It's frustrating at times to read about parents with keto kids who are old enough to explain the diet to, who can express interest in foods, and who have more mature taste palates. I see lovely arrangements of chicken, string cheese, avocado, and veggies with mayo-based dips, and other plates that look delicious and nutritionally balanced. With a toddler, all bets are off.
You've got issues of:
- Dexterity: dipping food (and consuming both the food and the dip) is a learned skill. Some kids are great at this, others aren't. So one of the major "get more fat into them" coping mechanisms for older kids aren't as successful. It's also harder for them to get "every last bit" of a fat they're served, whether it's a bit of ranch dressing or mayo or guacamole or whipped cream, without a parent to help.
- Cognitive maturity: let's see you explain to a 2 year old why he needs to try that baby carrot, and have it work. Go on, I'll watch.
- Oral-motor development: the thing is, most toddlers strengthen their chewing muscles by eating crunch foods. If you think about the foods you eat, the crunchiest ones are probably also the highest in carb - crackers, chips, raw veggies, etc. The stuff I was feeding my daughter at 2 was often crunchy, whereas since M's been on keto since he was 15 months old and we focused on a lot of softer "all in one" meals up front, he's missed out on a lot of that stuff. We try to offer nuts and pork rinds and even slightly-too-big homemade keto chocolates as often as possible to keep that chewing action developing, but it's a struggle. So those big kids dipping broccoli into ranch dressing are #goals but certainly not a reality for us at this point. We'll need to wait until he's weaned off the diet and give him a little more freedom to experiment and taste without hovering over him and weighing everything constantly. A delayed baby-led weaning effort, basically.
- Pickiness: toddlers are developing their tastes and oral motor skills, and they are developing OPINIONS and the realization that they can express them and affect their environments by doing so. The thing they loved last week may be something they refuse this week. Plenty of stuff gets refused for looking unfamiliar or being slightly too hot or slightly too cold or because Mercury is in retrograde or whatever ridiculous reason is behind it. Strong flavors are a challenge too - olives, for example, are a staple lunch item in big kid keto, but M licked one once and won't even look at them now.
SO. What have we figured out to make all this work?
First off, we have a big "cheat sheet" in our kitchen. We can do the math on nutrition labels or use the Keto Diet Calculator our dietician gave us access to, but it's annoying to do regularly and when we have family or caregivers helping out, it should be easy for them. So we made this chalkboard "menu" of some common favorites of M's that we can refer to.
As his ratio and tastes have changed we've modified the board, but this is a reasonable snapshot of his tastes at the moment. You'll note some of the Favorites are not super keto-friendly - Cheerios, for example - but he adores them, and as an occasional snack we're happy to let him enjoy toddler-sized handful with a syringe of oil.
We also rely heavily on syringes of extra-light tasting olive oil. There's no arguing with him to drink a cup of cream or whatever fat, and fat is literally his medicine, so if we treat it that way then he understands how to take it. He takes the oil very easily these days, sometimes even holding it up to his own mouth while we push the plunger, though at the beginning we had to give it the same way we gave other liquid meds - holding his head still so he couldn't avoid it, and up at enough of an angle that he won't choke but also won't just open his mouth and let it all spill out. Someone in the epilepsy keto group on Facebook practically accused me of child abuse when I noted that "he doesn't get to negotiate about taking his seizure meds, so he doesn't get to negotiate about the oil syringes." And yes, do not do this to a screaming hyperventilating child who will aspirate it. But also, do not expect a toddler to understand why he needs to take his medicine and be completely chill with it. Just hold him in place and give him the medicine.
Pro tip: get the syringes with caps so you can take them with you on errands and outings. Also, the syringe-interfacing cap you get with childrens' liquid medicines at the pharmacy works great in the top of an oil bottle like this, so we can turn the bottle upside down and fill the syringes from there.
