Master of Science in Nutrition and Dietetics Student at King's College
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Community Nutrition Supervised Experiential Learning (SEL)
Florida Blue Foundation 2024 Food Security Grant
Nassau county is a rural county whose food-insecure population is in dire need of increased nutrition services and nutrition education. Food insecurity impacts roughly 9,548 (9.7%) Nassau County residents.(1,2) An estimated 1 in 6 adults and 1 in 4 children suffer from food-insecurity as they do not have enough to eat and do not know where their next meal is coming from. 6,603 (6.8%) Nassau County residents live in poverty.(3) Additionally, 1,877 (10.2%) Nassau County children under the age of 18 and 1,323 (9.6%) children ages 5 to 17 in families live in poverty.(3) Barnabas provides a food pantry drive-thru four days a week, ensuring that each pantry client receives a variety of foods from each food group as recommended by the Dietary Guidelines for Americans. Additionally, Barnabas serves food-insecure residents of Nassau County by providing mobile-food distributions at three different off-site locations monthly. The Florida Blue Food Security Grant would allow Barnabas to expand our mobile food distribution to more sites monthly, which would also double as an opportunity to provide nutrition-education. Additionally, 44.8% of Nassau County residents live in food deserts and have low access to healthy foods.(4) Food deserts are positively associated with the development of diabetes and hypertension.(4) The Florida Blue Food Security Grant would allow the Barnabas Nutrition Services Department to expand its reach by providing nutrition education to teach and empower Nassau County residents living in food deserts by providing food resource management skills. Nutrition education provided by Barnabas would teach Nassau County residents how to shop healthy on a budget, how to utilize the resources they have, how to choose healthy affordable food options, with an emphasis on which foods to consume that follow the recommendations by the Dietary Guidelines for Americans, ensuring adequate fruit, vegetable, protein, dairy, and whole grain consumption. Additionally, it is our goal to ensure all residents have access to safe, quality, healthy food. Our rural county has grown 43.1% since 2010, 15.4% since 2020, with an additional 3.62% growth expected in 2024.(1) Continued growth in Nassau County has negatively impacted lower-income families as cost of living has increased, forcing many residents to become both food-insecure and homeless. Nutrition education and expanded mobile food distribution sites would positively impact low-income Nassau County residents. The Florida Blue Food Security Grant would allow Barnabas to expand its current diabetes and hypertension nutrition education programs and expand mobile food distribution sites. This expansion would ensure a greater number of low-income clients would have access to safe, quality, healthy foods. Ultimately, the Florida Blue Food Security Grant would greatly help Barnabas empower food-insecure residents by improving access to healthy foods, which ultimately results in decreased food insecurity and decreased risk of chronic diseases in Nassau County residents. References 1. Nassau County Economic Development Board. Nassau County Forida. Updated 2024. Accessed April 30, 2024. https://nassauflorida.com/site-selection/county-data/ 2. FlHealthCharts. Food Insecurity Rate. Accessed April 30, 2024. https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalIndRateOnly.Dataviewer 3. United States Census Bureau. Small Area Income and Poverty Estimates (SAIPE). Accessed April 30, 2024. https://www.census.gov/data-tools/demo/saipe/#/?s_state=12&s_county=12089&s_district=&s_geography=county&s_measures=5_17_fam 4. MySidewalk. Food Insecurity. Accessed April 30, 2024. https://reports.mysidewalk.com/79789d5687
Reflection
Prior to my Community Nutrition SEL, I was not familiar with the grant process, the impact and importance of receiving a grant, and all that seeking and obtaining a grant entails. However, while at my Community Nutrition SEL, I had the opportunity to attend a Grant Writing for Pantries webinar. The webinar taught me that when applying for a grant, one must be very familiar with the funder and ensure that the funder’s goal and vision aligns with your organization’s goal and vision. Additionally, incorporating your respective organization’s mission statement and responding using the language of the funding organization is important. Additionally, I learned to write in first person, avoid using acronyms, and collect impactful and authentic stories from those who have been served by your respective organization. I also learned that it is important to paint a picture of the need in your community and explain how obtaining grant funds will directly impact your community. This webinar also taught me different grant terminology, the steps that occur when applying for grant funding, how to create an effective grant template, how to write an introduction, and how to adequately communicate to the funder through the body of the grant. I also learned how to build a relationship with grant funders and how to explain grant sustainability if awarded grant funding. I was able to apply what I learned while at my Community Nutrition SEL site. I conducted research for a large, 4-year Florida Blue Foundation 2024 Food Security Grant that my SEL site applied for. I attended the Florida Blue Webinar pertinent to this grant to ensure I adequately did my homework before conducting research on the food-insecurity status of my local community. I learned that grant priority would be given to rural counties, and my county fell under that umbrella. I learned that this grant, if awarded, could yield $90,000 - $100,00 per year for four years. I conducted thorough research on the food-insecurity, poverty, and need in Nassau County to give the grant writer as much data as possible. It was very humbling and exciting to see my research included in the official grant. Overall, I am much more familiar with grant writing, applying for grants, and all that entails in obtaining funds through the grant process. After the experience I obtained from my Community Nutrition SEL, I am now confident that I can successfully find applicable grants, apply for these grants, and obtain grants should I work as an Registered Dietitian in a community nutrition setting.
