Not Your Imagination: Food Programs Make it Hard to Send Healthy Alternatives to School and Childcare

**Check me out in this week's Paleo Movement Online Magazine, there's lots of other great articles this week! http://paleomovement.com/its-not-your-imagination-food-programs-make-it-hard-for-parents-to-send-healthy-alternatives-to-school-and-childcare/

Healthy Parents, 

I'm sorry I gave you such a hard time about sending your child to our childcare center with gluten and dairy free lunches, Amino acid supplements, and halal meals that needed heating or your child with special needs wouldn't eat. I'm sorry that I wouldn't allow you to share those home-made date brownies with the class to celebrate your child's birthday. I could have been more understanding when you threw those cupcakes in the teacher's face, but she was only trying to follow the rules. We were all just trying to follow the rules. I didn't understand the health benefits you were fighting for, I didn't truly understand the disrespect I was showing for your families' values, and I couldn't figure out how to balance my legal responsibilities and budget with your needs. Your child should have come first. Now that I have a child who gets asthma from dairy and headaches from gluten, I get that. If I could go back, I'd do it all differently. 

 Sincerely, 

A Previous Childcare Director, but first a Mother

Fall is Here

I blogged before about 5 reasons school lunch programs are failing, Now it's September, and for many moms like me that means it's time to get doctor notes and jump through 21 hoops to justify our decision to send kids to childcare, school and after school programs with healthy lunches and snacks (special diets).

When I decided to take control of ManCub's nutrition all day, it was more difficult than filing taxes on April 14th. It required two different doctors, a medication form for our almond milk to be "administered" (no joke!) many guilt trips and snacks for an entire classroom. I provided multiple peer reviewed research briefs, and sent emails to the principal threatening to take more formal action if they couldn't monitor the "share table" to prevent a first grader with a dairy allergy from trading an apple for pizza. (Thankfully, ManCub FINALLY learned to self-monitor after getting sick a few dozen times)

If your child's school or day care participates in the National School Lunch Program (NSLP) or the Child and Adult Care Food Program (CACFP) you may have noticed they're exceptionally pushy. Ever wondered why the hard stance on fat free cows milk at every meal? I directed a childcare center for a while, and learned a lot as the administrator of the food program for my school. 

 Follow the Dollar

The USDA provides free food and subsidies to schools, childcare centers and adult daycare centers to provide meals throughout the day. The menu must meet USDA requirements for protein, grains, fruits and and "vegetables" (Ya know, like pizza sauce?). Fluid cow milk must be served at all meals and children over two years old must drink fat free or low fat milk. Breakfast must include a grain, a fruit, and milk. Schools can add a protein, but only as an additional item (expense). In CACFP, the meal can not be counted towards reimbursement without a grain, milk and fruit. 

 Center meal planning representatives are given one training on nutritional guidelines by USDA nutritionists and patted on the back for providing healthy meals for growing brains. When I attended my training ( to be fair, it was 2008, and things may have changed since then), it consisted of a notebook with guidelines. Most of the 4 hours was spent reviewing the paperwork for reimbursement and the contractual responsibilities. Childcare centers who participate in the CACFP program create menus that are in line with USDA's guidelines and are allowed to claim up to $3.52 for lunches and $1.86 for breakfast and snack. Programs with evening hours can also serve a dinner.

 It's not chump change. In my school, it added about $150,000 to my annual operating budget that was desperately needed. Hiring a kitchen manager who would comply with the guidelines was critical, and creating policies to require doctors notes for diet changes, and discouraging parents from bringing food from home became a necessary evil.  (If I had known then what I know now, I might have handed all of this VERY differently!)  

 If a child has a food allergy and a doctors note, both programs can make appropriate substitutions and still receive reimbursement IF they still provide the food. If your dietary change is preference only, for religious reasons, or if you provide the food, the meal cannot be collected upon. 

 Milk must be served with the meal in order for the entire meal to be counted, and two brands of soy milk (who paid the money for research to show equivalency) are the only acceptable substitutions. Now you see the motivation to get your kid to the milk trough, no? 

 I recently heard that some schools have even taken to guilt tactics, sending home letters to parents who send their own lunches to let them know that they are costing the school money, and the poor cafeteria workers may not have job security if this trend continues.

 Limiting Options 

In many states, licensed childcare has minimum requirements that the provider must monitor and ensure all nutritional components are provided in a child's meals while at the center.

