Healthy Eating Matters

Food and Nutrition Toolkit for Residential Care Settings

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This tool kit was prepared exclusively for the Ministry of Children and Youth Services by Carol Harrison, BASc, RD and Shannon Crocker, MSc, RD, Registered Dietitians and Nutrition Consultants. While the Ministry has attempted to verify the accuracy of the information contained in this tool kit, users should not rely solely on this information to make decisions regarding children and youth in residential care. The content of the tool kit is provided by the Ministry of Children and Youth Services for informational purposes only and should not be taken as advice or recommendations for any particular decision regarding a child or youth in residential care. Use of the tool kit is voluntary.

There are web sites linked to and from this tool kit that are operated or created by or for organizations outside of the Government of Ontario. Those organizations are solely responsible for the operation and information (including the right to display such information) found on their respective web sites. These linked web sites may or may not be available in French. The linking to or from this site does not imply on the part of the Government of Ontario any endorsement or guarantee of any of the organizations or information (including the right to display such information) found on their respective web sites. The Government of Ontario does not assume and is not responsible for any liability whatsoever for the linking of any of these linked web sites, the operation or content (including the right to display such information) of any of the linked web sites, nor for any of the information, interpretation, comments or opinions expressed in any of the linked web sites. Any comments or inquiries regarding the linked web sites are to be directed to the particular organization for whom the particular web site is being operated.

Acknowledgments

Healthy Eating Matters was written by Registered Dietitians and Nutrition Consultants Carol Harrison, BASc, RD and Shannon Crocker, MSc, RD.

We gratefully acknowledge the assistance of the many Ministry of Children and Youth Services staff that contributed to the development, review and refining of Healthy Eating Matters.

Special thanks to the members of the External Reference Committee volunteers who provided invaluable insight in reviewing Healthy Eating Matters:

Cecile Brookes
Foster Parents Society of Ontario

Margaret Spoelstra
Autism Ontario

Claire Fainer
Children’s Mental Health Ontario

Jennifer Foster
Ontario Association of Child and Youth Counselors

Andrea Rifkin
Ontario Association of Residences Treating Youth

R. Jack Falkins
Ontario Federation of Indian Friendship Centres

Special thanks to Natalia Morrison, MSc, RD, Nutrition Consultant for contributing her expertise and experience in Northern Ontario and Aboriginal nutrition and culture.

Table of Contents

Introduction

Healthy food, in appropriate amounts, provides children and youth with the nutrients and energy needed daily for growth and development, as well as the foundation for lifelong good health.

Yet we know that many children and youth are not well nourished:

Licensed residential settings have the ability to make a positive impact on the children and youth in their care; children and youth who develop life skills and healthy eating habits now are more likely to eat nutritious foods throughout their lifetime, thus reducing the risk of obesity and diseases such as diabetes, osteoporosis, heart disease and certain types of cancer.

Use this tool kit as a supportive guide

The purpose of this tool kit is to support licensed residential service providers in meeting the nutritional needs of children and youth (aged 3 to 18) in their care. This tool kit will assist licensed residential service providers in meeting Ministry requirements and policies concerning food and nutrition.

This easy-to-use tool kit includes basic food and nutrition information, tips and suggestions, as well as links to more information. Nutrition basics are based on Health Canada’s revised Food Guides: Eating Well with Canada’s Food Guide (2007) and Eating Well with Canada’s Food Guide – First Nations, Inuit and Métis (2007).

Residential care settings are diverse, and the needs of the children and youth within those settings can vary. Licensed residential settings already have a variety of good practices in place to foster healthy eating habits. Some ideas in this tool kit will not be appropriate for all children and youth. Use your own good judgment when applying this information, and always consult appropriate health professionals if you have questions.

NOTE: The tool kit does not address healthy eating for infants, toddlers, children and youth with food restrictions due to medical conditions and/or behavioural issues, children and youth who are tube fed or pregnant teenagers; these cases typically require very specific nutrition considerations. If you have nutrition questions regarding these client groups, contact your local public health department to speak with a registered dietitian, or talk to a doctor or nurse practitioner.


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Section One: Healthy Eating for Children and Youth

Introduction

Good nutrition is important for overall health, growth and development for all children and youth. It is important to provide children and youth in licensed residential settings with nutritious foods in appropriate amounts to support their mental, physical and emotional health and well-being.

Children and youth who eat right and are active tend to:

Children and youth who are hungry or poorly nourished (e.g., higher intakes of foods and beverages high in calories, fat, sugar or salt such as chips, donuts, soft drinks) may:

Children and youth who form healthy eating habits will benefit from these essential life skills in years to come. They will be able to better manage daily living, and will reduce their risk for chronic diseases such as diabetes, heart disease, osteoporosis and certain cancers.

In this section you will find:

For more information on lifestyle food issues such as vegetarianism, healthy weights and allergies, see “Section Three: Special Nutrition Considerations.”

Good to Know

Get trustworthy advice about healthy eating.

Speak to a registered dietitian. Call EatRight Ontario’s toll-free telephone information service at 1-877-510-510-2, Monday to Friday from 9 a.m. to 5 p.m. Eastern Time, or visit EatRight Ontario to email your question.


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Healthy eating basics

The best way to eat well is by following Eating Well with Canada’s Food Guide (2007) and Eating Well with Canada’s Food Guide – First Nations, Inuit and Métis (2007) (hereafter referred to as Canada’s food guide). The Food Guides’ recommendations are designed to help give children and youth the energy and nutrients they need to grow, develop and thrive.

The Food Guides provide recommendations for how much and what types of food children and youth should eat every day from each of the four Food Groups:

The Food Guides are simple tools that can help licensed residential settings make sure that children and youth are getting the right types of foods in the appropriate amounts. Remember, what is most important is their eating habits over time.

The Food Guide website is an excellent resource, covering everything from serving sizes and healthier choices to meal and snack suggestions.

Explore the Food Guides, order additional copies, and help children and youth create their own personal Food Guide online. Copies are also available from local public health units and community health centres.

Good to Know

Healthy eating does make a difference!

  • 70% of children do not eat the recommended five servings of vegetables and fruit*. Children and youth who don’t eat five servings of vegetables and fruit are more likely to be overweight, increasing their risk for chronic diseases such as type 2 diabetes, cancer and heart disease.
  • Risks of cancer from a poor diet are the same as from smoking.
  • Over 1/3 of children don’t eat the recommended two servings of milk and alternatives*. These children are less likely to be getting the calcium they need to develop strong, healthy bones.
  • Whole grains (e.g., brown rice, oatmeal, whole grain breads) have 80% more disease-fighting compounds than refined grains (e.g., white bread). That’s why the Food Guide recommends that at least half of our grain product choices be whole-grain.

* Canadian Community Health Survey, 2004


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Healthy food choices

Most of the food served should be healthy choices from each food group with minimal processing. The following charts offer guidance on what foods to serve more and less often. The “healthy foods to serve every day” contain less fat, salt (sodium) and sugar and provide more vitamins, minerals and fibre.

Remember to use food labels to compare brands to make healthier choices. See “Section Six: Budgetwise Shopping” for more on reading labels.

Good to Know

Teach children and youth how all foods can fit into a healthy diet.

Help children and youth understand that healthier choices give them energy to play, grow and learn, but also that all foods can be eaten and enjoyed – even treats. Avoid referring to foods as “good” or “bad.” Food should always be approached in a positive way. Calling a food “bad” or “fattening” can cause a child or youth to feel guilt or shame. Find out more: Foods to limit.