Legislative Meeting With US Senator Marco Rubio's North Florida Deputy Regional Director
Hello Mr. Dews, It was a pleasure meeting with you today. I have confidence that Senator Rubio will be a voice for food-insecure Nassau County school-aged children. Senator Rubio truly has the power to help break the vicious cycle of poverty and hunger that Nassau County residents have experienced for generations. The Summer EBT program (SUN Bucks), if implemented, would have a profound impact on food-insecure children living in Nassau County. 47% (~5,875) of Nassau County school-aged children currently receive free and reduced-price school meals. During the school year, the only meals many of these children receive are provided by Nassau County schools. This means that when these children leave school, they do not eat at home. This also means that during summer break, these children have little to no food to eat. Unfortunately, during summer months, less than 10% of school-aged children are served summer meals from existing state programs. This correlates to roughly 300-400 students during the entirety of the summer that are provided meals. The busiest site in Nassau County, Southside Elementary School, may serve 30 – 40 children maximum during the week. On top of that, there are 349 students currently enrolled in the FIT program, which provides weekend meals during the school year to homeless school-aged children who otherwise would not have food to eat. These children, due to the unpredictability of their living situation, may not have access to a summer school meal site. The $120 provided by SUN Bucks (Summer EBT) would greatly benefit Nassau Country children as most children live greater than 2-miles from school feeding sites. The school feeding sites in Nassau County are so spread apart, that many children cannot make it on any given day. Notably, there are no grab-and-go options, which means the children must physically sit down to eat their meal. This sit-down model is inaccessible to many children of working families, as their parents/guardians are working during the times of school feeding site times. Poverty and hunger beget poverty and hunger. Senator Rubio has the power to help stop hunger for food-insecure school aged children over the summer months. A malnourished brain cannot function properly, be it in a job, in school, etc. Because of this, it is difficult for food-insecure individuals to make enough money to pull themselves out of poverty. However, if these children are adequately fed over the summer months by the SUN Bucks (Summer EBT) program, these children may have a chance to break the vicious cycle of generational poverty. Access to food is a basic human need. Sadly, this summer, ~5,875 children in Nassau County may go to bed hungry. SUN Bucks (Summer EBT) can positively impact the food-insecure children of Nassau County. As previously stated, the $120 provided to families over the summer through SUN Bucks would greatly benefit the food-insecure children of Nassau County. Nassau County residents request that Senator Rubio be our voice, speak with Governor DeSantis, and lobby for us to join the SUN Bucks (Summer EBT) program for the 2025 school year. I look forward to hearing from you. Respectfully, Emma Becker King’s College Graduate Student
Reflection
I cannot understand why the State of Florida decided to “opt out" of the SUN Bucks (Summer EBT) program. While working in the Nutrition Services department during my Community Nutrition SEL, I had the opportunity to work several days at the pantry drive-thru and at various mobile food distribution sites. I also was given the opportunity to participate in the meal pack program, which works closely with Nassau County School’s Families in Transition Program (FIT), which provides weekend meals to children who do not have stable living arrangements. While serving as a dietetic intern at my Community Nutrition SEL site, I saw first-hand how food-insecurity impacts the children of Nassau County. I have looked in their faces and seen their eyes light up when we provide them with a “Kids Bag” during our pantry drive-thru. I would often fill a “Kids Bag” for pantry drive-thru clients who identified as having children. We would fill these bags with a variety of foods such as cereal, oatmeal, macaroni and cheese, peanut butter, goldfish, and other foods children enjoy consuming. Prior to beginning my Community Nutrition SEL, I learned about the impact food insecurity can have on growing children. However, observing this first-hand caused me to become particularly passionate about this issue. Because of this, I decided to contact Senator Marco Rubio’s office to ask his position on the Summer EBT program. I was able to meet directly with Matthew Dews via Microsoft Teams. Mr. Dews is the North Florida Deputy Regional Director for the Office of US Senator Marco Rubio. Mr. Dews had never heard of the Summer EBT program, but was very receptive, listened to my concerns, was interested in learning more about the program, and assured me he would pass my concern on to Senator Rubio. I plan to follow-up with Mr. Dews and plan to contact the offices of Governor Ron DeSantis, Senator Rick Scott, and Congressman Aaron Bean. I will not stop until the State of Florida decides to participate in the SUN Bucks (Summer EBT) program for the 2025 year. As a future Registered Dietitian Nutritionists, it is essential that we give a voice to those who suffer from food-insecurity – especially children. Politicians are often removed from the frontlines and do not see food-insecurity and poverty firsthand. However, we, as nutrition professionals, are not. Therefore, we are obligated to advocate for those most in need and speak up for those who are not able to speak for themselves (i.e. food-insecure children).
