NDI nutrition guidelines

Low Sodium Diet for Infants, Toddlers, and Children General Guidelines Many people with NDI follow a 300-500 mg sodium per day diet. (Compare this to the 2000 mg sodium per day guideline that is recommended for most Americans.) A diet pattern with 500 mg sodium per day should include foods from all food groups. Select foods low in sodium by following some general guidelines and the Food Guide Pyramid: • Softened water (water treated in a softener) can contain large amounts of sodium. Don’t use softened water for ice cubes or for food preparation. • Kosher meats and poultry are soaked in salt water. Look for low sodium Kosher products. https://static.wixstatic.com/media/4f9dda_a4f5f79038f9461998cd1f8159ca04e0~mv2.jpg A QUICK “RULE OF THUMB”… Use the values below to make a quick estimate of sodium intake. (These are values for foods that are prepared without salt and/or are reduced or low sodium products.) Milk/Dairy Products – 80 mg sodium per cup Breads and Cereals – 80 mg sodium per 1/2 cup Meat (plain) – 25 mg sodium per ounce Vegetables – 15 mg sodium per 1/2 cup Fruits – trace amounts of sodium

At this age, children should begin to explore new tastes and textures… slowly. It is a good idea to introduce one solid food at a time. Commercially prepared foods for this age group are generally low in sodium. Read the food label to make sure the foods your infant is eating are low in sodium. Do not add salt to baby food when making it at home. As your baby is introduced to 2nd and 3rd foods and progresses to table foods, pay close attention to the sodium content of foods. Many 3rd foods (especially meats) have more than 100 mg sodium per serving. Combination foods (for example, meat and rice dinners) have too much sodium too — sometimes more than 200 mg sodium per serving. Because the sodium content of similar foods varies between brands, food labels are the best source of information about sodium content.

Your infant should be eating a variety of foods and exploring new textures. Gradually decrease the number of strained foods your child is offered and begin to introduce chopped, well-cooked vegetables. Slowly introduce a few table foods. As your child is able to grasp foods and bring them to his/her mouth, offer more finger foods. Foods with less than 35 mg sodium per serving Remember, the amount of sodium can vary between brands — always read the label. Food Serving, Size, Amount of Sodium Infant formulas – e.g. Similac, Enfamil, Prosobee, Isomil, 1 ounce, 5-10 mg Infant rice cereal • dry 1 Tbsp, dry, 1 mg • Prepared with whole milk,  1/2 ounce (~1 Tbsp), 6 mg Single ingredient “First Foods” #fruits mixed with tapioca, etc. may be higher • Fruits, 1 jar, 0-10mg • Fruit Juices, 4 ounces, 0-7 mg • Vegetables, 1 jar,  0-30 mg Well-cooked, mashed vegetables # Most fresh and frozen vegetables are low in sodium. Check the sodium content of frozen vegetables; some are soaked in brine. # Canned vegetables are high in sodium unless specified on the label. • Carrots, 1/4 cup sliced, 1 medium, 25 mg* Meat (baby food) • Plain, cooked, chopped meats, 1 ounce, 25 mg* • Junior meats, 1 jar, 120 mg* • Strained meats, 1 jar, 58 mg* Crackers and Cookies • Arrowroot cookie, 1 cookie, 15-25 mg • Melba toast, 2 pieces, 33 mg • Keebler Zwieback – Nabisco, 1 piece, 10-15 mg Note: *NOT low in sodium As progress from 2nd to 3rd foods to Graduates, sodium increases. Most 3rd foods and Gerber Graduate foods have more than 100-200 mg sodium per serving. No ham, au gratin potatoes, beef… See Bowes and Church’s Food Values of Portions Commonly Used for the nutrient (including sodium) contents of other foods.

