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Melanie McGrice is an Advanced Accredited Practising Dietitian with a Masters in Dietetics. She specialises in Early Life Nutrition, also known as the 1st 1000 days, from preconception to toddlerhood, when a child's brain, body and immune system grows the fastest to set the foundations for a child's future. She is also a Permanent Care. When Melanie began fostering and later a permanent care Mum she did the research that planted a seed. So many children in foster care /permanent care were born to parents who had alcohol during pregnancy or who had a drug addiction. So Melanie used her training and knowledge in nutrition to do some further research into FASD (Fetal Alcohol Spectrum Disorder). What did Melanie find? Nutrients that were deficient because of alcohol or FASD. Nutrients that could slow the impact of FASD. Nutrients that were in smaller volumes in children from FASD. Impacts after puberty. Melanie wants us to do a blood screen of nutrient markers so that you can treat the deficiencies ASAP. Makes sense. That combined with a nutrition assessment might do wonders for our community of children. Find out more about her research here. 00:00 - Start 01:08 - Fostering and permanent care led to a focus on the first 1,000 days with nutrition 04:25 - Links between FASD and nutrition: alcohol impacts nutrition by impacting appetite and absorption 08:06 - Research tells us that particular nutrients are impacted by alcohol during pregnancy, that particular nutrients are low in these children, that particular nutrients can slow or reduce the severity of FASD and that kids who had FASD have less intake of Vit D, fat and calcium 11:16 - Key messages: get a blood test on your child's nutrient markers and a nutrition assessment through a dietician with pregnancy or paediatrics expertise ASAP. Consider choline as the best research at the moment shows that babies dont have enough choline, which is an important nutrient for brain development. 14:11 - Supplement through food if you can and supplements where its not possible 17:30 - Research suggests these children have impaired satiety so they snack more. Also suggests they are more active and eat more. Ensure others know this and dont assume when they leave the table they aren't hungry. It may be they need more occasions to eat as they cant sit still to eat. they have a higher risk of disordered eating and constipation is common. 21:26 - Fussy eaters? Play games and use strategies to keep them at the table. If you change something, go very very slowly. 25:00 - For older children: post puberty girls can put on too much weight so be aware of this impact. 26:50 - Safe Spaces?
This is Sonia Wagner, representing PCA Families in one of our recordings that capture lived experience and best practice evidence based learning that assist kinship, permanent and adoptive parents/carers in supporting young people.
PCA Families has a zero tolerance of child abuse and follows child safe standards.
I would like to acknowledge the traditional custodians of the land and pay respect to elders past and present and express our intention to move together to a place of justice and partnership.
Today we are speaking with Melanie McGrice about nutrition and how you can help your child in the first 1000 days of a child’s life.
Melanie is an Advanced Accredited Practising Dietitian with a Masters in Dietetics. She specialises in Early Life Nutrition, also known as the 1st 1000 days, from preconception to toddlerhood, when a child's brain, body and immune system grows the fastest to set the foundations for a child's future. She runs a global business, training other dietitians in this speciality as well as running a specialist clinic in Melbourne. She's also a Permanent Care Mum.
Welcome Melanie
01:08 Can you tell us about how you came to specialise in Early Life Nutrition?
Quite a long complicated story. I think for many reasons I was driven to this area. Ive done fostering for about a decade and just had in my heart to take on a little one. As most of the audience would know you need to commit to a longer period of time. I was a bit of a workaholic. How will I manage that. I did and then they said to me this little one might go into permanent care would you consider that. I was a bit shell shocked but said yes. She ended up going back to her birth mum. That planted a seed for me so after that I looked for opportunities to take a little one through permanent care. With all of that the fostering and the little ones that I took in and then finally getting my permanent care daughter you get so much experience that you don’t get from anywhere else. That in conjunction with my nutrition background and research meant that I just learnt there is so much opportunity in the first 1,000 days for these little ones. I feel so frustrated that I learnt so much that I wish I had of known that earlier. We want to give every family an opportunity. There are some kids that are highly likely to end up in permanent care and have been born addicted to drugs and whose parents have had alcohol throughout the pregnancy. Having read the research there is so much you can be doing in the first 1,000 days while their brains are still developing and which can minimise problems down the track. I would like to see the systems and the processes change so that these little ones getting more attention now rather than years and years down the track.