Association of Diabetes Care & Education Specialists (ADCES) and Diabetes Self-Management and Education (DSME) Program
Reflection
The site I completed my Community Nutrition SEL with, Barnabas Center, is accredited by the Association of Diabetes Care & Education Specialists (ADCES). As a result, Barnabas Center has a robust Diabetes Self-Management and Education (DSME) program. Throughout my Community SEL, I had the opportunity to observe my preceptor, a registered dietitian nutritionist (RDN), give 1:1 and group nutrition education to T2DM patients. My preceptor also taught lifestyle skills to further help T2DM patients manage blood glucose levels. It was an amazing experience to see how patients enrolled in the DSME program gained knowledge and grew in their self-care habits throughout the duration of the program. Additionally, all T2DM patients are given the option to enroll in Barnabas Center’s Food for Healthy Living Program, which ensure patients then receive fresh fruits, vegetables, whole grains, low-fat dairy, and lean proteins twice a month. My preceptor entrusted me in creating a pre- and post-test for each chapter of the DSME curriculum by using the ADCES Diabetes Education and Care Curriculum.(1) I learned a great deal about the nuances of diabetes and the recommended lifestyle interventions, treatments, medications, and dietary changes by going through each chapter. I focused on creating the most relevant test questions to ensure a positive and fostering environment while checking patient knowledge both before they have learned the material and after they have learned the material. Lastly, I had the opportunity to attend five ADCES webinars to further my knowledge on T2DM. I do not yet hold the credential of RDN, but if I did, I would have received 1.000 CPEU from the Commission on Dietetic Registration (CDR) for each respective webinar. Though I did not personally receive CPEU credit as I am not yet a credentialed practitioner by CDR (one must be an RDN to be credentialed through CDR), I did learn a great deal through each webinar. The webinars I attended included “Powered By” Mobile Apps and Digital Tools: Exploring Research and Implementation of Mobile Apps and Digital Tools; Behavioral Health Strategies in Diabetes Management, Building Relationships Will Keep Them Coming Back: It’s All About Retention; Update on Diabetes Care and Education in People with Diabetes and Chronic Kidney Disease; Diabetes and Pregnancy: What the Diabetes Care and Education Specialist Needs to Know. Overall, it was a very powerful experience to see the medical care team of a T2DM patient work together through the DSME program to ensure that the patient, who is either newly diagnosed with T2DM, or has had T2DM for quite some time, gets the best care possible. References 1. ADCES. Diabetes Education and Care Curriculum. 3rd Ed. ADCES; 2021.
Hypertension Blog Post & Handouts
How to Manage Hypertension Through Dietary Sources Blog Post Hypertension is a medical term for high blood pressure (HBP). HBP causes the heart to work harder to promote blood flow, which can be damaging to arteries and organs. To give you an analogy of HBP, think of the size of a normal straw and the size of a coffee straw. Now think about blowing bubbles through a normal size straw. The air flows through a normal straw easily, right? Now, think about blowing bubbles through a coffee straw. This is much more difficult due to the coffee straw being thinner and smaller! The coffee straw is a visual of what is happening in your arteries. Unfortunately, if HBP is not controlled it may result in many health issues, including heart attack, stroke, vision loss, kidney disease, peripheral artery disease, and even heart failure.(1) Feeling overwhelmed about your hypertension diagnosis and not sure what to do? Don’t worry, we here at Barnabas understand and are here to help you! There are two changes you can make today that are scientifically proven to decrease your blood pressure! These two changes are eating less salt and following a DASH dietary pattern. First, let’s focus on eating less salt! To help lower your blood pressure, make it a goal to consume no more than 2,300 mg of salt a day.(2) However, if you make it a goal to consume no more than 1,500 mg of salt a day, you will see a larger decrease in blood pressure.(3) In fact, research suggests that eating 1,500-2,000 mg of salt a day may reduce your systolic blood pressure by 12 mm Hg, and may decrease your diastolic blood pressure by 6 mm Hg.(3) Wondering how to eat less salt? Don’t worry, you’re not alone! There’s a SmartLabel website that will teach you how to identify how much salt is in the foods you enjoy! To get here, first go to https://smartlabel.org. Once on the website, look at the upper right-hand corner. You should see an “Enter Product Name” section. You will also see an image of a green magnifying glass. You can click on either “Enter Product Name” or the green magnifying glass image and type in a food you normally eat or are thinking about buying at the grocery store. Let’s try this together! Type in “Chicken Noodle Soup.” You’ll see a variety of chicken noodle soup brands pop up. However, since we live in Florida and Publix is a staple supermarket in our state, let’s select “Publix Chicken Noodle Soup.” Immediately you will see an image of the Publix Chicken Noodle Soup can and its nutrition information! You’ll also see, in bold, that this can of soup contains 690 mg of sodium!4 Now, if you love chicken noodle soup and choose to eat it, that’s completely fine. Just realize that your overall goal should be to consume no more than 2,300 mg. Therefore, if you decide to eat this can of soup for lunch or dinner, make sure you subtract 690 mg from 2,300 mg to help you keep track of your daily sodium intake! The SmartLabel website is a great tool to teach you how to read labels and identify how much sodium is in the food you enjoy! Remember, keep track of all sodium you consume at each meal. Next, lets focus on the DASH dietary pattern. The National Institutes of Health has a great website that explains what the DASH dietary pattern is, has several DASH-friendly recipes, and gives examples of daily and weekly food group servings to meet the DASH dietary pattern.