Foods with less than 35 mg sodium per serving. Remember, the amount of sodium can vary between brands — always read the label. Food, Serving Size, Amount of Sodium Grains (Crackers, Cereals, Pasta) • Low sodium bread, 1 slice • Cooked cereal (oatmeal, cream of wheat – not instant) 3/4 cup, cooked, 1-2 mg • Puffed Rice, 1 cup, 0-1 mg • Low sodium saltine crackers – Premium 5 crackers, 35 mg • Rice – white or brown (not flavored) 1/2 cup, cooked, 5 mg • Potatoes (plain), 1/2 medium potato, 5 mg • Pasta – macaroni (no salt added during cooking) 1 ounce (1/4 cup), dry, 2 mg • Pasta – egg noodles (no salt added during cooking) 1/2 cup, cooked, 5 mg Fruits, Juices, Vegetables • Fruit Juices, 1 ounce, 1 mg • Fruit (fresh, frozen, or canned): applesauce, apricots, bananas, cantaloupe, fruit cocktail, grapes, kiwi, mandarin oranges, nectarines, oranges, peaches, pears, strawberries, tangerines… ¼ cup, 0-5 mg • Fun Snacks, 1 pouch, 23 mg • Vegetables – fresh Some vegetables are not low in sodium (e.g. celery and carrots). Canned vegetables are high in sodium unless low sodium is specified on the label. 1/4 cup, 0-5 mg • Vegetables – frozen • Check the sodium content of frozen vegetables; many are soaked in brine. Avoid frozen “medleys” and “combinations” with seasonings or sauces. 1/4 cup, 10-20 mg • Prego no-salt-added pasta sauce, 1/4 cup, 25 mg* Meat • Ground beef, 1 ounce, 25 mg • Chicken, 1 ounce, 25 mg • Pork loin, 1 ounce, 20 mg Note: * NOT low in sodium Foods NOT low in sodium Food, Serving Size, Amount of Sodium Crackers, Breads, Cereals • Saltines (regular), 5 crackers, 190 mg • Animal crackers, 5 crackers, 50 mg • Graham Crackers – Honey Maid, 1 square, 45 mg • Teddy Grahams, 5 crackers, 30 mg • Cheerios, 1 cup, 280 mg • White bread, 1 slice, 120 mg Milk, Dairy Products • Milk 8 ounces (1 cup) 122 mg • Yogurt 4 ounces 150 mg • Ice cream 1/2 cup 40-50 mg

Label Reading Tips… How to Find the Hidden Sodium How to Read a Food Label Reading food labels is the only way to be sure of the sodium content of foods. The sodium content must be listed on the package – it is usually on the nutrition information panel. Food manufacturers change ingredients all of the time; make it a habit to READ THE LABEL. Nutrition facts • The label lists the amount of sodium per serving of food (not per package or container). • Ingredients are listed in decreasing order by weight – if salt or sodium appears on the ingredient list at all, make sure it is near the end. What the Label Really Means If the label says… It means… • Sodium free… salt free • Very low sodium… Low sodium • Reduced sodium… Light in sodium • Unsalted… No added salt Less than 5 mg sodium per serving • Less than 35 mg sodium per serving… Less than 140 mg sodium per serving • At least 25% less sodium than the original product… At least 50% less sodium than the original product • No salt added during processing (not necessarily sodium-free)… Ingredients that shout HIGH IN SODIUM! Baking soda Brine Disodiumphosphate Garlic salt, Onion salt Monosodium glutamate (MSG) Salt Sodium alginate Sodium benzoate Sodium caseinate Sodium citrate Sodiumhydroxide Sodium nitrate Sodium pectinate Sodium proprionate Sodium sulfite