Healthy Foods to Serve Every Day
Vegetables and Fruit Grain Products * Milk and Alternatives Meat and Alternatives
  • Fresh vegetables and fruit when in season, and frozen or canned at other times
  • Dark-green vegetables: broccoli, bok choy, peas, green beans, cabbage, fiddleheads, romaine lettuce, spinach, wild greens
  • Orange vegetables and fruit: carrots, squash, pumpkin, yams or sweet potatoes, cantaloupes, apricots, nectarines
  • 100% unsweetened fruit juice: grape, orange, pineapple, apple
  • Homemade frozen fruit juice bars made with 100% fruit juice
  • Homemade or canned vegetable soups tomato, carrot, butternut squash
  • Unsweetened wholegrain cereals (e.g., oatmeal) with four grams or more of fibre per serving
  • Whole-grain or wholewheat: bread, bannock, tortillas, bagels, pitas, buns, crackers, English muffins
  • Whole-wheat or multigrain pancakes
  • Muffins made with whole grains (whole wheat, oats)
  • Whole-wheat noodles, pasta, brown rice, couscous
  • Wild rice, bulgur, millet, barley
  • Whole-wheat roti, chapatis, naan
  • Chinese steamed buns White bread, white rice, enriched pasta

* make at least half of the Grain Product choices whole grains each day

  • Powdered milk
  • Milk: skim, 1% or 2%
  • Chocolate milk
  • Fortified soy beverage
  • Canned milk (evaporated)
  • Soups made with milk
  • Yogurt
  • Smoothies made with milk/yogurt
  • Kefir (yogurt drink)
  • Hard cheeses
  • Tofu
  • Beans, peas, lentils
  • Hummus
  • Peanut butter, nut butters
  • Nuts, seeds (plain, unsalted)
  • Fish**, seafood
  • Canned light tuna, sardines, salmon (in water)**
  • Frozen fish: smelt, haddock, Boston bluefish, ocean perch
  • Eggs
  • Chicken, turkey
  • Lean beef/pork: stew meat, shoulder pork, chuck/blade, brisket point, cross rib, sirloin tip, outside round or bottom, inside round
  • Lean or extra-lean ground meat, or regular ground meat that is well cooked and rinsed of excess fat
  • Ham (unprocessed)
  • Wild/game meat: moose, venison, rabbit, duck, goose
Foods to Serve Sometimes
Vegetables and Fruit Grain Products * Milk and Alternatives Meat and Alternatives
  • Vegetables with sauces or breading
  • Fruit leather, dried fruit bars
  • Dried fruit: raisins, cranberries, apricots
  • Granola bars (plain)
  • Popcorn (unflavoured)
  • Pretzels (unsalted)
  • Fruit crisps, cobblers
  • Cookies: oatmeal, peanut butter, dried fruit-filled (e.g., fig), gingersnaps, graham wafers
  • Biscuits, scones
  • Pudding made with milk
  • Milkshakes
  • Frozen yogurt Custards
  • Processed cheese slices
  • Cheese spreads
  • Low-fat fish sticks**
  • Low-fat chicken strips or nuggets
  • Canned fish (in oil)**
Foods, beverages and extras to limit
  • Pastries, danishes
  • Fry bread
  • Cakes, pies, sticky buns, donuts, tarts
  • Pre-sweetened cereals
  • Granola bars with chocolate
  • Cookies with icing
  • Instant noodle soups
  • Soft drinks, pop, diet pop
  • Fruit drinks (punch, cocktails)
  • Sweetened fruit juices
  • Sports drinks
  • Energy drinks
  • Coffee beverages (e.g., icy cappuccino)
  • Syrups
  • Frozen ice treats (popsicles)
  • Sherbet, ice cream
  • Marshmallows
  • Whipped cream, whipped topping
  • Candy, chocolate
  • Flavoured gelatin
  • Potato chips, nacho chips
  • Cheesies
  • French fries
  • Weiners, hot dogs, sausages
  • All deli meats
  • Canned meats e.g., corned beef
  • Bacon and back bacon
  • Dried meat dipped in lard or shortening
  • Dried processed meat strips such as pepperoni sticks
  • Gravy
  • Ketchup, mustard, relish
  • Butter, hard margarine
  • Cream cheese
  • Sour cream

**Call EatRight Ontario at 1-877-510-510-2 to learn about choosing low-mercury fish.

Adapted from Eat Right Be Active A guide for parents and caregivers of children ages 6-8, Nutrition Resource Centre, Toronto, Ontario, 2007


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How much food do children and youth need?

The Food Guides recommend how much food children and youth should consume every day for healthy growth and achieving or maintaining a healthy weight, including serving sizes of various foods within each Food Group. Remember:

Measuring specific servings is neither necessary nor practical. Use these visual cues to approximate serving sizes:

It is normal for appetites to vary from day to day and from one meal or snack to the next. Where appropriate, let children and youth determine how much to eat. This encourages them to listen to their body cues. A child’s or youth’s appetite will vary naturally depending on:

Note: Some children and youth may eat more than they need for a variety of physical, social and psychological reasons. Also, some medications may reduce or enhance appetite. See “Section Three: Special Nutrition Considerations” for more information.

Explore Canada’s Food Guide’s sample menus for children and youth to get an idea of how much food a child or youth might eat in a day. These menus are just guides; a child or youth may eat more or less depending on individual needs.

Good to Know

Boosting fruit and vegetable intake!

The Food Guides recommend children eat 4 to 6 servings of vegetables and fruit each day and teens should eat 7 to 8 servings. Most children and youth readily eat enough fruit, but getting vegetable servings can be more difficult. Here are some tips:

  • When possible, serve as a role model by eating vegetables in their presence
  • Involve the children or youth in growing, shopping for and cooking vegetables (where appropriate)
  • Serve a vegetable with each meal and snack
  • Serve colourful vegetables with a dip (hummus, tzatziki, baba ghanouj)
  • Puree cooked vegetables into sauces, dips and soups
  • Add canned pumpkin, grated carrot or shredded zucchini to muffin recipes
  • Serve cooked broccoli with a bit of cheese sauce
  • Make sweet potato French fries/wedges
  • Add canned diced tomatoes to tomato soup
  • Add frozen or canned vegetables to canned soups
  • Serve vegetable juice – warm or cold (look for lower-sodium brands)
  • Load up pizzas, sandwiches and pasta sauces with vegetables

Find vegetable recipes and more by visiting 5 to 10 a Day for Better Health and Foodland Ontario.

Adapted from Eat Right Be Active A guide for parents and caregivers of children ages 6-8, Nutrition Resource Centre, Toronto, Ontario, 2007


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Healthy meals, snacks and drinks

Meals and snacks should provide a variety of nutritious choices from the four Food Groups. Special dietary needs (e.g., allergies) and cultural and religious choices should also be considered.

Follow these guidelines for healthy meals and snacks:

Meals and snacks should be served at regular times (as much as possible) each day. Serve three meals and two or three snacks no longer than two to three hours apart for preschoolers and three to four hours apart for older children and youth.

For more information on healthy meals and snacks, see “Section Five: Menu Planning – The Basics.”

The importance of breakfast

A healthy breakfast should be eaten every day. Children who eat breakfast generally have a higher
intake of vitamins, minerals and other nutrients that can help fuel active learning and play. Research
also shows that children who eat breakfast:

For more information on healthy breakfast ideas, see “Section Five: Menu Planning – The Basics.”

Healthy snacking

Children and youth may need two or three healthy snacks that pack a nutritional punch rather than filling them up with “empty calories.” Snacks should:

Children and youth who are overweight or obese still require snacks; make sure that they are nutritious Food Group choices and amounts are appropriate.

For more information on healthy snack ideas, see “Section Five: Menu Planning – The Basics.”

Good to Know

Limit soda pop.

Soda pop has no place in a child’s diet, and it should be limited for youth. Here are the reasons why:

  • Just one can of caffeinated pop affects small children negatively (insomnia, headaches, irritability, nervousness)
  • Research shows that a high intake of pop is associated with increased caloric intake and increased body weight
  • Children and youth who drink pop are less likely to get enough calcium and vitamin D in their diets (because they drink less milk)
  • High intake of pop is associated with increased cavities

What to drink

Sugary beverages like pop and fruit punch provide little more than sugar and should be limited. Most often, serve:

Find out more about better beverages, bottled water and how to stay well hydrated by visiting EatrightOntario.ca.

Good to Know

Serve 100% juice, not “drinks.”

Only 100% unsweetened juice counts as a serving of vegetables and fruit. Fruit drinks may look like juice, but are mostly sugar and water with just a little, if any, real fruit juice. Most fruit drinks also have very few, if any, vitamins and minerals. Limit drinks made from crystals, and fruit drinks that have these words on the package:

  • drink
  • punch
  • cocktail
  • -ade
  • beverage

These fruit drinks do NOT count as a serving of vegetables and fruit.


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Fat in children’s and youths’ diets

Fat in small amounts is actually an important part of a healthy diet because it can provide essential nutrients for growth and development. When it comes to fat:

Some fats are better than others. Health Canada recommends:

Avoid trans fat

Trans fat is an unhealthy type of fat linked to heart disease. There is no safe amount of trans fat. Avoid it as much as possible. It is found mostly in processed foods such as:

Trans fat also occurs naturally in small amounts in some meat (e.g., beef and lamb) and dairy, but it is not known to be as harmful as the processed type of trans fat.

Limiting trans fat

Good to Know

Omega-3 fatty acids are one of the “good” fats to include in a healthy diet.