04:25 You've been reviewing the evidence on nutrition and connecting that with FASD. Can you tell us more about that?
There is a lot. The best place to start is to help people understand why nutrition is so important for Mums who drink during the pregnancy.
Firstly alcohol has a really big impact on the birth Mums nutrition and therefore the growing fetus’ nutrition in 2 key ways. The alcohol itself is high in kilojoules. Putting that into context, sugar or carbohydrates provide around 16 kj per gram. Alcohol provides about 29kj per gram. So it’s really high in calories. Often for that reason, depending on how much someone is drinking it decreases appetite and impacts their ability to organise their meals and so forth. The drinking in of itself can cause malnutrition for the Mums. Obviously if the birth Mum is providing that nutrition through to the fetus, if Mum is malnourished then baby is malnourished. Secondly, Mums can end up with secondary malnutrition by not absorbing the nutrients properly. With alcohol in particular it can cause malabsorption. So people who don’t know this term of the first 1,000 days it is a really important period of time. It is when a babies brain grows the fastest it will grow in its life. Its when the genetic programming happens for our immune system and our learning ability and all those kinds of things. So the key messages are is if mum is drinking or doing drugs and not eating properly during pregnancy, then that is having a massive impact on the brain and immune system and everything else. But it doesn’t end there. There is so much brain development and opportunity in those first few years for the healing to be done or risks and harm to be reduced. There is a really great quote from a research paper “ Although abstinence from alcohol is the only way to prevent FASD, it is possible to reduce its affects through dietary therapy.” That was a wow why aren’t people doing more moment?
08:06 So, can you take us through some of your findings and the minerals and supplements?
There are 5 messages I would talk through.
1. Research papers have found there are particular nutrients that are often impacted by alcohol intake during pregnancy. Particularly B vitamin, Vitamin A, magnesium and iron.
2. There are other research studies that have found particular nutrients are found to be low in offspring of children who have been drinking during pregnancy. Those in particular are studies on zinc, magnesium and choline.
3. Nutrients that have been identified that can potentially slow the development of FASD or reduce its severity. This is what most people want to know. There are 4 categories.
a. Vit D a brain hormone.
b. Neuron development in the brain: Vit A, zinc, folate and choline.
c. Third is antioxiadants. Vit E, folate and selenium.
d. Fourth is the research around iron and Mums not having adequate iron in pregnancy.
4. Kids who had FASD and their dietary intakes compared to the general population. Those general studies found kids with FASD has less intake of Vit D, fat and calcium.
11:16 Key Messages
Key messages are that first of all if you have a child with FASD or Mum has been drinking or doing drugs during pregnancy, my personal belief is that whatever age you are getting them, when they are having a blood test do a blood screen of those nutrient markers. Things like iron, folate, B12 and B1 needs to be checked. Any doctor should have a good idea of key nutrients to check in a blood test. Vit D I would add as well.
The second thing is people should be having at least one nutrition assessment through a dietician with some expertise in pregnancy or paediatrics. Hopefully people can get that funded through Medicare or NDIS early intervention. I think that would be a great idea.
The third thing is the best research at the moment is around choline. Its really important for brain development. The research shows that most babies don’t have enough choline, particularly for these babies at the risk of FASD. The research isn’t strong enough for the authorities to say everyone should be on choline. Its not professional of me to say that but I think everyone should be getting advice on that. It’s a really important question to be asking. The other one would be Omega 3. I would also ask if they should be supplemented.
14:11 When you talk about supplementing do you mean food or supplements?
As a dietician I tend to be very much food first but when I talk about choline and Omega 3 its really supplements. Although you can get both those nutrients from food, the amount these little ones would benefit from is higher than what you would get through food. They have a lot to make up for. And if you take too much of some nutrients it can have additional affects. For example if you take too much iron you can end up with constipation. With choline and Omega 3 you don’t want to be taking tablespoons of it but taking a good quality supplement of those 2 nutrients is generally going to be beneficial for most of these kids.
Choline I bought as a powder, which is quite hard to find as it normally comes in a capsule, and mixed it into my daughters milk. Omega 3 you can get in a liquid form and you can mix it into something or put it on a teaspoon like a medicine or in a syringe. Be aware when you buy supplements that you are getting the right ones. I’ve seen Omega 3 gummies on the market but its more lolly than it is supplement. So I believe its worth getting proper advice and speak to somebody who can give you proper advice. I can’t mention brands on social media. Also doses change depending on kids age and other things as well.
