the entire meal pattern for children ages 1-2 years, these meals are not reimbursable if they do not meet the Infant Meal Pattern Requirements. For example, iron-fortified dry infant cereal is required up until the child’s first birthday, so a breakfast including “regular” cereal would not be creditable for infants.

Also, meals that do not meet CACFP meal pattern requirements due to parental request are not reimbursable. Meals may only vary from the meal pattern with a written statement from a recognized medical authority.

For more information on infants, see Feeding Infants, publication No. FNS-258.

More resources about feeding infants

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