This type of fat is necessary for normal development of the brain, eyes and nerves. It is especially important for young children, whose brains are developing rapidly. Try to include sources of omega-3 fats regularly. The best sources are:

  • Fatty fish: canned salmon, herring and halibut. Call EatRight Ontario at 1-877-510-510-2 to learn about choosing low-mercury fish.
  • Foods fortified with omega-3 fats, such as orange juice, milk and eggs

For more information

Eating Well with Canada’s Food Guide to Healthy Eating, Health Canada, 2007

Eating Well with Canada’s Food Guide – First Nations, Inuit and Métis, Health Canada, 2007

EatRight Ontario, Ministry of Health Promotion


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Section Two
Positive Mealtimes

Introduction

Establishing a positive mealtime where children and youth feel safe and relaxed is critical to learning healthy eating habits – it is just as important as the food they eat. Handling common feeding challenges effectively can help to avoid conflicts over food, keep mealtimes pleasant and contribute to good eating habits.

In this section you will find:


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Feeding situations that may require medical advice

At times, it can be difficult to distinguish between developmentally appropriate behaviour related to food and more complex issues. For example, the following would most often be considered developmentally appropriate, or typical, behaviour:

The following list is not exhaustive but provides some examples of behaviour that may indicate the need to work with qualified professionals, the child or youth’s case manager and/or the parents or guardians to identify any medical, medication-related or mental health issues and develop a plan for response:


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Positive mealtime checklist

The ideas listed below may help make mealtimes positive, establish appropriate roles, resolve conflicts over food, and help children and youth feel safe and relaxed.

Good to Know

Pressure AND praise about what and how much children and youth eat can lead to poor eating habits and future health problems.

In our efforts to encourage children and youth to eat well, we may actually be pressuring them to eat. Often, as a result, children and youth will eat less. Conversely, praising children and youth for eating everything on their plate may result in overeating as they try to earn approval – and that can lead to overweight.

Avoid comments like these:

  • “Just take one more bite.”
  • “No dessert until you eat your meat.”
  • “No more bread until you eat some vegetables.”
  • “Finish your milk. It’s good for you.”
  • “How do you know you don’t like it unless you try it?”
  • “Good boy! You ate all your peas.”
  • “You are such a good eater. You ate everything on your plate!”

Note: Reinforcing statements, food rules and routines for how, when and what to eat may be appropriate for some children with developmental disorders. For example, in some situations, using pictures or statements such as “eat first, then play” may help a child or youth with autism to understand routines.

Adapted from Eat Right Be Active A guide for parents and caregivers of children ages 3-5, Nutrition Resource Centre, Toronto, Ontario, 2007


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Approaches to feeding different age groups

Assuming that no specific issues or responses related to medications, medical conditions, special needs or mental health issues have been identified, the ideas provided here, if appropriate to a particular licensed residential setting, can help handle everyday situations in a positive way.

Also see “Section Three: Special Nutrition Considerations” – Food and Behaviour.

Behaviours and approaches

The following examples are provided to illustrate possible strategies for dealing with food challenges. Note that for some children and youth, including those with special needs and Autism Spectrum Disorders, these approaches may not be appropriate. Specific approaches for dealing with such cases should be discussed with a health care or rehabilitation professional.

Feeding children aged 3-5

Young children should eat the same healthy foods as adults – just in smaller portions. Here are a few helpful tips:

Good to Know

Foods that are high-risk choking hazards for younger children (aged 3-5)

Young children are especially vulnerable to choking on food. These foods pose a high risk of choking:

  • Whole hot dogs and grapes (make them safer: slice lengthwise and cut into bite-sized pieces)
  • Raw hard vegetables (make them safer: soft-cook or shred into foods)
  • Peanut butter served from a spoon (make it safer: serve thinly spread on crackers, not moist bread)
  • Fruit with seeds (make it safer: remove all seeds and pits and buy seedless watermelons, grapes, etc.)
  • Popcorn, peanuts, nuts and hard candies – do not serve these to young children
  • Soft breads, muffins or cakes (they can form a sticky ball)

Behaviour: The child wants to eat the same food all the time.

Approach: Let the child have his or her “favourite food” as long as it belongs to one of the four Food Groups. For example, plain pasta is a favourite of many preschoolers. Keep offering other healthy choices at each meal.

Behaviour: The child eats very little or skips an entire meal.

Approach: During the preschool years, growth and consequently appetite may slow down. The odd skipped meal is not a concern as long as the child is growing normally. Serve small portions, provide snacks about two hours before mealtimes, and offer only water between meals and snacks since even juice or milk can spoil a child’s appetite for the next meal or snack time.

Behaviour: The child does not want to drink milk.

Approach: Offer a small amount (½ cup) of milk, but don’t force it. Preschoolers need 2 cups of milk or fortified soy beverage each day. Cooking with skim milk powder counts too. Try using milk in pancakes, oatmeal and soups. Talk with a doctor, nurse practitioner or registered dietitian if the child will not drink milk. He or she may be lactose intolerant.

Behaviour: The child drinks a lot of milk.

Approach: Milk can be filling, and too much can spoil the child’s appetite for other healthy foods. Limit milk if the child is drinking more than 3 cups a day.

Feeding children aged 6-13

At this age, children start to make more food decisions on their own, but they still need adults to make healthy choices available and guide their eating habits by teaching them why it is important to eat right and how to eat right.

Children aged 6-13 are also becoming more aware of their bodies. Promote healthy food choices and positive body image with these tips:

Behaviour: The child wants the same lunch every day.

Approach: As long as the child’s lunch contains Food Group foods (e.g., a turkey sandwich, milk and an apple), it is acceptable for him or her to want the same thing every day. Offer a variety of foods for other meals and snacks to provide nutrients the child may be missing at lunch.

Behaviour: The child wants to snack all day and then won’t eat supper.

Approach: Keep regular sit-down mealtimes and snack times, and serve only water in between so children will come to the table hungry. Offer healthy morning and after-school snacks at least one to two hours before mealtimes, followed by an evening snack.

Adapted from Eat Right Be Active A guide for parents and caregivers of children ages 6-8, Nutrition Resource Centre, Toronto, Ontario, 2007

Feeding youth aged 14-18

Healthy eating fuels growth, and also helps maintain a healthy body weight. The teen years mean periods of rapid growth and sexual maturity. Females develop earlier than males, but nutrient needs for both sexes are still high – a teenaged boy may need more food than the average adult.

The Food Guide serving ranges are based on low activity levels, and will usually be enough food for non-active youth. Teens who are active (60 minutes or more each day) and/or going through a growth spurt may need more servings.

Teens’ bones grow fastest during pre-puberty and puberty. Offer three to four servings of milk and alternatives (e.g., milk, fortified soy beverage) daily to help teens develop strong bones for now and the future (i.e., reducing their risk for osteoporosis).

Rates of overweight and obesity have increased for youth. Teens’ concerns about body weight and body image may result in dieting or a desire to be thinner or more muscular. Encourage healthy eating, feeling good about themselves and daily physical activity for all youth, regardless of their weight. Refer to “Section Three: Special Nutrition Considerations” for more about helping youth who are struggling with weight issues.

Behaviour: The youth is not always interested in eating breakfast.

Approach: Teens’ internal clocks are set differently – they might not be able to get up early enough to eat breakfast. Try packing a breakfast with three or four Food Groups that they can take with them.

Behaviour: The youth only wants to eat “junk.”

Approach: It may not be possible to control the amount of “junk” consumed when teens are not under supervision. Limit how often these treats are available in the residential facility. Be sure to provide healthy choices from the Food Groups whenever possible.

Behaviour: A youth is vegetarian.

Approach: See the information on vegetarianism in “Section Three: Special Nutrition Considerations.”

For more information

Teens who are interested in finding out more about food, physical activity and healthy weights can visit TeensHealth, a credible website designed specifically for teens.

Secrets of Feeding a Healthy Family: Orchestrating and Enjoying the Family Meal by Ellyn Satter, 2008. Madison, Wisconsin: Kelcy Press.

Child of Mine: Feeding with Love and Good Sense by Ellyn Satter, 2000. Palo Alto, California: Bull Publishing.

“Common Eating Problems and How to Cope”, Niagara Region Public Health.


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Section Three
Special Nutrition Considerations

Children and youth with special needs

Any specific dietary considerations for children and youth in a residential setting need to be identified and documented; a registered dietitian can help determine how to best meet nutritional needs.

Some physical, developmental and/or mental health conditions and medications may affect a child’s or youth’s food preferences, appetite or digestion (e.g., bowel regularity) or cause weight fluctuations. Always rule out a health issue before making dietary changes.