How to Evaluate the Sodium Content of Favorite Recipes 1. Examine the ingredients. 2. What is the sodium content of packaged ingredients? (Read the labels of the ingredients you will use.) 3. What is the sodium content of other ingredients? 4. Examine any ingredients used in preparation. 5. Total the approximate sodium content for the entire recipe. 6. Divide the total sodium content by the number of servings the recipe makes. 7. Make sure the serving size listed on the recipe is the same as what will actually be served. 8. Does this food fit into your child’s food pattern? 9. If he eats this, how much sodium will be “left” for the rest of the day? Example: Billy Bob’s Grandma’s Best Apple Pie Sodium content of packaged ingredients: Sodium content of other ingredients: • Total sodium for this recipe equals: 4743 mg • Total sodium divided by number of servings: Although this recipe says it makes 12 servings, we make 10 large servings. So, we divide 4743 by 10 = 474 mg sodium per serving. • Does the food fit into a low sodium food pattern This recipe is too high. Although one serving is less than the 500 mg sodium in Billy Bob’s food pattern, it does not leave him with much sodium for the rest of the day. (It would be impossible to eat enough food for one day and no more than 26 mg sodium!) How to Adjust the Sodium Content of Favorite Recipes Identify the “high sodium” ingredients. Can these ingredients be omitted? What low sodium ingredients can you use as substitutes? Do the changes make the recipe acceptable? (Evaluate the modified recipe to make sure.) Example: Billy Bob’s Grandma’s Best Apple Pie High sodium ingredients: Salt–can be omitted Butter–substitute unsalted butter or vegetable shortening Baking powder–could omit this or use low sodium baking powder Evaluate the modified recipe: Sodium content of packaged ingredients: Sodium content of other ingredients: • Total sodium for this modified recipe equals: 96 mg • Total sodium divided by number of servings: 96 by 10 = 9.6 mg sodium per serving. This item will fit into a low sodium food pattern.

Infant 6 month old 7.5 kg (16 lbs.) Sample Meal Pattern: • Less than 300 mg sodium, 750 calories of energy, 15 grams protein. • 28 ounces human milk or infant formula • 4 Tablespoons dry infant cereal • 4 ounces fruit juice • 5 Tablespoons strained fruit Infant 10 month old 9 kg (20 lbs.) Sample Meal Pattern: • Less than 500 mg sodium, 900 calories of energy, 30 grams protein. • 20 ounces infant formula • 8 Tablespoons dry infant cereal • 4 ounces junior fruit • 4 ounces junior vegetables • 3 ounces junior meat • 1 Zwieback cracker • 1 ounce chopped chicken – prepared without salt • 1 Tablespoon mashed green beans (not canned) • 1/2 medium banana • 2 Tablespoons sorbet Toddler 18 month old 13 kg (29 lbs.) Sample Meal Pattern: • Less than 500 mg sodium, 1200 calories of energy, 35 grams protein. (This meal pattern does not provide an adequate amount of calcium or iron. A child following this pattern should receive a calcium supplement and a general children’s multiple vitamin and mineral supplement.) • 1-1/2 cups whole milk • 1/4 cup oatmeal (not instant) with raisins, sugar, and cinnamon • 1/4 to 1/2 cup melon • 1/2 cup applesauce • 1 slice low protein bread with unsalted butter and jelly • 1/2 cup apple juice • 3 low sodium saltine crackers • 1-1/2 ounces chicken • 1/4 cup mixed vegetables (not frozen) • 1/2 cup rice Young Child 4 year old 20 kg (45 lbs.) Sample Meal Pattern: • 1800 calories of energy, less than 500 mg sodium, 40 grams protein (This meal pattern does not provide an adequate amount of calcium or iron. A child following this pattern should receive a calcium supplement and a general children’s multiple vitamin and mineral supplement.) • 16 ounces whole milk • 8 ounces apple juice • 2 slices low sodium bread with jelly and unsalted butter • 1 cup puffed rice cereal • 2 ounces hamburger, prepared without salt • 1 pouch fruit snacks • 1/2 cup low sodium chicken noodle soup • 5 low sodium saltine crackers • 3/4 cup green beans, with unsalted butter • 1/2 cup sorbet • 1 graham cracker • 1 medium apple • 1 medium banana

American Heart Association, Low-Salt Cookbook. 175 low sodium recipes, including tips on cooking techniques and ingredient substitution. This book can be purchased at your local bookstore or you can borrow it from the library. To find out more information on where to purchase the book directly from the publisher, please visit American Heart Association Cookbooks.(http://www.americanheart.org/presenter.jhtml?identifier=3040190)

The NDI Foundation does not endorse nor is compensated for the links below but provide them as a service to NDI families. • Healthy Heart Market(http://www.healthyheartmarket.com/) • MegaHeart(http://www.megaheart.com/) • Low Sodium Cooking(http://www.lowsodiumcooking.com/) • Low Sodium Living(http://www.lowsodiumliving.com/) • Salt Watcher(http://www.saltwatcher.com/)