Toddlers. Toddlers, children from 1 to 3 years of age, have a materials that you may find helpful are listed on page 15. Loss of Appetite. Loss of appetite can result from a variety also very important for both parents to support each other in slow growth rate compared with that of infants. Toddlers may Toddlers and Preschoolers. Permit your preschooler to make of causes including poor metabolic control; illness; eating too managing a food strike. If a child is allowed to eat foods not on gain 4 to 5 pounds (1.8–2.3 kilograms [kg]) a year, compared food choices, such as what fruit he wants to eat. Plan meals that many sweet foods or desserts that satisfy the appetite and her diet, LEU levels will not be controlled. with the infants’ gain of 12 to 22 pounds (5.5–10 kg) per year. have variety in color, texture, flavor, and preparation methods. decrease the desire to eat the foods prescribed; getting too On a food jag, a child wants to eat the same food or foods for Growth during this period involves changes in body form. Legs A child who is involved in food selection and preparation will much I-Valex, which may depress the appetite for other foods; long periods. If the foods are nutritious and are in the diet, lengthen and body fat decreases. Energy needs are decreased be more interested in trying a new food. Involve your child in or having a lower than normal blood LEU level. Medications there is no reason for concern. Remember that most of your because of the slower growth rate. However, mineral and planning menus to become familiar with foods allowed and may also decrease appetite. child’s nutrient needs are supplied by I-Valex. vitamin needs increase. excluded. Let him help grocery shop, set the table, and prepare Unusual Hunger. This may be an indication that the diet needs Toddlers seek independence and are very curious about the food. to be adjusted. The amount of I-Valex may need to be increased Inappropriate Feeding Behavior. Inappropriate feeding their environment. Because toddlers want to do things for because the table foods prescribed are not satisfying needs. behaviors, such as refusing to give up the bottle and/or At about 3 to 4 years of age, children want to serve themselves. Using low-protein foods is a great way to manage hunger difficulty in eating solids, chewing, or self-feeding, may result themselves, encourage your child to feed himself. Teach your child the proper food portions. One way to do this without increasing protein intake. from a variety of causes. These can include a delay in offering Preschoolers. Preschoolers also have a slow weight gain of is to use a “token” system. Tokens symbolizing 5, 15, or 30 mg table foods, delay in teaching the child to drink I-Valex by cup, 4 to 5 pounds (1.8–2.3 kg) per year. On the other hand, their of LEU, or 1 gram of protein, may be used to “purchase” foods Refusing Medical Food. A child may refuse I-Valex because of or not allowing the child to feed himself either with fingers total energy needs are greater than those of toddlers. Because containing these amounts. normal variations in appetite, and this should not be of concern or spoon. Always keep a positive attitude and make feeding a your preschooler’s nutrient and energy needs are greater, the School Age. When your child reaches school age, she will if average intake over a week is adequate. If I-Valex is not pleasurable event. nutritionist may tell you to increase foods with a high nutrient become more independent in many aspects of her life and offered regularly, a child may decide to refuse it. Improperly Try not to feed a child longer than necessary at mealtime to content. These foods are packed with vitamins and minerals eating is one of them. As she begins to develop logic and math mixed I-Valex also can cause refusal— too much water makes encourage self-feeding. Remember that small amounts of food and are energy dense. skills, it is important she use these skills to understand the diet. the volume too great; too little water makes the I-Valex mixture are usually wasted when a child first learns to self-feed, but Let your preschooler make some decisions. For example, Encourage your child to help prepare the medical food and too thick. A child may refuse I-Valex as an attention-getting this is normal. Keeping food records will help your nutritionist permit him to choose which cereal, fruit, or vegetable to eat. calculate the amount of LEU in foods. As your child gets older, device, especially if he senses that his parents are anxious for estimate your child’s intake. Be aware that most preschoolers want to do things at their she should understand what levels of LEU are considered him to drink the I-Valex mixture. Remember, I-Valex plays own speed. Be prepared to have your child spend so much time normal and the consequences of high LEU levels. an important role in providing most of your child’s nutrition A child may be using his diet as a way of getting attention or talking that little is eaten. This is normal behavior. needs. If refusal of the medical food continues to be a problem, manipulating parents. If your child has any of these problems, Adolescence. Adolescence may be a difficult time for both the use of a feeding tube may need to be considered. call the nutritionist. The nutritionist will give you support and Social Interaction at Mealtime. Mealtime is an important you and your child, regardless of the DLC! The influence of Refusing Solids. A child may experience normal variations in offer suggestions to help solve the problem. part of every child’s social development and, whenever friends and the struggle for independence may make dietary appetite or taste for certain foods. The prescribed amount of possible, the family should eat together. Younger children can compliance a challenge. Teens may feel that the DLC makes I-Valex may be too high and the energy in it is causing her to THE ROLE OF FAMILY AND OTHER CARE learn how to feed themselves by watching older brothers and them different from their friends. Eating out with friends is lose her appetite. PROVIDERS IN MANAGING A DLC sisters. part of growing up. Help your child develop the skills for eating Make meals for your child with a DLC as similar as possible to out, traveling, and “sticking” to the diet when not at home. Toddlers and preschoolers periodically have one of two Parents carry the bulk of the responsibility for managing the family’s meals. Menus for him can be planned from those Sometimes teenagers with a DLC would rather tell people they characteristic feeding behaviors that cause parents concern. their child’s DLC. If possible, try to share the responsibility for the rest of the family. For example, whenever possible, are vegetarian or vegan than explain about the DLC. Help your They may decide to stop eating by going on a “food strike,” or in preparing meals and monitoring your child’s diet. Other use the same fruits and vegetables for everyone. You can also teenager deal with her peers and not be self-conscious that she they may go on a “food jag.” Food jags and strikes are common children in the family, as well as the child with a DLC, prepare a low-protein pasta or meatless dish that is similar to has a DLC. Finding a peer with a DLC through support groups among young children. should learn about the diet as soon as they are old enough to the one served to other family members. The family’s help and can be a great comfort for a teen. Ask the clinic for resources understand it. Older brothers and sisters should be encouraged support are very important to maintaining the diet. and suggestions. During a food strike when your child refuses to eat, offer food to be involved in feeding the child with the DLC so they at usual mealtimes, and if she refuses the food, take it away. become familiar with foods allowed and excluded. Make sure TEACHING YOUR CHILD DIET FEEDING PROBLEMS Allow only water between meals. She will become hungry and they understand the importance of the diet for their brother’s MANAGEMENT Parents may be tempted to treat their child as a “sick” child then eat. Remember that I-Valex supplies most of your or sister’s health. Brothers and sisters should not feel sorry for and not follow their usual patterns of child rearing. The child child’s nutrient needs, so her medical food should never be the child with the DLC because he is on a special diet. Treat Explaining the diet can begin by calling allowed foods “special” restricted. your child with a DLC as normally as possible. or “just for you.” From the time your child is very young, with a DLC is a normal child who needs to manage food intake teach her to ask about unfamiliar foods before eating them. As carefully. Ask your child’s doctor, nutritionist, public health Do not give in to a food strike and offer Free Foods or foods Grandparents love to spoil their grandchildren! It may be your child grows older and is able to understand the concept nurse, or social worker for support and help if any of the that are not on the LEU-restricted diet. The nutritionist can difficult for them as they sometimes feel the child with the of a missing or nonworking enzyme, explain the DLC. Some following problems should occur. help you during this trying time, so do not hesitate to call. It is DLC is “missing out.” It is important they understand the 12 13