In addition, for children and youth with developmental disabilities, autism and other communication exceptionalities, healthy eating habits, food rules and routines may need to be individually determined in consultation with the child or youth, qualified professionals, the child’s/youth’s case manager and/or the parents/guardians.

Individualized learning goals for children and youth with special needs in relation to food can be part of a comprehensive approach to building daily living and communication skills and prompting appropriate behaviours. For example, the use of pictures of certain food items may be very important in helping a child or youth with autism to understand meal routines.

For all children and youth, become familiar with individual behavioural issues, common challenges and side effects of medication, and monitor them closely to watch for what might be affecting their food intake.

It is not realistic to list every possible condition that might have an impact on a child’s or youth’s food intake; however, some of the more common challenges are described here.

In this section you will find:

Good to Know

Special needs considerations

Children and youth with developmental disabilities, autism and other communication exceptionalities may exhibit varying food-related behaviours, preferences and sensitivities.

Some children and youth may have challenges with certain textures, colours, smells or hot and cold temperatures. They may exhibit the following:

  • Eating very hot food without apparent concern about burning their mouth
  • Avoiding crunchy or soft foods
  • Refusing to use certain utensils
  • Leaving the table because of the smell of certain foods
  • Only eating (or avoiding completely) foods with certain colours

Children and youth may choose to eat such a limited range of foods that, at times, may place them at risk for nutritional deficiencies.

For children and youth with special needs, food rules and routines may need to be individually determined in consultation with appropriate professionals, the individual and other family members (if possible), and made a part of the child’s or youth’s plan of care.


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Food and behaviour

What determines a child’s behaviour will vary greatly depending on the individual, and what works for one child may not work for another. And while there is little data available on the role of any specific food in extreme behaviours, providing nutritious foods at regular meals and snack times can help all children and youth.

Here are some basic strategies that may help:

Serve meals and snacks at regular times.

Meals and snacks should be served about every two to three hours for preschoolers and three to four hours for older children and youth. Children and youth who skip meals or go hungry for long periods during the day will:

Serve healthy foods.

Including healthy foods from the four Food Groups provides a child’s or youth’s growing body with essential nutrients. For example:

Whole grains (e.g., whole-wheat pasta, brown rice, whole grain, whole-wheat bread) provide carbohydrates that can actually have a calming effect. Be sure to provide at least the minimum number of servings of Grain Products each day.

Protein in a meal or snack can help keep children and youth fuller longer, keeping hunger at bay. Include protein when planning meals and snacks (e.g., meat, legumes, peanut butter, cheese, and yogurt).

Avoid sugary snack foods.

A diet that is high in sugary snacks likely lacks nutrients required to feed a child’s or youth’s body and brain, such as protein and essential fats.

Skip the soda!

It doesn’t take much caffeinated cola, energy drink or coffee for a child or youth to feel the impact. Caffeine is a drug, and it can cause symptoms similar to those experienced by people under stress, such as irritability, anxiety, restlessness and nervousness.

Watch for food reactions.

While studies are limited and not conclusive, some research shows that some children may react negatively to food dyes and preservatives in food. In particular, chemical preservatives called “benzoates” and four specific artificial colours (tartrazine, sunset yellow, ponceau and carmoisine) may trigger hyperactive behaviour.

Good to Know

Too much sugar?

Too much sugar in children’s diets is often blamed for a range of poor behaviours, such as irritability, anxiety, violent behaviour and fatigue. However, eating sugar actually makes a person feel sleepy because it stimulates the production of serotonin, a “sleep chemical,” in the brain.

Foods that contain large amounts of sugar, such as soft drinks, candies and other sweet foods, also contain artificial colours and preservatives, which may cause behavioural changes in some children.

Adapted from the Canadian Health Network, Public Health Agency of Canada

For more information about feeding children with behavioural issues, contact a registered dietitian.


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Food allergies and intolerances

Food allergy – what is it?

A food allergy is a response of the immune system to a protein in a specific food. The reaction can range from mild to severe. It can be triggered by a very small amount of food, and it can occur very quickly after eating that food. In some children and youth, simple contact with an allergic food can cause a severe reaction.

In order to keep a child with food allergies safe and avoid serious reactions, staff or foster parents should follow the directions provided by a registered dietitian, doctor or nurse practitioner and parents (if applicable).

Common food allergy symptoms include:

Severe allergic reactions (anaphylaxis) are rare. They cause a rapid heartbeat, a drop in blood pressure and unconsciousness, and can be life-threatening.

Food allergies occur in about six percent of young children. Many outgrow certain allergies, such as egg and milk allergies. In Canada, the most common food allergies are:

Currently there is no cure for food allergies. The only option is complete avoidance of the specific food. Emergency treatment for anaphylaxis is the immediate injection of adrenaline through an auto-injector device (EpiPen™) followed by further treatment at a hospital emergency room.

Food intolerance – what is it?

Food intolerance is a sensitivity reaction to food that does not involve an immune-system response. While symptoms of intolerance vary and may be mistaken for a food allergy, typically the response is gastrointestinal and caused by the body’s inability to break down certain components in food. Common symptoms include:

For example, lactose intolerance is caused by the body’s inability to break down lactose, a natural sugar found in milk. Unlike a milk allergy, where milk products must be avoided completely, a child or youth with lactose intolerance can usually still eat small amounts of milk products with meals, such as ½ to 1 cup of milk, hard cheese and yogurt made with active cultures (read the label to be sure).

Lactose-reduced milk and fortified soy beverage are also options for those with lactose intolerance. Additional alternative sources of dietary calcium and vitamin D, such as fortified orange juice, may be necessary.

Be aware that lactose intolerance is more common amongst people of Aboriginal, Asian, and African descent. For individuals who don’t drink milk or fortified soy beverage, speak with a registered dietitian about the need for dietary supplements.

What to do?

If a child or youth is suspected to have a food allergy or intolerance, he or she should see a doctor for a reliable allergy test. When feeding children and youth with food allergies or intolerances, help minimize risks by:

For a child or youth who lacks the communication skills to describe intestinal discomfort, it is important to check with individuals who are familiar with his or her history regarding sensitivities to foods and/or medications.

For more information

Good to Know

It is important to learn the signs and symptoms of allergies.

Beyond the obvious physical signs (swelling, hives, etc.), some children experiencing a reaction will put their hands in their mouth, or pull or scratch at their tongue. Their voice may change (i.e., become hoarse or squeaky), and they may slur their words. If an allergic reaction is suspected, get medical help immediately.

Some children will use different words to describe an allergic reaction:

  • This food is too spicy.
  • My tongue is hot (or burning).
  • It feels like something is poking my tongue.
  • My tongue (or mouth) is tingling (or burning or itching).
  • My tongue feels like there is hair on it.
  • There’s a frog in my throat or There’s something stuck in my throat.
  • My tongue feels full (or heavy).
  • My lips feel tight.
  • It feels like there are bugs in there (to describe itchy ears).
  • My throat feels thick.
  • It feels like a bump is on the back of my tongue/throat.

Adapted from Contra Costa Child Care Council – Health and Nutrition


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Vegetarianism

Children and youth follow vegetarian diets for a variety of reasons, such as concern for the environment, a simple dislike of meat, or cultural or religious beliefs. It is important to support a child or youth in this personal choice – find out from him or her which foods are included in their diet.

Vegetarian meals can be budget-wise, nutritionally balanced and easy to plan:

For more on vegetarian diets, including how to meet nutritional needs, visit:

Good to Know

What is the reason?

Some youth, especially teenage girls, may see vegetarianism as a way to lose weight or cover up their intention to diet. Discuss the reasoning for their choice and ensure that vegetarian teens are still eating regular meals and snacks.

If you notice that the vegetarian diet is leading to more extreme food restrictions or behaviours, determine the appropriate response through consultation with relevant individuals, e.g., parents/ guardians (if possible), doctor, nurse practitioner and case manager, and a registered dietitian who specializes in vegetarianism and eating disorders.

What about vegans?

A vegan is a vegetarian who follows a diet that does not include any foods of animal origin – no meat, poultry, fish, eggs, milk, cheese or other dairy products. A vegan diet can be healthy if foods are chosen wisely and there is enough food to support growth, development and appetite.

Because there are several nutrients that may be difficult for a child or youth to get from a vegan diet – such as iron, calcium, vitamin B12 and zinc – it is important to have a registered dietitian develop a nutritional plan that provides appropriate nutrients and calories. A doctor or nurse practitioner may be able to provide additional support and/or a referral to a registered dietitian.