(2) This is a great starting tool that will help you learn more about the DASH dietary pattern! In conclusion, remember to decrease the total amount of sodium you eat and incorporate the DASH dietary pattern into your overall lifestyle. Eating less sodium and following the DASH dietary pattern is more effective in lowering blood pressure than reducing sodium intake alone.(3) Please do not hesitate to contact the Barnabas Nutrition Services department if you have any questions or need help getting started! References 1. American Heart Association. Health Threats from High Blodo Pressure. Reviewed March 4, 2022. Accessed April 11, 2024. https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure 2. NIH National Heart, Lung, and Blood Institute. DASH Eating Plan. Updated December 29, 2021. Accessed April 11, 2024. https://www.nhlbi.nih.gov/education/dash-eating-plan 3. Lennon SL, DellaValle DM, Rodder SG, et al. 2015 Evidence Analysis Library Evidence-Based Nutrition Practice Guideline for the Management of Hypertension in Adults. J Acad Nutr Diet. 2017;117(9):1445-1458.e17. doi:10.1016/j.jand.2017.04.008 4. SmartLabel. Publix Traditional Chicken Noodle Soup 19 oz. Updated July 7, 2020. Accessed April 11, 2024. https://smartlabel.syndigo.com/id/ed060af4-098c-4d19-add5-b56c9f7363f6#nutrition
Reflection
I was given the opportunity to create a How to Manage Hypertension Through Dietary Sources blog post, in addition to two hypertension (HTN) handouts for my Community Nutrition SEL site (Barnabas Center). Barnabas has a program called Food for Healthy Living, in which Barnabas patients with HTN opt-in to receive two monthly no-cost boxes packed with fresh fruits, vegetables, lean proteins, whole grains, and dairy or dairy alternative products. Amazingly, Barnabas’ Food for Healthy Living Program has reduced the blood pressure of 58% of program participants.(1) While serving as a dietetic intern for Barnabas, I was able to pack boxes for the Food for Healthy Living Program, accompany my preceptor while delivering these boxes to participants at one of our drop-off locations, and observe when my preceptor called new patients to enroll them in the program and get their lean protein and dairy preferences. Overall, it was incredible to see first-hand how food has a positive impact on lowering blood pressure in patients with HTN. I also gained the knowledge necessary to enact such program should I work as a community nutrition Registered Dietitian Nutritionist in the future. References 1. Barnabas. Access to Healthy Foods Improves Barnabas Patient’s Chronic Illnesses. June 4, 2021. Accessed August 5, 2024. https://barnabasnassau.org/access-to-healthy-foods-improves-barnabas-patients-chronic-illnesses/
Nutrition Assessment Forms
Reflection
I had the opportunity to create nutrition assessment forms (designed to be filled out in 60 seconds or less) for the 3rd Annual Health and Safety Expo. My Community Nutrition SEL site, Barnabas, manned a booth at the expo and measured blood pressure, gave diabetes nutrition education, gave out samples of our “agency bags” (contains canned fruits, vegetables, lean protein, peanut butter, and whole grains), and also conducted brief nutrition assessments. I knew the nutrition assessment forms I created needed to be easy to understand and non-overwhelming, as the goal was to have those passing by our booth willing to take the nutrition assessment. If the nutrition assessment was several questions or multiple pages, I do not assess many people would be interested in the nutrition assessment. Therefore, I designed a nutrition assessment form centered around the food groups that are visible on USDA’s MyPlate. Through its design, myself and my preceptor could easily identify what meals certain food groups were consumed by nutrition assessment participants, which meals certain food groups were not consumed, and to also to identify food groups that were not consumed at all. Overall, this nutrition assessment form allowed us to give quick nutrition education to those passing by our booth in a non-overwhelming manner for participants! During the 3rd Annual Health and Safety Expo, I was given the opportunity to provide nutrition education on MyPlate, diabetes education, food group education, and general dietary pattern education to those in my local community. Serving as a dietetic intern at Barnabas has taught me how to effectively communicate nutrition education with my local community! SEL site (Barnabas Center). Barnabas has a program called Food for Healthy Living, in which Barnabas patients with HTN opt-in to receive two monthly no-cost boxes packed with fresh fruits, vegetables, lean proteins, whole grains, and dairy or dairy alterative products. Amazingly, Barnabas’ Food for Healthy Living Program has reduced the blood pressure of 58% of program participants.(1) While serving as a dietetic intern for Barnabas, I was able to pack boxes for the Food for Healthy Living Program, accompany my preceptor while delivering these boxes to participants at one of our drop-off locations, and observe when my preceptor called new patients to enroll them in the program and get their lean protein and dairy preferences. References 1. Barnabas. Access to Healthy Foods Improves Barnabas Patient’s Chronic Illnesses. June 4, 2021. Accessed August 5, 2024. https://barnabasnassau.org/access-to-healthy-foods-improves-barnabas-patients-chronic-illnesses/
Community Nutrition SEL PREREQUISITES
Nutrition for Children with Special Healthcare Needs
