SEED - Questionaire Packets

Instructions for

DIARY OF

CHILD’S

DIET

Public Reporting Burden Statement

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0741)

Study to Explore Early Development

Information about the Three Day Diet Diary

Thank you for your interest in the Study to Explore Early Development (SEED). This packet contains a diet diary for you to complete. More instructions about how to complete the diary are on the next pages. Someone from the study will call you in the next few days to make sure you have started the diary, help you complete materials if needed, and answer your questions.

When you have completed the diary, please send it back in the postage-paid envelope provided. If you have any questions while you are completing these forms (or want help before you begin), please call contact one of our study staff at the numbers below.

404-498-0058

If you have any questions about your participation in this study, please refer to the Developmental Assessment Consent Form. A copy of that consent form has already been given to you and it describes use of these questionnaires along with any other information obtained during study-related activities. All research on human volunteers is reviewed by a committee that works to protect your rights and welfare. If you have questions or concerns about your rights as a research subject you may contact, anonymously if you wish, the Institutional Review Board at 401 498-4026 or by email to [email protected].

We are grateful to you for your willingness to participate in this important research study. If you would like to speak to anyone at any point during the study, please call the Georgia SEED study research phone line.

If you have questions, call

Charmaine McKenzie

404-498-0058

Important Food Diary Do’s and Don’ts

• Stick to normal eating habits.

• For EVERYTHING that your child eats or drinks, *including* vitamins, herbs and other supplements, record:

1 . The time the item was consumed

2. The serving size or amount eaten

3. What your child ate

4. The brand name

5. Any special details about the type of food

6. A detailed description of how the food was prepared

Helpful Hint #1:

Take the diary with you everywhere you go, so you won’t forget what your child eats or drinks.

Helpful Hint #2:

If your child regularly uses a sippy-cup, or has a favorite cup of some kind, fill it once and measure the volume with a measuring cup – this will help you to estimate exactly how much your child is drinking later on.

Vitamins and Supplements

Time	Amount	What did you eat?	Brand name	Type	Preparation
8 :15 am	250mg	Vitamin C	Puritan’s Pride	With rose hips
	1 pill	multi-vitamin	Flintstones	Gummies

• U se one line on the food diary page for each item: This means that Home Cooked Foods or Sandwiches could take several lines to describe, but that’s OK. For things like homemade Casserole, put the amount that your child ate (on the first line) followed by the ENTIRE recipe (listed by ingredient) underneath. For instance:

One serving of a homemade cheesy-beef casserole

Time	Amount	What did you eat?	Brand name	Type	Preparation
5:15 pm	½ cup	Cheesy-beef casserole	N/A	Homemade	Ingredients below
	1 lb	Beef	Harris Teeter Reserve	Ground Chuck, 15% lean	pan-fried and drained
	¼ cup	Onion		Yellow	finely chopped
	7.5 oz box	Macaroni and Cheese	Kraft	Original	cooked
	¼ cup	Milk	Maple View	2%	with macaroni
	2 TBSP	Butter	Land O Lakes	Whipped	with macaroni

A turkey sandwich

Time	Amount	What did you eat?	Brand name	Type	Preparation
12:00 pm	2 - 1 oz slices	Bread	Wonder	Whole Grain White
	3 oz	Turkey	Sara Lee	Oven Roasted
	1/8	Tennis Ball Sized Tomato	Harris Teeter		sliced
	1 - .75 oz slice	Cheese	Kraft	American Singles
	1 tsp	Mayonnaise	Duke’s

Note: Instead of recording “2 slices” of turkey, record the amount you use by weight. (You can calculate the weight of each slice by using the package weight divided by the number of slices in the package)

• F

  

  or Dry Ingredients use CUPS.

For Liquids use OUNCES.

Time	Amount	What did you eat?	Brand name	Type	Preparation
7:45 am	¾ cup	Cheerios	General Mills		with milk
	5 oz	Milk	Maple View	2%

• For Condiments, such as sour cream or ketchup, please use specific amounts to measure by.

Both of these are good:

Time	Amount	What did you eat?	Brand name	Type	Preparation
6:30 pm	golf ball size	Sour Cream	Daisy	Regular
6:35 pm	2 TBSP	Ketchup	Heinz

These two are bad:

Time	Amount	What did you eat?	Brand name	Type	Preparation
6:30 pm	a dollop	Sour Cream	Daisy	Regular
6:35 pm	6 packets	Ketchup	Heinz

• B

  

  e very detailed when recording your child’s intake, even for Fast Food.