For more information

The Teen’s Vegetarian Cookbook by Judy Krizmanic, 1999. (includes “fast food” and easy-to-prepare dishes)

Raising Vegetarian Children by Joanne Stepaniak and Vesanto Melina, 2002. (offers tips, advice about vegetarian teens, recipes and suggestions for handling holiday meals)

Moosewood Restaurant Cooks for a Crowd: Recipes With a Vegetarian Emphasis for 24 or More. The Moosewood Collective, 2006. (recipes including stews, pastries, pasta dishes and holiday fare)

The Vegetarian Resource Group (provides information about vegetarianism and children, youth and adults, from nutritional needs to recipe ideas)


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Healthy weights

There is no one ideal weight for children and youth, especially since they are continually growing and changing as part of normal development. Children and youth need enough calories to support growth and development, but not too many calories, which might lead to excessive weight gain.

It is important to promote healthy eating and physical activity for all children and youth at a licensed residential setting. Promote healthy eating as a means to feel strong and healthy, not changing looks or losing weight.

There are several concerns for an overweight or obese child or youth:

Good to Know

Do not forbid or force.

Forbidding foods like cookies and candy can actually make children and youth want them more. Instead, provide occasional treats in reasonable portion sizes.

Children and youth who are forced or pressured (e.g. clean their plates) to eat may lose touch with their body’s natural appetite control. This can lead to overeating and possible weight problems or eating disorders.

Caring for an overweight or obese child

The causes of obesity are not as simple as too much food intake and too little physical activity, especially for children and youth experiencing physical, emotional and social challenges. For children and youth who might be overweight or obese, consider these suggestions:

Note: If a child or youth loses or gains weight rapidly without apparent cause, medical attention is required.

For more information

Teens who are interested in finding out more about food, physical activity and healthy weights can visit TeensHealth, a credible website designed specifically for teens. Children can visit KidsHealth.

The Weight of the World, a video by the Canadian Broadcasting Corporation and David Suzuki. You can order this video and a support guide (with activities). The video uses lively animation and hard-hitting science to help children and teens understand the obesity epidemic.

Raising Happy, Healthy Weight-wise Kids by Judy Toews and Nicole Parton, 2002. (information about guiding children toward a healthy body weight and a positive body image, from infancy through the turbulent teen years).

Your Child’s Weight – Helping Without Harming by Ellyn Satter, 2005. (how to develop a healthy weight, including topics such as the feeding responsibilities of adults and children, the importance of not restricting foods for children who are overweight, and healthy food choices). “Tips for Raising Kids with Healthy Weights,” EatRight Ontario.

Tips for Raising Kids with Healthy Weights,” EatRight Ontario


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Dieting and eating disorders

While it is normal for teenagers to be self-conscious about their body, constantly worrying about weight or restricting food is not healthy. Teens are still growing and need the right amounts of food and nutrients to be healthy. Taking in too few calories and nutrients can have serious negative effects on their health.

Good to Know

Dieting is not just a girls’ thing.

Studies show that there has been an increase in body image concerns among males. With males, the focus is not usually on being thin, but rather being buff and lean or muscular. Boys may get into unhealthy habits such as:

  • Taking protein supplements
  • Steroid use
  • Binge eating

Make sure to have positive body discussions with teen boys and watch them for unhealthy dieting habits. Consult a registered dietitian, doctor or nurse practitioner if body image issues arise.

Try the following suggestions when dealing with children and youth who seem preoccupied with their weight or are dieting:

Adapted from Dieting: Information for Parents, Teachers and Coaches, Caring for Kids

Eating disorders

Eating disorders are not about food or vanity; they are coping strategies to deal with deeper emotional problems. Clinical eating disorders that are recognized as medical conditions are defined by strict criteria. They include:

Adapted from the National Eating Disorder Information Centre (NEDIC)

Eating disorders can have a serious negative impact on overall health and can even cause death. A child or youth with an eating disorder requires specialized medical attention.

Children and youth who experience only some of the symptoms may still suffer from disordered eating (abnormal eating habits including restrictive dieting). For definitions, symptoms and strategies for dealing with clinical eating disorders and disordered eating, see the National Eating Disorder Information Centre (NEDIC).

Early warning signs

When dealing with eating disorders, dieting and disordered eating, caution is needed to avoid contributing further to mental and physical health problems. Professional help may be required if a child’s or youth’s dieting has gone too far, or if these early warning signs are noticed:

Adapted from the Student Nutrition & Activity Manual, Wellington-Dufferin-Guelph Public Health, 2006

Good to Know

Disordered eating is not always about being thin.

Disordered eating includes a wide range of abnormal eating behaviours. Children and youth may suffer from:

  • pica (eating non-food items)
  • Prader-Willi syndrome (genetic disorder that causes insatiable appetite)
  • compulsive eating
  • hoarding or hiding food
  • irregular, chaotic eating patterns
  • Often, physical hunger and fullness signals are ignored. If a child or youth may be suffering from this type of disordered eating, it is important to get the advice of an appropriate health-care professional. For more information on various types of disordered eating, visit the National Eating Disorder Information Centre (NEDIC).

For more information

Your Child’s Weight – Helping Without Harming by Ellyn Satter, 2005. (how to develop a healthy weight, including topics such as the feeding responsibilities of adults and children, the importance of not restricting foods for children who are overweight, and providing healthy food choices)

Shapesville by Andy Mills and Becky Osborn, 2003. (this book for children aged 3-8 promotes positive body image by depicting shape, size and cultural diversity)

The Beginner’s Guide to Eating Disorders Recovery by Nancy J. Kolodny, 2004. (self-help guide for youth and young adults)

National Eating Disorder Information Centre (NEDIC) ( this Canadian organization provides facts, tips and resources for disordered eating, including a referral list for community treatment services and support groups; call 1-866-633-4220 or 416-340-4156)


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Section Four
Cultural Considerations

Introduction

Considering the cultural and religious needs of children and youth is essential to helping them adapt, feel accepted and build their self-esteem. Similarly, it is important to build cultural awareness of all children and youth by exposing everyone in the group or foster home to food from particular cultural backgrounds. Here are some ideas:

In this section you will find:


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Cultural and religious food-based traditions

It is not realistic to expect foster parents and staff at licensed residential settings to know every culture’s and religion’s food habits, celebrations that involve special foods, and dietary restrictions, and it is impossible to cover them all in this tool kit.

The most important thing to do:

Ask the children and youth about their cultural or religious food traditions or restrictions. Do not assume that all children and youth from a particular ethnic group or culture follow the same traditions. They may be able to tell you what food traditions (if any) they observed in their families, as well as some of their favourite traditional foods.

Resources for research

  1. Call EatRight Ontario. Speak to a registered dietitian for free. In Ontario, call toll-free, 1-877-510-510-2, Monday through Friday, 9 a.m. to 5 p.m. Eastern Time.
  2. Canada’s Food Guide is available in 10 languages in addition to English and French. Translated directly from the 2007 Eating Well with Canada’s Food Guide, these resources are available in Arabic, Chinese, Farsi (Persian), Korean, Punjabi, Russian, Spanish, Tagalog, Tamil, and Urdu. These languages reflect the nation’s top 10 non-official languages spoken in the homes of recent immigrants.
  3. Speak to someone from the Ontario Federation of Indian Friendship Centres.
  4. Call the local public health unit and ask to speak with a registered dietitian.
  5. Check local libraries for multicultural cookbooks, or search for recipes online. At the library, look for the book “You Eat What You Are: People, Culture & Food Traditions”, enlarged 2nd edition, by Thelma Barer-Stein (1999, Toronto, Ontario: Firefly Books). This encyclopedia examines the history and food traditions of more than 170 ethno-cultural groups in 73 countries. Each chapter ends with a Glossary of Foods and Food Terms that explains how certain foods and preparations differ from those in other cultures.
  6. Find out more about Islamic food traditions. Read “Guide to Understanding Halal Foods,” Toronto Public Health.
  7. Read “Healthier Choices for Multicultural Cuisines,” EatRight Ontario.
  8. Go online and look up cultural calendars to find out about festivals and celebrations.

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Aboriginal children and youth – nutrition and traditional foods

Just as with other cultures, there are various traditions followed by different Aboriginal groups across Ontario. Many Aboriginal people eat a diet made up primarily of store-bought foods, sometimes supplemented with much-valued traditional foods. Traditional foods are more often included in special ceremonies or celebrations (e.g., harvest feast). Some Aboriginal people may not eat any traditional foods at all.

Traditional food choices depend on the Aboriginal group as well as the region of Ontario from which the child or youth came. By talking to children and youth, you can discover what traditions are important to them and which foods have special meaning as comfort or celebration foods.