Prior to completing the Nutrition for Children with Special Health Care Needs modules, I didn’t understand how to properly weigh a child with special needs in the healthcare setting and didn’t realize the profound negative impact obtaining an improper weight may have. I now understand know how to properly weigh children with various special healthcare needs, understand when and how to apply specialty growth charts, and understand what health conditions may alter the growth potential of a pediatric patient. It was very helpful to learn that developmental delays may lead to oral-mortar problems, such as difficulty swallowing.1 One aspect that stood out to me when learning about feeding skills and behavior is that many reflexes, such as sucking and swallowing, fades as an infant matures but if these reflexes persist, they may prevent children from gaining the necessary skills needed to chew increased textured foods.1 I also learned that if gag or cough reflexes are hypersensitive due to a child’s medical condition, oral intake may also be impaired.1 These stood out to me as it made me realize that eating should never be taken for granted as many skills needed to properly consume foods may not be second nature for a child with special needs. Importantly, I learned that coordination between a Registered Dietitian and feeding therapist is critical for children with feeding problems.1 When learning about tube feeds, what stood out to me the most was that if malabsorption is not present in a pediatric patient, it is okay to use standard pediatric formula whereas if malabsorption is present, a specialized formula must be used.1 Additionally, I learned to always ensure that the formula chosen for the pediatric patient is compatible with all medications the child is on to avoid contraindications.1 Prior to reviewing these modules, I was familiar with the dangers of homemade formulas. However, I appreciated the reminder to be on the lookout for “homemade formulas” as they may be nutritionally inadequate and may also contain dangerous foods, such as raw eggs.1 Interestingly, I learned that medication-nutrient interactions may be a main cause of diarrhea in children with special healthcare needs and that severe fluid imbalances can lead to devastating consequences.2 I also learned that severe fluid imbalances may be caused by improper formula mixing, increased fluid needs, and inadequate fluid intake.2 Additionally, it was interesting to learn that nutrition-related issues that may aid in constipation include inadequate fluid intake, inadequate fiber intake, or, what I didn’t realize before, a milk or other food allergy.2 In contrast, I learned that nutrition-related issues that may aid in diarrhea include carbohydrate intolerance, increased dietary fiber intake, food poisoning, food allergy or intolerance, “dumping” due to excessive feeding rate or improper formula preparation, and micronutrient deficiency.2 Prior to going through these modules, I did not realize that chronic diarrhea may be resolved with the introduction of lactaid-treated milk.2 Importantly, I learned that children over 5 are not available for WIC services but that Medicaid may cover costs of needed liquid nutritional supplements.3 I also learned that food allergies, because they are a documented medical condition, can be included in a 504 Accommodation plan.3 It was also interesting to learn that nutrition therapy goals can be implemented into an IEP with collaboration from family, school, and healthcare providers.3 Thought I was familiar with SMART goals, these modules provided great examples of real-life scenarios in which measurable outcomes and timelines were set (weight-for-length, etc.) for pediatric patients with various health conditions. This completely underscored the importance of setting SMART goals. References 1. PacWest MCH. Module 3: Feeding Skills. Accessed March 26, 2024. https://depts.washington.edu/pwdlearn/web/mod3/3a.php 2. PacWest MCH. Module 4: Fluid and Bowel Problems. Accessed March 26, 2024. https://depts.washington.edu/pwdlearn/web/mod4/3e.php 3. PacWest MCH. Module 5: Integrating Community Services and Programs. Accessed March 26, 2024. https://depts.washington.edu/pwdlearn/web/mod5/2a.php
CACFP Infant Meal Pattern Requirements
Proper nutrition is crucial for the healthy growth and proper development of an infant.1 Additionally, a healthy dietary pattern ensures infants thrive in their earliest years and later in life. What I didn’t realize prior to starting the CACFP Infant Meal Pattern Requirements course is that the consumption of breastmilk and healthy foods are encouraged by reimbursement. This empowers both infant and parent (or caregiver) alike. I learned that there are two meal patterns from 0-5 months and 6-11 months.1 It is important to know that breastmilk or infant formula are the only required food components for infants between the ages of 0-5 months, with an emphasis on breastmilk.1 I did not know that 4-6 fluid ounces of breastmilk or formulas should be served for all meals and snacks during the 0–5-month age range.1 I breastfed both of my children and let them feed until they were full, so was unaware of the actual fluid amount they were consuming. However, knowing that 4-6 fluid ounces is recommended is important to know for bottle feeding and to ensure that the infant is receiving the proper amount of nutrition. Importantly, breastfeeding is encouraged and is the optimal food for an infant for the first 6 months of life as it provides the proper balance of essential nutrients.1 Iron-fortified infant formula, due to iron supporting healthy growth and brain development, is an acceptable alternative to breastmilk if breastfeeding is not an option.1 Additionally, infants should be fed on demand and not on a specific strict schedule as this may result in over- or undereating.1 I think it is incredible that infant meal reimbursements are available if expressed breastmilk is fed to infants and that meal reimbursements may be claimed when the baby is fed by its mother at the childcare site. I think this empowers parents and encourages expressed breastmilk as this is a reimbursable meal or snack. However, reimbursable