Like this:

Time	Amount	What did you eat?	Brand name	Type	Preparation
2:15 pm	4	Chicken Nuggets	McDonald’s
	1 kid-size order	French Fries	McDonald’s
	12 oz	Soda	Coca-Cola	Diet

Not like this:

Time	Amount	What did you eat?	Brand name	Type	Preparation
2:15 pm	all	Chicken Nuggets Happy Meal	McDonald’s

• Avoid using “slices” for anything other than bread, cheese, or bacon. For example, when eating Pizza, please record what portion of the total pizza was eaten.

Do this:

Time	Amount	What did you eat?	Brand name	Type	Preparation
7:00 pm	1/ 8	Large Pizza	Dominoes	Extra Cheese & Hand-tossed Crust

Don’t do this:

Time	Amount	What did you eat?	Brand name	Type	Preparation
7:00 pm	1 slice	Large extra cheese Pizza	Dominoes

• When it comes to Snacks, like crackers, use a measured amount

• or a specific number:

This works:

Time	Amount	What did you eat?	Brand name	Type	Preparation
9:25 am	½ cup	Cheez-Its	Sunshine	Cheddar

This works too:

Time	Amount	What did you eat?	Brand name	Type	Preparation
9:25 am	22	Cheez-Its	Sunshine	Cheddar

This doesn’t work:

Time	Amount	What did you eat?	Brand name	Type	Preparation
9:25 am	Small handful	Cheez-its	Sunshine	Cheddar

• And for Drinks…use the actual amount in oz. or ml.:

Fantastic:

Time	Amount	What did you eat?	Brand name	Type	Preparation
11 am	12 oz	Soda	Pepsi	Cola
1 pm	6.75 oz	Juice	Capri Sun	Tropical Fruit

Not so fantastic:

Time	Amount	What did you eat?	Brand name	Type	Preparation
11 am	1 can	Soda	Pepsi	Cola
1 pm	1 pouch	Juice	Capri Sun	Tropical Fruit

• For whole pieces of Fruit, estimate their size by using similar objects:

Time	Amount	What did you eat?	Brand name	Type	Preparation
8:45 am	½	Tennis Ball Sized Apple		Fuji	chunked
10:30 am	1	Golf Ball Sized Plum		Red
2:15 pm	1	Softball Sized Grapefruit		Pink
3:45pm	½	8 inch Banana	Chiquita		sliced

Portion sizes are important, so make sure you write one for every item.

Please refer to the “Visualize Your Portion Size” sheet and record everything in terms that you are comfortable with. Thank You!

Visualize Your Portion Size

1 cup = Tennis ball

¼ cup = Golf ball

Visual hints-

• ¼ cup is about the size of a golf ball or ping pong ball.

• 1 cup is about the size of a baseball or tennis ball.

• A 1 inch diameter sauce cup will hold one ounce.

• A ‘pint’ deli container holds 16 oz or about 2 cups.

Meats and Fish-

• 3 oz = Checkbook

  
  

  3 oz = Deck of cards

  3 oz serving is similar in size to a deck of cards, an audiotape, or a checkbook.

• 1 oz of cooked meat is similar in size to 3 dice.

• A 1-inch meatball is about one ounce.

• 4 oz of raw, lean meat shrinks to about 3 ounces after cooking.

Fruits and Veggies-

• A medium apple, peach, or orange is about the size of a tennis ball.

• A small piece of fruit is the size of a golf ball.

• A large piece of fruit is the size of a baseball; a really large piece is about the size of a softball.

• For cut fruit and vegetables such as watermelon, broccoli, or peas, use cups

1 oz cooked meat = 3 dice

Cereal and Pasta-

• 1-cup pasta is about the size of a tennis ball.

• An average bagel is the size of a hockey puck.

Cheese, Butter and Spreads-

• 1 oz of cheese is about a 1 inch square or about the size of your thumb or four stacked dice.

• 1 Tbsp of peanut butter / butter is about the size of your thumb.

• 1 tsp of peanut butter is the size of the area from the base of your thumbnail to the tip of your thumb.

• A typical salad dressing ladle in a restaurant will hold 3-4 Tbsp of dressing.

