Pack lunches are always a challenge. Take away sandwiches and it can seem overwhelming. This post is lengthy, but it's goal ito demystify the process of making pack lunches safe, healthy and fun for CSID kids from toddlerhood through elementary school.
My guys love bento boxes. You can buy fancy boxes, or use new, clean organizing boxes like for fishing tackle, or find a rectangular box and used smaller boxes or silicone cupcake molds to seperate the snacks. The goal is to have a variety-maybe 4-5 snack sized portions of a sampling of foods. The Bento is great for CSID because:
- Portions of individual foods are kept small
- No sandwiches necessary
- They are FUN!
To fill the box, use anything your child tolerates. Shoot for one ot two protiens/fats, a veggie and a fruit for carbs. One of our go-to combinations was kale chips, fresh strawberries, cheese slices and a few pepperoni slices. Easy, balanced, done.
I like to start with whole foods, because it makes it easier to eliminate weird ingredients that could be a problem. If you aren't sure where to start, pick from the 'tolerated by most' list found here, then pretend you are on an unending episode of Chopped. When you are ready to venture out into prepared snacks, look for organic brands with fewer ingredients. We love the Simply Organic line at Aldis because of the simplicity of the ingredients lists.
Note on the CSID induction diet and food journaling
There are various induction diets for CSID available online. Some plans are more aggressive, or may contain foods your child can't tolerate, or may be missing important sources of protien and calories your child relies on. One of the more debatable inclusions/exclusions is dairy. If your child tolerates dairy, it can be included as a great source of calories and makes the induction diet a bit easier and more varied. If your child does not tolerate dairy-skip it. Also, any other foods that are not tolerated should be avoided.
I recomend reviewing a few plans, then developing a diet plan with your doctor and dietician. Because dietary information on CSID is not generally known in the medical community, this may mean that YOU the parent devlops the plan, then presents it to professionals for review. Keep in mind the following as you plan:
- This is triage. The first step is to make the patient stable. If that means limiting the diet to a few safe foods until symptoms subside, that is OK.
- Once symptoms are under control, then you can start introducing new foods one at a time as described below. This can take up to 6 months or more, and that is OK.
- After the initial sucrose induction, (both with and without sucraid) repeat the process for starches and set a goal for a more balanced diet. Give yourself time, even a year or two is OK.
Are you sensing a theme? Breathe in, breathe out, allow yourself and your family TIME to adjust, and trust that it will be OK. Initally I was worried that a limited diet would further exacerbate the weight loss issues my son was facing, however, as his gut healed and he was able to properly absorb nutrients from his food, his weight increased even on a limited diet. If you have weigh loss concerns, lean toward calorie dense choices like bacon, cheese, whole milk, eggs etc. and consider adding fats like coconut oil to smoothies. Work with your doctor to monitor weight and consider adding CSID safe formula if needed.
We have found that for ease, it is preferable to adjust the whole family's diet to it's most limited member(s). That way there are less accidents and food sneaking. Remember that it is the person responsible for the grocery shopping who dictates what foods are available in the house. Older kids can always be given money for school lunches and treats away from home, and adults can choose to eat out for lunch. By making home a safe haven for your CSIDer you are helping them adjust to the diet both physically and developmentally while showing them that you support them unconditionally. This is a common approach in the food allergy community as well.
During the induction phase, foods should be introduced one at a time, in small and increasing amounts. Ie: 30g of blueberries on Monday, skip Tuesday, 60g of blueberries on Wednesday or Thursday ect. This allows enough time inbetween trials to detect delayed reactions and allows easy dectection of the offending food. Generally, you should introduce only sucrose foods first, then work on adding starch foods. My only exception was the inclusion of low starch protiens like nut butters and beans because they can be a good source of nutrition and variety during the induction diet, so it may be worth considering introducing these foods after symptoms are stable.
Food journaling during this process is critical so you can track reactions and pinpoint offending foods. I provide two samples:
- Numbers version for use on Apple devices with the numbers app installed. Calculates sucrose load for individual food, meal and daily total.
- Pdf version
I believe that this process should be handled both from a dietary and developmental standpoint. Some advocate pushing tolerances until symptoms reappear so that you know the max load. I do not. I advocate pushing tolerances until you and your child are happy with the diet. In my opinion, it is important that your child trust you and the food they eat. Max load tolerances can be tested when they are developmentally ready to make that decision themselves and are willing-like maybe teens or twenties. More about my personal philosophy can be found in the first Lunches of Fun post.
For ease, the food suggestions in this post are limited to the sucrose induction phase of the CSID diet, using foods that most can tolerate without Sucraid.
Note on yogurt and probiotics
Some induction diet plans recomend a balance of 1/4 yogurt, 1/4 animal protiens, and 1/2 fruits and veggies. This is a great goal, but might not be feasible immediately. However, if yogurt is tolerated, the natural probiotics can help regulate the gi tract. Look for plain yogurt, preferably whole milk or greek varieties, or make your own. You want to find something where the ingredients are milk and active cultures. Be wary of discount store brands as they often use corn starch as a thickener. If you are looking for fun ways to incorporate yogurt in the diet, check pinterest and this post for ideas.
After illness or reactions, yogurt can be an easy to digest first food. To enhance yogurt's natural probiotic and binding properties, with the approval of our doctor, we add 1pk florastor and 1-2t sugar free pectin to a half cup yogurt 3-4 times a day until diarrhea ceases. Powdered pectin does not contain any sugar or starch (but check the label) and is one of the substance responsible for the binding properties of the BRAT diet. It has been used medically to treat diarrhea and various gi conditions.
Now, about that lunch box that refuses to pack itself...
Easy, mostly whole food ideas to include in a CSID bento:
- Kale, spinach, pepperoni, salami or cheese "chips", pork rinds
- Fresh berry fruit salad with strawberries, blueberries, rasberries, blackberries, grapes or rasins, pomegranate, unsulfured figs, and other tolerated fruit
- Plain yogurt mixed with stevia sweetener like truvia, a 1/4t vanilla and mashed berries or pixi stix, fun dip, or koolaid powder
- Dill pickles and olives
- Various cheeses
- Plain cooked meats cubed into bite sized pieces
- Dextrose cured cold cuts or deli meats
- Meat jerky, slim jims, bacon
- Low starch/sucrose veggies for munching like celery, cucumber, bell pepper, cherry tomato, brocolli, cauliflower, mushrooms
- Sugar free peanut butter, ranch dressing/dip, or hummus for dipping
- Dehydrated berries (no sugar added)
- Hard boiled eggs
- Deli salads like ham, egg or chicken salad in a bowl served with a fork or dippers, or in a lettuce wrap (if you have an egg allergy, sub mashed avocado or sour cream for the mayo)
- No sugar added applesauce (or pearsauce), sometimes we can find fun flavors like pomegranate, cranberry, blueberry or strawberry. Or make your own.
- For drinks I like to stick with water or whole milk as much as possible, but Honest Kids grape and lemonaid flavors are also well tolerated without sucraid and come in juice boxes. Other juices would be pomegranate, grape, lemon, lime. Make sure to check the labeling for added sucrose. You can do fun infused in their water bottles (think cucumber strawberry, pomegranate blueberry, or lemon raspberry) just add a few fresh fruits in with the ice and shake.
Prep ahead bento ideas:
Lettuce can replace bread and stuffed with so many fun things! This was one of our first CSID safe lunches. This might not work for toddlers, but is a great option for older kids.
I found more great ideas and inspirations on Pinterest. Check out my CSID Lunches board and follow along for more ideas!
Please feel free to ask questions below!