meals and snacks must be 4-6 fluid ounces for an infant from the age of 0-5 months or 6-8 ounces from 6-11 months.1 Importantly, any remaining expressed breastmilk or formula amount must be offered to the infant later for this to be a reimbursable meal or snack.1 Formula is also reimbursable considering the minimum serving size is offered to the infant.1 This also encompasses any food or beverage served to CACFP participants.1 I also learned that solid foods should not be introduced until ~6 months to ensure that the infant is developmentally ready to consume the texture and complexity of these foods. I did not realize that if these foods are introduced too early and before the infant is ready, it may result in an increased risk of overweight or obesity later in life.1 When infants are ready to consume solid foods, the infant meal pattern has introduced a greater variety of nutritious foods. For example, when the infant is developmentally ready, an emphasis has been placed on the consumption of a variety of fruit, vegetable, infant cereal, and meat/meat alternatives during breakfast, lunch, and dinner. Interestingly, there are three food components that must be offered during snack which include breastmilk and/or iron-fortified infant formula, grains, and fruits and/or vegetables.1 It was interesting to learn that most infants are ready to consume solid foods at 7 or 8 months.1 What is most amazing to me is that meal snacks are reimbursable, which encourages serving a healthy dietary pattern to children. The introduction of solid foods is an important milestone and should only occur when the infant is ready. Risks associated with introducing solid food too early include choking, not consuming enough calories and nutrients, and increasing the risk of being overweight or obese later in life.1 The appropriate timeframe is ≥6 months, depending on the infant.1 I also learned that it may be helpful to provide parents with the American Academy of Pediatrics Developmental Readiness Guide to show parents that the infant may be ready for solid foods. Interestingly, 0-2 tablespoons of fruits, vegetables, or a combination should be offered at snack when an infant is developmentally ready.1 I also learned that juice is no longer reimbursable as an infant meal or snack. This is important to let parents know. Interestingly, I learned that yogurt is now a credible meat alternate for infants due to its protein content.1 I also learned that 0-4 ounces of yogurt can be served during breakfast, lunch, or dinner. Additionally, there should be no more than 23 grams per 6 ounces of yogurt to ensure overall health.1 One important nuance to mention is that WIC approved yogurt does not meet the sugar requirements and will not qualify for reimbursement.1 Eggs are also considered a meat alternative and 0-4 tablespoons of whole eggs qualifies for credit towards a reimbursable meal. Additionally, 0-2 ounces of cheese and cottage cheese also counts as meat alternatives.1 However, cheese foods and cheese spreads are not advised for infant meals and snacks and will not be reimbursed.1 For snacks, ready-to-eat breakfast cereals and breads should contain no more than 6 grams of sugar per dry ounce.1 Additionally, all grains must be enriched, fortified or be considered a whole grain (if not enriched/fortified).1 Overall, learning about the CACFP Infant Meal Pattern Requirements has been invaluable to my future career as a Registered Dietitian. References 1. Institute of Child Nutrition. CACFP Infant Meal Pattern Requirements. Accessed March 26, 2024. https://theicn.docebosaas.com/learn/course/70/CACFP%2520Infant%2520Meal%2520Pattern%2520Requirements
CACFP Child and Adult Meal Pattern Requirements
I was not familiar with the Child and Adult Care Food Program (CACFP) prior to beginning the CACFP Child and Adult Meal Pattern Requirements lesson.1 I was amazed to learn that CACFP has ensured that nutritious meals and snacks were first served to children attending childcare, and later branched out to include adults receiving adult care services.1 In recognizing that deficiencies of vitamins A and C, in addition to the rise of chronic diseases such as type 2 diabetes, hypertension, and heart disease, the CACFP revised the CACFP meal patterns to align with the Dietary Guidelines for Americans.1 In response to these micronutrient deficiencies and rise in chronic diseases, the meal patterns were updated to improve overall nutritional quality and to support a healthy, balanced dietary pattern in young children and adults.1 Some of these updates include five meal components, which include fruits, vegetables, meats/meat alternatives, milk, and grains.1 For a breakfast meal to qualify as a reimbursable meal, three components must be served, which include a vegetable, fruit, or both, a grain, and milk.1 For a lunch or dinner to qualify as a reimbursable meal, a fruit, vegetable, grain, meat/meat alternative and milk must be served.1 For a snack to qualify for reimbursement, a participant must choose two different options of either a fruit, vegetable, grain, meat/meat alternative, and milk.1 Additionally, only one beverage should be served and two beverages will not count towards reimbursement.1 For adults, yogurt can be served in place of milk once per day.1 For individuals with medical or special dietary needs, non-dairy milk alternatives may be served in place of milk as long as these alternatives are nutritionally equivalent.1 Plant-based milks are not a milk option for children between the ages of 2-5 and 6-12.1 However, there are a variety of acceptable milk options to include fat-free or low-fat milk, buttermilk, lactose reduced milk, or acidified milk.1 However, if a special dietary need is in place, a non-dairy milk beverage can be served provided it is nutritionally equivalent to cow’s milk.1 Importantly, to minimize the preference for sweet foods and to help establish a healthy dietary preference later in life, children
Lifecycle: Community Health Lecture Series