 Washington's Minimum Licensing Requirements for Child Care Centers, for example, includes the following requirements: 

(b) Each lunch and dinner meal the child eats at the center must contain:

(i) A dairy product (such as milk, cottage cheese, yogurt, cheese);

(ii) Meat or meat alternative (such as beef, fish, poultry, legumes, tofu, or beans;

(iii) A grain product (such as bread, cereal, bagel, or rice cake);

(iv) Fruits or vegetables (two fruits or two vegetables or one fruit and one vegetable to equal the total portion size required). When juice is served in place of a fruit or vegetable it must be one hundred percent fruit or vegetable juice.

(3) When meals are not provided by the center you must:

(a) Notify parents in writing that meals they provide for their children must meet the daily nutritional requirements;

(b) Provide adequate refrigeration for keeping potentially hazardous foods (such as meats of any type, cooked potato, cooked legumes, cooked rice, sprouts, cut melons or cantaloupes, milk, cheese);

(c) Refrigerate foods requiring refrigeration at 45 degrees Fahrenheit or less and keep frozen foods at 10 degrees Fahrenheit or less until they are cooked or consumed.

 

This is often interpreted as supplementing meals sent from home to meet the nutrition guidelines. As with any compliance statutes, there is room for interpretation. If a parent sends a lunch of cookies and chips, most centers would offer a fruit, vegetable and milk to supplement, because they genuinely want children to be healthy and ready to learn.  (As you can imagine, teaching a room full of three year olds is a lot easier when they have eaten a  nutritious ow sugar meal!). How about when a parent intentionally packs a grain or dairy free lunch? What about vegetarians or those who follow a kosher or halal diet? When is it no longer appropriate to tamper with the lunch sent from home? What are parent's rights to decide their child's menu? There isn't much guidance on these grey areas. 

 Most childcare centers I've worked with avoid this complex situation by participating in the Child and Adult Care Food Program and NOT ALLOWING food from home to be brought unless there is a documented medical need. In compliance with nutritional and food safety requirements, food from home is discouraged. Food to be shared with other children must be store bought or cooked in a licensed kitchen. Families who cannot afford to buy treats are put at a disadvantage, and families who wish to send special diets without medical documentation have an uphill battle. 

 What's a Parent to Do? 

 As a parent in this awkward space, you have a few options for how to handle this situation. If your child attends public school (Or a private school that participates in the NSLP), you can simply pack the lunch, and ignore the guilt letters. However, be sure to also pack snacks and make the teacher aware of your preferences. Be sure to have a plan for birthday parties and other class parties that involve food. A letter to the teacher and nurse stating "under NO circumstances should my child ever have..." is suggested. For an allergy, you should go ahead and get that doctors note with an allergy plan to keep on file with the school. This provides you with some additional rights and will help you advocate for your child's needs. (This is the part where you might have to just take a deep breathe and get that medication form for almond milk signed). 

 Find out your school rules about lunch room trading, and be sure that your child understands your expectations of them. Teachers often have planning time and their own lunch during children's lunch period, and may not be able to supervise. I went to school and introduced myself to the volunteer cafeteria supervisor, flashed a mug shot of my child, and shared his allergy plan with her. I then pleaded with her, mother to mother, to help me keep him from trading for food that would make him sick. 

 You can get those doctors notes, write an allergy plan, and request the school provide substitutions. This works well for minor allergies like oranges. Work with the school nurse or the childcare center director to get the right forms they need to be in compliance. Many will say "Homeschool!" and that would certainly be another way to avoid this situation. If you have the means, lucky you, I fully support home schooling. 

 If your infant or young child is in childcare, start by understanding your state's minimum licensing requirements and meal requirements, then work with the director to find flexibility in the interpretation. Or, find a smaller center or family provider who isn't enrolled in the program and avoid this problem all together. 

 I've learned that it is best to be compassionate, patient and educational. The mother of a child with special needs once showed up on the first day of school with a pamphlet for me about her child, highlighting his smile, his strengths, and his needs. It made me sad that she has learned this to be necessary, but I also appreciated her taking that time to help me understand why that special diet was so important. My child's teachers have been much more helpful once they understand that although milk will not cause an immediate reaction, it makes him miserable in a few hours, and without dairy we've been able to keep him off all of the inhalers and steroid creams for eczema. 