1 tablespoon

1 bagel = Hockey puck

1 tablespoon

1 teaspoon

Example of Complete Toddler Food Diary

Today’s DATE:___12/3/2008___

D ay of week: M Tu W Th F Sa Su

Please circle the day of the week

	Time eaten	Amount EATEN	What did you eat?	Brand name	Type (low fat, low sugar, creamy, crispy…)	Preparation / Cooking method
1	7:30 am	1	egg	Kroger	large egg	scrambled
2		1 Tbsp.	milk	Horizon	skim	w/egg
3		1 tsp.	margarine	Country Crock	light spread	w/ egg
4		4 oz.	orange juice	Tropicana	No pulp
5		1 pill	multi-vitamin	Flintstones	Children’s chewable with iron
6	10:15 am	8 pieces	Goldfish crackers	Pepperidge farm	Original
7		5	grapes		Green seedless	raw
8		3 oz.	milk	Horizon	Low fat, 1%
9	12:30 pm	1oz	turkey lunch meat	Kroger	oven roasted
10		½, 1 oz slice	white bread	King Soopers	Butter split-top
11		4 oz	Mandarin orange slices, fruit cup	Kroger	In light syrup
12		6	cookies	Oreo	Bite-sized minis
13		4 oz	milk	Horizon	2% chocolate
14	2:45 pm	3 oz	cheddar cheese	Kroger	2% mild cheddar	cubed
15		3 oz	soda	Sprite	Regular (not diet)
16	6:30 pm	1/2 cup	Kraft Mac and Cheese	Kraft	Original	Ingredients below
17		7.25 oz box	macaroni & cheese noodles	Kraft		boiled
18		1/4 cup	milk	Horizon	skim	w/ macaroni
19		3 Tbsp.	butter	Land O’Lakes	unsalted	w/ macaroni
20		1.5 oz pkt	cheese powder packet	Kraft		w/macaroni
21		1/8 cup	green beans	Kroger	canned – cut	microwaved
22		3 oz	water	Deer Park		With ice
23		1.1 oz	1 popsicle ice pop	Popsicle	Dora the Explorer Ice Pop
24
25
26

Example of Incomplete Toddler Food Diary

Today’s DATE:___12/3/2008___

D ay of week: M Tu W Th F Sa Su

Please circle the day of the week

	Time eaten	Amount EATEN	What did you eat?	Brand name	Type (low fat, low sugar, creamy, crispy…)	Preparation / Cooking method
1	7:30 am	1	scrambled egg			scrambled
2		1 glass	orange juice	Tropicana
3		1	vitamin	Flintstones
4	10:00 am	1 handful	Goldfish crackers	Goldfish	cheese
5		1 small handful	grapes			raw
6		½ glass	milk	Horizon	Low fat
7	12:00 pm	1 slice	turkey	Kroger	lunchmeat	cooked
8		½ slice	bread		White
9		1	mandarin orange slices	Kroger	snack cups
10		1 bag	cookies	Oreos	minis
11		1 glass	milk	Horizon	2% chocolate
12	2:30 pm	3 cubes	cheese	Kroger	cheddar
13		1	Sprite
14	6:30 pm	½ c.	macaroni and cheese	Kraft		cooked
15		3	green beans	Kroger		cooked
16		1 glass	water
17		1	popsicle		cherry
18
19
20
21
22
23
24
25
26

Day of week: M Tu W Th F Sa Su

Please circle the day of the week

	Time eaten	Amount EATEN	What did your child eat?	Brand name	Type (low fat, low sugar, creamy, crispy…)	Preparation / Cooking method
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

Date:

Day of week: M Tu W Th F Sa Su

Please circle the day of the week

	Time eaten	Amount EATEN	What did your child eat?	Brand name	Type (low fat, low sugar, creamy, crispy…)	Preparation / Cooking method
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

Date:

Day of week: M Tu W Th F Sa Su

Please circle the day of the week

	Time eaten	Amount EATEN	What did your child eat?	Brand name	Type (low fat, low sugar, creamy, crispy…)	Preparation / Cooking method
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

Date:

When complete, place in the self-addressed, stamped envelope and return by US mail.

Thank you so much for your participation in this study. Please complete diet and stool diary mail the diet and stool record back to us in the postage-paid envelope that was given to you.

If you have questions, please call

Charmaine McKenzie

404-498-0058

1 teaspoon

CDC Version 12-08 SNC

Page 0 of 11