Watching the Community Health Lecture series will help me better identify key medical risk factors, symptoms, nutritional interventions, and disease management. This lecture series contained a variety of videos from a vast variety of topics such as heart disease, somatic movement for spine and mobility, arthritis, trauma coping and emotional health, CKD nutritional interventions, fatty liver, diabetes management, breast cancer management, and sleep health, just to name a few. Prior to watching the Community Health Lecture series, I was familiar with heart disease dietary interventions. However, during the Women and Heart Health webinar I was shocked to learn that 44% of women in the US live with heart disease and that heart disease is the number one cause of death amongst women.1 I also learned, after a heart attack has occurred, one-year survival rates are lower in women than in men.1 I was shocked to learn that 47% of women will die, suffer from stroke, or develop heart failure within the first 5-years after experiencing a heart attack.1 This was surreal to learn as I did not realize this was the case. I also learned that heart failure cannot be reversed, but that symptoms can be managed by medication, nutrition, and lifestyle interventions.1 Prior to watching the Community Health Lecture series, I was familiar with dietary interventions for Chronic Kidney Disease (CKD). However, watching the lectures on CKD meal planning and dietary interventions further advanced my knowledge. I am a visual, hands-on learner, so appreciated the plant-based MyPlate visual representations. Watching the CKD lectures was a great reminder that CKD disease progression may be delayed by consuming a healthy diet that aids in controlling both blood pressure and blood sugar.2 Importantly, a CKD food preparation tip that I did not know was that some potassium could be “leached” from high-potassium root vegetables by peeling, slicing, adding 2x water, boiling, and then changing water to cook until soft.2 As a future RD, this was great to learn. Overall, watching the several videos available in the Community Health Lecture series has given me a well-rounded introduction to medical ailments that I may see as a future Registered Dietitian. Additionally, this lecture series furthered my knowledge in specific dietary interventions that may help with disease management. References 1. Community Health Resource Center. Women’s Heart Health: Insights from Female Cardiologists. February 2024. Accessed March 26, 2024. https://chrcsf.org/videos/community-health-lectures/#womenshearthealth2024 2. Community Health Resource Center. CKD Recommendations. August 2022. https://chrcsf.org/videos/community-health-lectures/#ckd2022-2
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
When I began the WIC Learning Online courses, I quickly realized that I did not know much about this very important program. I knew that WIC helps women, infants and young children receive supplemental nutrition and nutrition education but was not familiar with the entirety of services provided. I was delighted to learn that WIC food packages resemble the Dietary Guidelines for Americans and was amazed to learn that WIC foods accommodate specific cultural and nutritional needs of participants.1 It was great to learn that breastfeeding is highly encouraged and that mothers who do choose to breastfeed receive a higher quantity of food and variety of foods.1 One of WIC’s major goals to is improve the nutritional status of infants.1 Providing extra incentives to breastfeeding mothers will encourage the continuation of breastfeeding, which greatly benefits their infant. Additionally, it was encouraging to learn that breastfeeding mothers may also receive breastfeeding pumps, guidance, and support.1 Additionally, WIC provides iron-fortified infant formula for mothers who choose not to, or cannot, breastfeed their babies.1 Amazingly, research suggests WIC has been successful at reducing fetal deaths, infant mortality, and low birth rates and improving dietary intake of pregnant women, postpartum women, while also improving the growth of nutritionally at-risk infants and children.1 I did not realize that 95% of persistent criers (daily inconsolably crying) are healthy and thriving and that only 25-35% of persistent criers have digestive problems.2 Before taking this course, I thought that a non-hungry inconsolable crier must be suffering from digestive distress but now know this is not the case. Though I breastfed both of my children, I didn’t realize that breastfeeding infants wake up more frequently than formula-fed infants due to breast milk digesting more quickly than formula.2 I was reminded that family and friend support, if possible, is key to help mothers during times when an infant wakes frequently at night.2 Importantly, WIC provides iron-fortified infant formula and cereal for the first year of life, which has proven be successful at reducing iron deficiency.3 I knew that the two protein sources in infant formula are casein and whey, but did not realize that whey protein is the primary protein found in human milk.3 Additionally, isolated soy protein-based formulas fortified with iron are appropriate for infants with special dietary needs.3 Soy-based infant formulas may be appropriate for infants with galactosemia, lactase deficiency, or infants on a vegetarian diet.3 I did not know that infants who have an allergy to cow milk protein may also have a soy protein allergy.3 Additionally, I did not realize that lactose intolerance is uncommon in full-term infants.3 Additionally, I was reminded that cow milk should not be given to infants during the first year of life as it is not easily digestible and may stress infant kidneys due to high concentration of protein and minerals.3 Equally as important, the appropriate amount of iron, vitamin C, and critical nutrients for infants is also lacking in cow milk. I used to think that breastfed human milk provided all nutrients