BREAKFAST
M typically starts his day with play at his train table before deigning to grace us with his presence at the kitchen table. If we can, we like his breakfast to be a plate of a Johnsonville breakfast sausage, some berries, and a fat; it's a good balance of protein and carbs and berries are good for fiber. The fat is typically a syringe of olive oil, but recently he's been more pro-whipped-cream so a bowl of that works too. (We either have to over-serve it, so like 30g instead of a target 25g, or be ready to scrape the bowl with a small spatula for him to finish up) Some days he wakes up hangry and we need to jump start his blood sugar a bit, so those are the days when we'll offer a few grams of Cheerios with some oil to get him going. We might also make him some "hot chocolate" with Milkadamia or heavy cream and some sugar-free chocolate syrup.
With breakfast comes a syringe of water and 1/4 tsp baking soda, which helps balance his blood pH to avoid acidosis, and a syringe of low-carb compounded Keppra, his anti-seizure drug.
He also gets half a Flintstone's vitamin. They have some carb, but they're very low as chewable vitamins go, and the powdered keto-friendly vitamins we'd tried before had stopped being received well and were becoming a battle. The Flintstones are better - he chews them occasionally, but otherwise will just swallow them like an adult pill (something we taught him with half an adult ibuprofen, since he can't have the storebought liquid version). Unlike most kids this age, the vitamins are a necessity for him, since the medical keto diet is deficient in a lot of the nutrients and vitamins he needs. We also have to supplement with additional calcium, vitamin D, and carnitine; more on that later.
MORNING SNACK
If he's out and about, a snack's gotta be packed - we can't rely on opportunistic food finds. A common snack might be some goldfish crackers (3.5:1 on their own), or a bit of fruit (usually berries) with an oil syringe, or a sunflower seed butter cookie. We also love these single-serving packs of macadamia nuts, which are great to throw in a purse or a bag and not worry about going bad... though we do need to be careful if we're in a nut-free play area. He also usually downs a cup or so of Milkadamia throughout the morning.
LUNCH
If he's had a morning snack he often won't eat much lunch, so sometimes it's just Snack Round 2. If he hasn't, then he might have some all-in-one chicken nuggets, or an all-in-one veggie muffin.
NAPTIME
An ounce or two of his keto shake (a 3:1 mixture of heavy cream and whole milk), diluted with water, while we have a cuddle and he settles down to sleep.
LATE AFTERNOON GRAZING
"Dinner" is just a construct, really. Some time between 4 and 6 PM he will eat a bunch of food. Maybe it's Moon Cheese with oil, some frozen Italian meatballs with oil, all-in-one chicken nuggets or fish fingers... whatever he has decided is acceptable that particular week. We try to lean more protein-heavy for dinner, given that his breakfast and snack occasionally end up more biased toward carbs, but we're mostly concerned with tanking him up for the night so we all get some good sleep. For dessert, he'll sometimes have a homemade "fat bomb" chocolate.
BEDTIME
He still enjoys a cup of milk before bed, so as we read his bedtime stories he'll have about 4oz of his keto shake diluted with water. We mix in 1/2 tsp of powdered, flavorless calcium/vitamin D, per his dietician's guidance. Before bed he also has another syringe of Keppra, a syringe of water and 1/2 tsp baking soda, and a syringe of water and half a prescription levocarnitine tablet. Levocarnitine is an amino acid needed for digestion of fat and many keto kids are deficient in it; his levels are regularly monitored during the bloodwork we have done every few months, and they put him on the carnitine supplement about six months ago when the bloods came back low.
WHEN OUR STANDARDS ARE LOW
He's sick? He's teething? He's just in a crappy mood? We will literally feed him whatever it takes for him to eat. Sugar-free jello with a syringe of oil (even the sugar-free stuff has protein that needs to be balanced!). Rebel ice cream with some whipped cream. FBomb salted chocolate macadamia nut butter, letting him eat directly from the container with a spoon. Whatever we can manage, as long as we balance out the fat to ratio. We had a good run when he was a little under the weather scooping fresh snow from our deck and serving it in a bowl drizzled with heavy cream. If we're desperate, anything goes.
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