 Equity Issues

There are some glaring equity issues underpinning all of this. Most of those forms, minimum licensing requirements, and guidelines are available in English only, even when many providers are not native English speakers. Parents with lower literacy levels may have a difficult time navigating the requirements. Families who qualify for free and reduced lunches often have less options because there is a financial need to access the school food programs. Meeting the school nurse, volunteers, and getting doctors notes can require a lot of time off from work and transportation. Cultural preferences for meals are not as easily understood, and often seen as optional preferences when staff do not have enough training in cultural competency or just plain old empathy and open mindedness. Families in rural areas and "food deserts" often have less access to gluten free alternatives packaged to send to school.

Find natural community leaders to help advocate, interpret and speak up! When healthy food access is addressed as a parental right for one family, it must be addressed for ALL families. Let's grow this movement in solidarity. If you are privileged enough to read the forms, learn the legal requirements, take off time, drive to school, get the doctors notes and provide the foods...please don't forget to use that privilege to speak out for those who may have even more of a struggle than you do. If you homeschool, remember that there are many who are unable to do so and are faced with some tough challenges. Support community programs that address food scarcity with locally farmed foods. Get involved and don't get shut down. Awareness and action are key. 

 May you all have a healthy and happy September! I'd love to hear from you on your journey. Please share in the comments if you've found ways around these challenges. As always, I love hearing success stories of healthy happy children who's diets have improved behavior or disability. 

In Solidarity, 

Kellie 

Real Foods Build Better Brains

**Check out Paleo Movement Online Magazine, where my article below was first published August 9. http://paleomovement.com/real-food-builds-better-brains/

Food is preventative medicine,  economic investment, education reform and resource development. Food is community strengthening.

Our most primal instincts tell us that babies are precious and miraculous: requiring fierce protection.  Science confirms this: the first 5 years of brain development are the most rapid and easily impacted. In the first few years, synapses are growing at a rate of 700 connections per second.

I've been sitting in a conference for early educators and school leaders for the past few days.  We are discussing brain development and the importance of positive early experiences for children.  I can't stop thinking about what's missing from this conversation in our nation.

First, parents should understand brain research, and be honored and respected as brain builders.  Secondly, we should be having a national discussion about how the food we feed young children impacts their brains.  We should be talking about the future of young brains, and why the return of investment for growing healthy children is higher than any other investment we could ever make in our society.  There should be no question of removing Genetically Modified Organisms (GMOs) from the market and creating equal access to healthy foods in all neighborhoods.

The healthiest brains are those that are well fed with experiences, positive interactions and good nutrition.  Feeding babies breast milk and introducing young children to real foods that their ancestors ate helps brain development for children to reach their highest potential.

“The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition.”  ~Thomas Edison

We have an epidemic in the United States of children who are both obese and malnourished at the same time as a result of an abundance of low quality foods.  While our children may not look like the emaciated children on National Geographic, there is clear evidence that lack of nutrient dense diets are contributing to the rise in disease, learning delays and mood disorders.

From the Urban Child Institute:

"A proper balance of nutrients in this formative period is critical for normal brain development.2,3 Shortages of nutrients such as iron and iodine can impair cognitive and motor development, and these effects are often irreversible. Similarly, there is growing evidence that DHA, an essential fatty acid, is a key component of the intensive production of synapses that makes the first years of life a critical period of learning and development. Many other nutrients—choline, folic acid, and zinc, to name just a few—have been linked specifically to early brain functioning.4,"

Building Blocks for Brain Development

Young brains use certain proteins and fats to build new connections and protect fragile pathways.  Amino acids and fatty acids work together in the brain to build new proteins and fats that are critical in cognitive repair and development.  Just like the building blocks children play with, nutrition needs balance for strength.

Examples of precursors include:

Aspartic Acid, used to make aspartate;

Choline,  used to make acetylcholine;

Glutamic acid, used to make glutamate;

Phenylalanine, used to make dopamine;

Tryptophan, used to make serotonin;

Tyrosine, used to make norepinephrine

These neurotransmitters play an important role in hormone balancing, moods, memory, focus, and learning.  When these important precursors aren't available, the brain is not able to build enough connections.  Neurological and mental disorders may occur when this fragile balance is upset.  Many traditional foods such as high quality meats, fish, and eggs contain precursors (starting materials) for neurotransmitters.  Some can also be found in nuts and seeds, but may need to be paired to achieve the same effects.

A diet of nutrient dense foods is a mother's best tool for creating healthy brain.  It's not surprising that the most important micronutrients for healthy brain development are found in traditional foods our ancestors ate.