the baby needed. I now know that human milk does not contain sufficient vitamin D and that infants should receive a minimum of 400 IU vitamin D and needs iron fortification at 4 months of age.4 I did not know this and wish I would have known this sooner, as I did not supplement my children with vitamin D or iron when they were exclusively breastfeeding for the first 8-months of their lives. Learning how to communicate with limited literacy audiences was very helpful as I have little to no experience in this area. However, I now feel well-equipped to do so. I also learned that, when speaking to an audience with limited literacy, to use the active voice, short sentences, and words less than three syllables.4 I did not realize that avoiding synonyms is recommended but am glad to now know this. Lastly, I was taught to repeat and review important points several times.4 My ultimate goal is effective and concise communication, so will implement all I have learned throughout these modules. When learning about the Value Enhanced Nutrition Assessment (VENA) program, I was saddened (though not surprised) to learn that most US women and children consume fewer servings than recommended by MyPlate.5 Additionally, I learned that the WIC nutrition services process is comprised of four components, which include nutrition assessment, nutrition education, food package tailoring, and referrals.6 It was helpful to learn about using a “circle chart” for nutrition counseling and education sessions, as this helps stay on track and not overwhelm the participant. I plan to use this in future practice as it is easy to understand and truly highlights the important key takeaways. Lastly, I learned that WIC food packages are not “one size fits all” and that these packages can be tailored based off of food preferences, allergies, and dietary restrictions, cultural foods, a pregnancy of twins or multiples, living situation, infant developmental stage and readiness, and infant formula need.6 I also didn’t realize that WIC is known as the “Gateway to Health” as it connect participants with other resources such as health care, educational assistance, additional food assistance, literacy resources, child care, and mental health services. This is truly important to nurture the overall health and well-being of WIC participants. Overall, I now feel like I have a well-rounded understanding about all services provided by WIC and how best to serve WIC participants. References USDA FNS. WIC Learning Online (WLOL): WIC 101. Accessed March 27, 2024. https://wiclearning.percipio.com/linked-contents/abf2fb6d-aeb4-4bdd-ba23-df9674b96eed/landing 2. USDA FNS. WIC Learning Online (WLOL): WIC Baby Behavior. Accessed March 27, 2024. https://wiclearning.percipio.com/linked-contents/f4fb915f-2376-49bd-a026-082b3251cc01/landing 3. USDA FNS. WIC Learning Online (WLOL): Feeding Infants: Nourshing Attitudes and Techniques. Accessed March 27, 2024. https://wiclearning.percipio.com/linked-contents/24434038-87bc-47c2-bc75-83302c65e509/landing 4. USDA FNS. WIC Learning Online (WLOL): Communicating with Participants. Accessed March 27, 2024. https://wiclearning.percipio.com/linked-contents/03bc907b-ccf4-49a6-b2f4-473bf5c20a91/landing 5. USDA FNS. WIC Learning Online (WLOL): Value Enhanced Nutrition Assessment (VENA). Accessed March 27, 2024. https://wiclearning.percipio.com/linked-contents/b98afc3e-67ef-488b-8cb0-fc743ec3a8a1/landing 6. USDA FNS. WIC Learning Online (WLOL): VENA: Connecting the Dots Between Assessment and Intervention. Accessed March 27, 2024. https://wiclearning.percipio.com/linked-contents/e8263a7f-1ec6-4cb5-b06e-8f968ddb4714/landing
Airplane Choo Choo: National Dairy Council & American Academy of Pediatrics Child Feeding Resource
I have two children and often stressed about their food consumption during the first two years of their lives. I often wondered if I was “doing it right” or was “feeding them appropriately” as I had little to no knowledge about what science suggested was best for my growing babies. It would have been extremely helpful if I was given the Airplane Choo Choo: A Guide to Feeding Your Baby For The First Two Years as this would have cleared up so many questions.1 I am now glad to know this resource exists as I know resource is beneficial to new parents! What stood out to me the most for 0-6 months is that iron-fortified infant formula should be used if a baby is not fed breast milk. This is a great reminder to parents that the infant formula they choose for their baby should be iron fortified. This is important as I have seen many new parents fall into the “organic wellness trap” and buy unregulated infant formula from “holistic practitioners” that have little to no knowledge of evidence-based methods. As a result, these homemade organic formulas do not have the appropriate nutritional profile nor contains fortified iron. The result of consuming such formula may be catastrophic for a developing baby. However, if a parent received Airplane Choo Choo they would understand what nutritional needs their growing baby has. Airplane Choo Choo is also helpful as this resource lists food groups, servings per day and examples of the types of foods that should be consumed between the ages of 6-8 months, 8-12 months, and 12-24 months. Additionally, thorough “Feeding tips” are provided for 6-8 months, 8-12 months, and 12-24 months milestones. Equally as helpful is a “Do Not Do” section, which explains to parents what should not be given to their child at each stage.1 Lastly, “Healthy Eating Behaviors” are highlighted, which helps parents develop habits that will lead to a healthy, balanced dietary pattern. I am glad to know that this resource exists as I will happily give this handout to new (and seasoned) parents. References 1. American Dairy. Airplane Choo Choo: A Guide to Feeding Your Baby For the First Two Years. Updated 2021. Accessed march 26, 2024. https://www.americandairy.com/wp-content/uploads/2021/07/Airplane-Choo-Choo-2021-Final.pdf