Below is some basic information about traditional Aboriginal foods. In some regions, these foods will be more difficult to obtain and may not be practical.

Good to Know

Obesity and diabetes are major health concerns for Aboriginal children.

These health concerns have arisen from reduced access to traditional diets based on hunting, gathering and fishing, sedentary lifestyles and increased consumption of refined, higher-calorie foods and drinks.

Like non-Aboriginal children, obesity and diabetes result from diets containing too many calories, especially from fatty, processed and fried foods. At the same time, physical activity levels have decreased as video-game playing and TV viewing have increased.

Both obesity and Aboriginal ancestry are risk factors for diabetes. The rates of type 2 diabetes in Aboriginal children and youth have increased dramatically over the past two decades.

Diabetes can lead to premature blindness, kidney failure, amputation (loss of limbs) and heart disease. Healthy food choices and physical activity are key factors in reducing the risk of diabetes as well as effectively managing diabetes.

For Aboriginal children and youth who are obese or have diabetes, consult a registered dietitian to plan appropriate meals and snacks.

For more information


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Section Five
Menu Planning – The Basics

Introduction

Preparing budget-wise, healthy meals and snacks that are appealing to children and youth takes some planning. This section will be especially helpful for those newer to menu planning; however, everyone will find the menu planning checklist and fast food makeovers of interest.

In this section you will find:


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The benefits of menu planning

Investing a small amount of time in menu planning is well worth the effort.


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Seven simple steps for menu planning

There is no right or wrong way to go about menu planning. These tips can help make the process easier in many licensed residential settings:

  1. Regularly ask for input from the children and youth (if appropriate).
  2. List the meals and snacks you often serve (this can be a handy reference for future planning).
  3. Make a list of food supplies. Spoiled food is a waste of money, so plan to first use up the food already at hand. Check the fridge, cupboards and freezer.
  4. Smaller-scale facilities and homes can check grocery store flyers for specials to include in the menu plan. Refer to “Section Six: Budget-wise Shopping” for additional ideas.
  5. Plan three meals and two to three snacks a day. Try the sample menu planning form.

    Tips:
    • Start by slotting in the meals and snacks listed in step 2 above.
    • For better nutrition and more interesting mealtimes, think variety (colour, taste, textures, foods, cuisines) from meal to meal, and from day to day.
    • Fill in any remaining meals and snacks. The ideas on page 43 and sample menus on page 44 may be helpful.
    • Reminder:
      • Breakfast – food from at least three Food Groups
      • Lunch and dinner – food from four Food Groups
      • Snacks – food from at least two Food Groups
      • Have water for drinking available at all times
    • Refer to page 8 for a list of healthy foods to serve most often.
    • For good nutritional value, include plenty of foods from the “best buys."
  6. Compare the menu against the Menu Planning Checklist on page 40 as a guide. Make adjustments as needed. Consider involving the child/youth at this stage for some hands-on life skills training.
  7. Make a grocery list based on the menu plan. If food will be purchased at a grocery store (as opposed to ordering it, as a larger facility may do), organize the list according to the store layout to save time when shopping.
Menu Planner
Season:______________________________
__ Smmer __Fall __Winter __Spring
Meal Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Breakfast Offer choices from at least 3 Food Groups            
AM Snack Offer choices from at least two Food Groups            
Lunch Offer choices from each of the four Food Groups            
Afternoon snack Offer choices from at least two Food Groups            
Dinner Offer choices from each of the four Food Groups            
Evening snack Offer at least two Food Groups            

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Menu planning checklist

Use this checklist as a guide. It can be adapted for a particular care setting and the needs of the children and youth.

Menu planning checklist
Overall considerations
Children and youth have been consulted in developing this menu plan (if appropriate).
There is the time, kitchen equipment and budget to follow through on this menu.
Any special dietary needs (allergies, intolerances, medical conditions, medications) have been planned for in consultation with a qualified health-care provider (registered dietitian, doctor, nurse practitioner).
Menu plans are posted and substitutions are noted on the menu plan (where applicable).
Healthy meals and snacks
Breakfasts include foods from at least three Food Groups.
Lunches/dinners include foods from four Food Groups.
Snacks include foods from at least two Food Groups.
A variety of foods is served from each Food Group, avoiding repetition within the week as much as possible.
Every day, serve at least one dark-green vegetable (broccoli, romaine lettuce and spinach) and one orange vegetable (carrots, sweet potatoes, winter squash or pumpkin; apricots, cantaloupes, mangoes, nectarines, papaya and peaches also contain vitamin A and can be chosen instead of one orange vegetable).
Be budget-wise and choose fresh in season, and frozen or canned at other times.
Within a meal, balance nutritious higher-fat choices (peanut butter, cheese, meats and nuts) with lower-fat foods (raw vegetables, beans, rice and milk).
Each day, at least half of the grain products are whole-grain (barley, brown rice, oats, quinoa, wild rice, couscous, breads, pitas, tortillas, roti, crackers, oatmeal and pasta).
Hard cheeses rather than processed cheese slices and cheese spreads are served. Cream cheese and cottage cheese are less nutritious and are served less often.
Meat alternatives such as beans, chickpeas, soybeans, lentils, eggs and tofu are served often (try for two or three times a week or more).
Processed/canned luncheon meats (e.g. ham, beef and balogna) are limited. (Serve meat alternatives or slice up cooked meat – beef, goat, poultry, pork or wild game – instead.)
Each weekly menu includes at least two Food Guide servings (½ cup x 2) of low-mercury fish (light canned tuna, canned salmon, char, herring, mackerel, sardines and trout).
Salt is not put out on the table. (Try salsa, pepper or Parmesan cheese instead.)
Processed foods (e.g., frozen pizzas, boxed macaroni and cheese, corn dogs, etc.) are used infrequently and not served daily.
Meals and snacks are set for the same times each day.
Only water is served between meals and snacks (to avoid spoiling appetites).
When desserts are served, they are most often Food Group-based (rice pudding, milk pudding, fruit crisps, yogurt topped with fruit, fruit salad, bread pudding, carrot cake, banana bread and date squares).
Cooking methods
Food is flavoured with herbs, spices, onion, garlic, etc., and prepared with little or no added fat, sugar or salt.
Visible fat/skin is removed from meats and poultry before cooking. Cooked ground meats are drained of excess fat.
Canola, olive and soybean oils and soft margarines that are trans fat-free are used. Butter, lard and shortening are limited. Margarines containing trans fats are not served.
Lower-fat cooking methods (baking, broiling, grilling, steaming, roasting and poaching) are used most often.
Amounts of food served
Children and youth are provided with enough food to at least satisfy the Food Guide recommendations.
Active children and youth and those going through a growth spurt may need more servings to satisfy their needs.
Whenever possible, food is served family-style – children can help themselves. If that is not possible, serve appropriate child- or youth-sized portions with the option for seconds.
Drinks served
2 cups of powdered (reconstituted), skim, 1% or 2% milk or fortified soy beverage are offered to every child daily, and 3 cups of milk are offered to youth daily (may include milk used in cooking).
Vegetables and fruit are served more often than 100% juice.
Juice is limited each day to no more than ½ to 1 cup.
These drinks are avoided or seldom offered: fruit cocktails, fruit punches, lemonade, fruit drinks and soft drinks.
Water is offered/available throughout the day to satisfy thirst, especially on hot days or when children and youth are active.
Meals are appealing and respect lifestyles, culture and religion
There is a good variety of well-matched flavours, colours, temperatures and textures (cooked, raw, crispy, crunchy, chewy, smooth/chunky consistencies) and shapes (shredded, in strips, cubes, chunks and slices of different sizes).
Seasonal vegetables and fruit are offered for great taste and good food value.
For younger children, food is often served separately, and mixed dishes are introduced gradually over time.
When a new food is introduced, it is served alongside some familiar and well-liked foods.
Some foods that children and youth can help prepare are included (wherever appropriate).
At least one food item that children and youth are known to like is available, even if it is just bread, pasta, rice or potatoes.
Especially for the younger children (aged 3 – 6), some finger foods are included.
Foods that pose a high choking risk for young children have been avoided.
Cultural and religious food habits and restrictions are respected.
Vegetarian meal options are offered as needed.

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Sample menu plans


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Fast food makeovers

Many children and youth enjoy “fast” foods like French fries, pizza and hot dogs, and may turn to these foods for comfort. Although they are convenient, they offer few nutrients, typically include trans fat and lots of sodium (salt) and are costly. They should be served infrequently and in small portions. The following table offers ideas to boost the nutrition in these fast foods.