Iron helps in the synthesis of neurotransmitters and myelin, a critical component of brain growth. Iron deficiencies can lead to lower cognitive function and social problems, and are often found in children with attention deficit disorders or autism.  The best source of dietary iron is heme iron, found in high quality organ meats, turkey, beef, chicken or fish.  Non heme iron is found in broccoli, spinach and dried apricots and is less efficiently absorbed by the body; pair it with foods high in vitamin C such as oranges or strawberries to increase absorption.

Zinc helps the body to metabolize fats, carbohydrates and protein, and is critical in binding proteins to build brain structure.  It also protects against free radicals.  Reach for salmon, pumpkin seeds, garlic, organic beef, and egg yolks.

Vitamin D helps protect the brain by preventing neuro-degenerative diseases and strengthening the immune system.  Food sources include fish, eggs and fortified dairy products.  You might want to add fermented cod liver oil.  This traditional food is also high in omega 3 fatty acids, DHA and EPA

B Vitamins (1,6,9,12) help to modulate cognitive function and moods.  These vitamins support memory, focus and self regulation.  B12 improves cognitive and language function in young brains.  Again, your best sources are leafy greens and animal products such as chicken, fish and organic beef.

Brain-Gut Connections

I'm going to save this complex subject for another post, but there's increasing evidence that digestion and gut bacteria also impact behavior and how the brain works.  The American Academy of Pediatrics recently acknowledged the brain-gut connection and called for further research on links between autism and diet.  Gluten intolerance and yeast may be two big culprits in creating intestinal problems that impact brain development.

 Follow These Five Tips For Healthy Brain Development:

 1. Breast-feed or make formula from real foods.

We know that breast milk is best, but maternal nutrition is important too. Mothers need diets rich in vitamins, minerals, fats, carbohydrates and proteins during pregnancy and breast feeding.  If something goes wrong and your baby can't breastfeed, check out The Weston A. Price Foundation for recipes for infant formula and foods you can make with real foods.

2. Just Eat Real Food

Plan for meals as a family where everyone's plate includes leafy greens, high quality sources of protein and fats, and some varied fruits, nuts and seeds.  Get your carbohydrates from the most nutrient dense sources such as root vegetables.  Avoid processed foods, including chemicals, preservatives, and anything you can't pronounce.

3. Be sure to get enough Omega 3 fatty acids.

Most Americans eat far too many foods high in Omega 6 fatty acids, and not enough Omega 3's.  Omega balance supports healthy brain development, as well as a host of other health benefits. The best source of Omega 3 is wild caught fish.

4. Find a supportive pediatrician.

Look for a naturopath or holistic pediatrician who understands that nutrition impacts health.  Most traditional doctors get very little nutrition information, and what they do get is often from biased texts paid for by food companies and drug companies.  If you are committed to a whole foods diet, you'll want good guidance, and may want to explore supplementation or food sensitivities.

5. Establish good habits early.

Eat together as a family and model healthy eating. Introduce new foods often and revisit foods together as a family.  By encouraging exploration of foods, you can establish good habits at an early age and offset some of the peer pressure that comes later with weekly school cupcakes and candy rewards.

References:

Urban Child Institute: Nutrition and Early Brain Development

http://www.urbanchildinstitute.org/articles/updates/nutrition-and-early-brain-development

Daniel L. Coury, MDa, Paul Ashwood, PhDb, Alessio Fasano, MDc, George Fuchs, MDd, Maureen Geraghty, PhD, RDe, Ajay Kaul, MBBS, MDf, Gary Mawe, PhDg, Paul Patterson, PhDh, and Nancy E. Jones, PhDi. Gastrointestinal Conditions in Children with Autism Spectrum Disorder: Developing a Research Agenda, PEDIATRICS Vol. 130 No. Supplement 2 November 1, 2012 pp. S160 -S168

http://pediatrics.aappublications.org/content/130/Supplement_2/S160.full

Elizabeth Prado and Kathryn Dewey, Nutrition and Brain Development in Early Life, A&T Technical Brief Issue 4, January 2012

http://www.aliveandthrive.org/sites/default/files/file-attachments/Technical%20Brief%204-%20Nutrition%20and%20brain%20development%20in%20early%20life.pdf

Baby’s Brain Begins Now: Conception to Age 3

http://www.urbanchildinstitute.org/why-0-3/baby-and-brain

Nutrition and the Brain

http://faculty.washington.edu/chudler/nutr.html

Five Numbers to Remember About Early Child Development, Center on the Developing Child, Harvard University

http://developingchild.harvard.edu/resources/multimedia/interactive_features/five-numbers/