16:50 Where is the best spot to look for a dietician or nutritionist?
GP referral. Dieticians Association (https://dietitiansaustralia.org.au/) and look in there. Although you could see any dietician someone who specialises in pregnancy or paediatrics.
17:30 Helping children understand when they are hungry, full or satisfied can be a part of our world. Do you have any tips?
This is something that I really noticed in my daughter so I had a lot of massive aha moments when I looked at the research. The research offers a few key messages.
One is that these children seem to have impaired satiety so they tend to snack a lot more than other kids. The research doesn’t explain why but I would put two and two together to show that these kids are generally more active than the general population. One study found that kids with FASD eat the equivalent of one more meal per day compared to other kids. So quite an additional amount of calories. There is also a higher risk of them being underweight, whether due to picky eating or hyperactivity or the fact that they need these extra kj’s, we don’t know yet. Again its about knowing your child and knowing what their growth charts look like and knowing that they might be a bit more hungry than usual. One of the things I have really noticed is that if they go off to daycare or what have you, as soon as they leave the table, other people assume that they have had enough to eat. Kids with FASD find it hard to sit still for long enough. So its really important to ensure that they are getting adequate food. It might be about having more eating occasions.
Higher risk of disordered eating.
Constipation is more common, which could be due to them not having as much to eat. Not getting enough fibre or getting dehydrated due to more physical activity or not having enough to drink.
Personalised advice is important to understand what is going on for your child, but its interesting to know what are the common things.
21:26 You mention extreme pickiness and one of the questions we often hear from families is how to help with extreme pickiness or sensory issues. Do you have any tips here?
Playing food games all the time. So we are cooking. Even if we cook and she doesn’t eat it. Picking foods from the garden and growing your own food. Picking something from community gardens. Going to the supermarket and taste testing. Or playing games like pasta games where you thread the pasta. Or food in sensory play for little ones. It might be messy like a container or mashed pumpkin. Trying to use food as a sensory play tool is great.
When kids are picky you usually have to go very very slowly. It may be they only eat chicken mcnuggets from Mcdonalds and plain pasta. So if that is the case its about going very slowly. It may be about trialling the chicken mcnuggets from somewhere else or just having them out of the packet because they normally have them in the packet. Sometimes its tiny changes to get them to progress and expand their horizons. It really depends on how extreme the child is.
25:00 What about older children?
Never too late and you should never give up. Part of the reason why Im passionate is because anything you can do in those early years will have a multiplied affect later on. Babies being born where they know Mum was drinking during pregnancy, straight away put them onto Choline at the same time and get these things started right from the word go.
For older kids I would still do all of the things I have discussed. A blood test for nutritional deficiencies. Personalised assessment. Tracking their growth.
One thing with growth is that post puberty girls can go to the other extreme and put on too much weight. Tracking caloric intake and trying to have a variety of nutritious foods. Not too late but not as great.
26:50 What are some things you would have done to create a safe space at mealtimes for the children in your life?
One of the things that is frustrating for me is trying to get my daughter to stay at the table at meal times. Accepting the fact that that’s not going to happen. If she gets up its more about getting her back again. I have a sensory cushion for her to sit on. Rather than going ok that’s the end of the meal. I do things at the table like I’ll read to her to keep her entertained. I found one thing that is not dietetically correct but it works really well. Telling them not to eat healthy foods. Playing it up “Your not allowed to eat that salmon…..that will make you too smart”. “No more carrots for you… you will be able to spot everything before I can spot it”.
Trying to make things fun and knowing your child. It can become stressful particularly when you know how much good these foods are doing for your child. They can pick up on your angst so easily. The more fun we can make things the better.
29:33 Do you have any recommendations for resources for parents and carers?
Not really on nutrition and FASD yet. I would like to make some in the future.
I have a youtube channel and a website.
My youtube is “Nourish with Mealanie” (https://www.youtube.com/c/NourishwithMelanie) that has videos about nutrition generally. Like I have one on iron rich foods. Im fairly easy to track down. I hope to put some resources together by then.
Website is www.nutritionplus.com.au
Just that you guys are doing an amazing job. All the other adoptive parents and carers I have met are incredible. Its not about a perfect diet but just adding little things.
Thankyou Melanie.