“FAST” FOODS MADE BETTER
“Fast” Food Choices Making it Healthier Healthier (and inexpensive) Alternatives
Boxed macaroni
and cheese dinners
  • Add canned tuna
  • Add frozen peas (cooked)
  • Use less butter or margarine and more milk instead
  • Make macaroni and cheese from scratch: Use whole-wheat macaroni (or half whole-wheat, half regular) and lower-fat cheeses
Canned soups
  • Choose broth-based soups more often than cream-based
  • Add a can of legumes to vegetable soup (e.g., kidney beans, chickpeas, black beans)
  • Add leftover meat or frozen vegetables
  • Make a quick pot of homemade soup using salt-reduced chicken or beef broth, frozen or fresh vegetables, lean meat and cooked noodles (including leftovers) and canned beans (e.g., kidney beans)
Frozen pizzas
  • Choose vegetarian, chicken and other types with less meat
  • Add extra sliced vegetables or fruit e.g., canned pineapple (drained) or sliced green pepper
  • Serve with a salad or raw vegetables
  • Make pizza using pizza dough, pre-made crusts or wholewheat tortillas; if appropriate, have children and youth make individual pizzas
  • Use extra vegetable or fruit toppings and lower-fat meats (such as cooked chicken)
  • Add extra tomato sauce – it counts as a vegetable
Hot dogs
  • Serve on a whole-wheat bun
  • Serve with extra vegetables and a glass of milk for a complete meal
  • Serve with vegetable toppings such as chopped tomatoes, onions and shredded lettuce
  • Try vegetarian wieners
  • Make homemade hamburgers using lean ground beef on a whole-wheat bun
  • Try tacos made with ground chicken or turkey, lots of vegetable toppings and whole-wheat tortillas
Fish sticks
  • Look for “light” fish fillets, reduced in fat and/ or calories (compare Nutrition Facts labels)
  • Prepare fresh or frozen fish fillets, add breading, and bake or pan-fry in a nonstick pan
  • Serve with vegetables and potato wedges in place of fries
Chicken nuggets or fingers
  • Look for products with less fat and/or calories and sodium (compare Nutrition Facts labels)
  • Serve fewer e.g., three pieces instead of five
  • Make homemade chicken nuggets or fingers, and bake instead of frying
  • Slice cooked chicken breasts into strips and serve with lower-fat dipping sauces, such as tomato sauce, barbecue sauce or honey mustard dips
French fries
  • Choose frozen fries that are “baked not fried,” then bake in the oven on a nonstick pan with no added oil or salt
  • Make potato skins – cut baked potatoes into quarters, then scoop out most of the cooked potato, brush the remaining potato with a bit of olive oil, sprinkle with garlic and Parmesan cheese, and bake until golden
  • Make homemade home fries: Cut up potatoes (with the skin on) into fries, toss with a small amount of vegetable oil (e.g., canola) and bake in the oven, turning every five minutes until golden
Luncheon meats
  • Use less meat and more vegetables (e.g., lettuce) and a thin slice of lower-fat cheese when making sandwiches
  • Choose “light” varieties (reduced in fat and/or calories and sodium – compare Nutrition Facts labels)
  • Use leftover roast beef, venison, pork, chicken or turkey instead of luncheon meats
  • Try canned tuna, chicken or salmon mixed with lemon juice and a bit of low-fat salad dressing

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Meal and snack ideas

This section offers healthy, budget-wise meal and snack ideas that are child- and youth-friendly. Remember, water is the best choice between meals and snacks. Keep water available for children and youth throughout the day.

Breakfast

Banana split breakfast Slice a banana on a plate. Add a big spoonful of yogurt in the centre. Top with frozen berries, dried fruit (e.g., raisins), sunflower seeds, canned apricots or granola.

Apple pie oatmeal Top oatmeal with chopped apples or applesauce, sprinkle with cinnamon, and serve with warmed chocolate milk or chocolate fortified soy beverage.

A Northern Ontario mixed breakfast Serve bannock with scrambled eggs, fried moose meat, an orange and milk.

Breakfast to go Mix and match items, such as a chunk of cheese, whole-grain crackers/pita/muffin/ bagel, canned fruit, a reusable container with milk or juice, a hard-cooked egg or a plain granola bar.

Lunch

Tasty pita Spread peanut butter on a whole-wheat pita, top with thinly sliced apples, sprinkle with cinnamon and warm in the oven. Enjoy with milk.

Wrap it up! Fill a whole-wheat tortilla with leftover meat or beans, cheese, vegetables (cooked from frozen) and rice. Serve with salsa and lower-sodium vegetable juice.

Beans! Warm up some canned beans in tomato sauce, then serve with whole-grain toast. Serve with sliced fruit and hot chocolate (made with skim milk powder).

Simple school lunches – peanut-free*

When packing lunches for a child or youth who attends school in Ontario, chances are that it has to be peanut-free. Here are some simple suggestions:

Adapted from Eat Right Be Active A guide for parents and caregivers of children ages 6-8, Nutrition Resource Centre, Toronto, Ontario, 2007

Dinner

Chili baked potatoes Top baked potatoes with vegetarian chili and shredded cheese. Serve with vegetables and dip, milk and oatmeal cookies for dessert.

Quick stir-fry Stir-fry frozen mixed Asian vegetables and small chunks of tofu. Try adding bok choy, a type of Chinese cabbage. Serve over brown rice. A glass of milk or fortified soy beverage makes it complete.

Indian rice with lentils and mushrooms Use cooked basmati rice and canned lentils to make a quick dish. Frozen veggies can take the place of mushrooms. Serve with a fruity smoothie.

Stews Use beef, venison, goat, poultry, fish or vegetarian alternatives. Look up interesting stew recipes from around the world online or in cookbooks. Try Moroccan chicken stew over couscous or Irish stew.

Thai noodles Use whole-wheat spaghetti noodles if Thai rice noodles are not available. Add vegetables in season or frozen vegetables, an egg for protein and jarred peanut sauce to top it off.

Some Aboriginal food ideas

Moose or venison stew Make wild-meat stews by using the same recipes used for beef stew and replacing the meat. The stew could be served with bannock or fry bread and milk.

Boiled fish and wild rice This dish could be served with a green salad and milk.

Adapted from Eat Right Be Active A guide for parents and caregivers of children ages 6-8, Nutrition Resource Centre, Toronto, Ontario, 2007

Terrific snacks

Some Aboriginal ideas

For more information

Aboriginal recipes

General healthy recipes


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Section Six
Budget-wise Shopping

Introduction

Whether food is ordered from a supplier or bought at a grocery store, it is important to build the menu around nutritious and budget-wise buys. This is especially true in Northern and remote communities where food costs are higher and the variety of foods available is limited.

In this section you will find:

Good to Know

Less costly foods are often more nutritious.

Shopping for less costly foods can be healthier since the focus is on basic, whole foods, such as carrots, cabbage, turnips, apples, beans (e.g., kidney beans, chick peas), milk powder, canned fish, whole-grain or enriched pasta, oatmeal and rice. These are more nutritious and less expensive than processed convenience foods, such as boxed macaroni and cheese, fruit drinks, frozen pizza, hot dogs, chicken nuggets and fish sticks.

Choosing more wholesome, natural foods over highly processed foods also provides a good example for children and youth of how to eat right on a budget.

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How to read labels to make better choices

It is easier to eat right when the kitchen is stocked with healthy choices. When choosing cereals, soups and other packaged foods, compare their Nutrition Facts tables.

Step 1: Check the serving sizes on each brand to see if you are comparing similar amounts.

Step 2: Choose the brand with more vitamins, minerals and fibre.

Step 3: Choose the brand with fewer calories and less sodium, saturated fat and trans fat.

Adapted from Eat Right Be Active A guide for parents and caregivers of children ages 6-8, Nutrition Resource Centre, Toronto, Ontario, 2007

For more information:

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Best Buys in Vegetables and Fruit
Choose dark-green and orange vegetables and fruits more often.

Fresh

Save by buying…

Tips! Buy a variety of vegetables and fruit including dark-green and orange vegetables and fruit for the best nutritional value. Store vegetables and fruit properly so they will not spoil too quickly. Pick your own wild berries to eat fresh or freeze.

Frozen and canned

Save by buying…

Tips! Canned and frozen vegetables and fruit are a better buy when fresh vegetables and fruit are not in season. Compare the prices of canned products using unit pricing to find the best buy.

Juices

Save by buying…

Tips! 100% pure unsweetened juice is healthier than a fruit drink or punch. Once opened, keep juice in a closed container in the fridge to prevent loss of vitamin C.

Find out what is in season, review seasonal recipes and find pick-your-own farms at Foodland Ontario.

Adapted from Ottawa Public Health

Best Buys in Grain Products
Choose whole-grain and enriched products more often.

Breads

Save by buying…

Tips! Look for “whole grain, whole-wheat flour” as the first ingredient on the label. It has more fibre than white flour and is your best nutritional value.

Breakfast cereals

Save by buying…

Tips! Cereals made from whole wheat or bran (oat, wheat, corn) are good sources of fibre. Look for those with four grams or more of dietary fibre per serving.

Pasta, rice and grains

Save by buying…

Tips! Whole-wheat pasta and brown rice provide more fibre than refined grains. Look for these foods on special.

More expensive items

Adapted from Ottawa Public Health.

Best Buys in Milk and Alternatives
Choose lower-fat milk products more often.

Milk

Save by buying…

Tips! Use lower-fat milk or evaporated milk instead of cream to make recipes more nutritious, lower in fat and less expensive. Dry or reconstituted skim milk powder can add a nutritious boost to baking and is less expensive than fluid milk.

Cheese

Save by buying…

Tips! Buy blocks of cheese when on sale and freeze. Thawed cheese will crumble, but it is just as nutritious.

Yogurt

Save by buying…

Tips! Plain yogurt is the best choice. Add your own flavourings. To cut down on the amount of fat in recipes, use low-fat yogurt instead of sour cream.

Other sources of calcium

For variety try…

Food Safety Tip! Check the “best before” date on all dairy products. If the date has passed, throw it out.

Adapted from Ottawa Public Health.

Best Buys in Meat and Alternatives
Choose leaner meats, poultry and fish as well as dried peas, beans and lentils more often.

Meat alternatives

Save by buying…

Tips! Legumes are low in fat and rich in fibre. Add them to soups, pasta sauces and salads.

Cuts of meat

Save by buying…

Tips! A serving of meat is 75 grams (1/2 cup). Meat in bulk packages or family-size packages may be cheaper, but always check the price per kilogram (or kg).

Poultry

Save by buying…

Tips! Buy poultry with skin on and bone in as it is less expensive. Remove the skin before serving as it is high in fat. Boil the bones to make soup stock.

Fish

Save by buying…

Tips! Fishing can be an inexpensive way to get fish. Make sure that you know which lakes and rivers are considered safe sources of fish by contacting the Ontario Ministry of Natural Resources.

Adapted from Ottawa Public Health.


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Top five tips for saving money while you shop

  1. Shop around the edges of the store first. This is where you can usually find the healthy basics: vegetables and fruit, milk products, grain products and meats.
  2. Compare bulk, “no name” and store-brand prices. Pasta, rice, flour, oatmeal, dried fruit, nuts, seeds and beans may be better buys in bulk. Look high and low on the shelves for cheaper brands. End-of-aisle displays may not be the best buy. Remember to look through store flyers for specials.
  3. Make wise convenience-food choices. Convenience has a cost, whether it’s pre-shredded cheese or oatmeal with added sugar and flavouring. Buy foods in their natural state as much as possible for better nutrition and value.
  4. Buy pre-bagged food. Produce (onions, carrots, apples, oranges and potatoes) and buns, rolls and bagels in bags are cheaper than individual items.
  5. Buy fresh and store it right. Spoiled food is wasted money. Buy the freshest foods – check the “best before” dates. Buy an amount that can reasonably be consumed before it spoils. Store foods properly at home. For more information, see Section Seven: Safe Food Handling.

Good to Know

Save A LOT by making your own baked goods and “treats.”

Processed baked goods, individually packaged snacks and higher-fat snacks do not offer good value. Instead of buying them, where appropriate, involve children and youth in making treats they can enjoy in smaller amounts from time to time, such as:

  • Date squares
  • Bread pudding
  • Carrot, banana or zucchini muffins
  • Air-popped popcorn
  • Trail mix (e.g., pretzels, dried cereal, seeds, dried fruit)
  • Oatmeal raisin or peanut butter cookies

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Community food programs that may help with budget-wise healthy food choices

Consult the local public health unit to find out if these programs or similar ones are available or if it is possible to start one. They can help stretch food dollars and may make sense in some settings as part of youth programming.

  1. The Good Food Box program is a non-profit program that distributes high quality fresh fruit and vegetables at various locations across the province, at a low cost. The cost savings of buying directly from the farmer or Ontario Food Terminal (as opposed to grocery stores) is passed on to the customers.
  2. A collective kitchen is a small group of people who meet to plan, budget and shop, then cook meals together. This is a great way for youth to learn about cooking.
  3. In a community garden, people get together to grow vegetables and herbs on shared land.
  4. The Community Food Advisor program offers demonstrations in cooking, safe food handling practices, shopping on a budget and more.
  5. Food co-operatives and buying clubs can buy directly from a wholesaler to save money.
  6. Farmers’ markets offer locally grown produce in season, usually available at reasonable prices.

For more information


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Section Seven Safe Food Handling

Introduction

All foods, including fruit and vegetables, have the potential to cause illness. In fact, even foods that look, smell and taste okay can have the potential to cause illness. Young children are especially at risk for serious health problems from food poisoning.

The tips provided here are simple, basic approaches. They do not replace the responsibility of a licensed residential setting for meeting requirements of any legislation that is applicable, for example, the Health Protection and Promotion Act.

In this section you will find:


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Four steps for safe food handling

These simple steps will help reduce the risk of illness related to food. Contact the local public health department for more information about regulated food handling, hygiene and food safety practices.

Clean

Separate

Cook

Chill


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When in doubt, throw it out!

If a food looks or smells strange or different than it should, don’t taste it – just toss it out.

Follow these simple tips for food storage:

Adapted from Community Food Advisors Resource Binder, Ontario Public Health Association, 2004, and Canadian Partnership for Consumer Food and Safety Education

Good to Know

Use leftovers before they spoil.

As a rule of thumb, as long as leftovers have been refrigerated within two hours of cooking time and stored properly, they can be eaten (within a day or two).

  • Use leftover rice in soups, fried rice or rice pudding
  • Use ripe fruit in smoothies, fruit crisps or muffins
  • Make a stir-fry, soup or wrap with leftover meats
  • Use leftover plain spaghetti as a salad base the next day
  • Use leftover veggies for quiche, pasta sauce or pizza toppings or in soup

For more information


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Section Eight
Cooking with Children and Youth

Introduction

Involving children and youth in cooking at licensed residential settings can encourage healthy eating and good group communication. Teaching children and youth to prepare their own food also gives them a sense of accomplishment, which can boost their self-esteem. Where possible, all children and youth, regardless of their level of functioning, should be supported and provided with opportunities to participate in food preparation.

Although it is not possible in every situation, having children and youth assist in all aspects of food preparation – planning, shopping, cooking and cleaning up – helps teach life skills including:

Cooking with children and youth offers other benefits as well:

In this section you will find:


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Tips for success

Before cooking, teach children and youth the rules of the kitchen, and which tools and equipment they can use and which ones are off-limits. Show them how to safely use any kitchen tools, and tell them what to do in case of an emergency, such as a fire, or if they are injured (burned or cut).

Here are a few simple tips to help things run smoothly:


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Food-related activities


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For more information

The Science Chef Travels Around the World: Fun Food Experiments and Recipes for Kids by Joan D’Amico and Karen Eich Drummond, 1996. (a terrific book to share with older children and youth)

For More Information

Resources for specific topics are found within the tool kit. Please go to the appropriate sections for resources on specific topics. The following resources provide basic healthy eating information.

Canada’s Food Guides

Eating Well with Canada’s Food Guide to Healthy Eating, Health Canada, 2007

Eating Well with Canada’s Food Guide for First Nations, Inuit and Métis, Health Canada,

Contacts

Registered dietitians

Registered dietitians are uniquely trained to provide advice on food, diet and nutrition. Here’s how to find a registered dietitian:

Find out more:

Public health

Consult a public health unit or community health centre for information, referrals, handouts and more about healthy eating, physical activity and safety.

EatRight Ontario

For trustworthy advice about healthy eating, speak to a registered dietitian. Call the EatRight Ontario toll-free information service at 1-877-510-510-2, Monday to Friday from 9 a.m. to 5 p.m. Eastern Time, or visit EatRight Ontario to email your question.

Online resources

Dietitians of Canada
Canada’s Physical Activity Guide for Children
Canadian Diabetes Association
Nutrition Labelling Education – Healthy Eating is in Store for You
5 to 10 a Day Vegetable and Fruit Campaign
Foodland Ontario

Download the Healthy Eating Matters Printable PDF


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