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Daily Dose

Don't Let Your Child Become an Obesity Statistic

Healthy eating begins with the first foods that you feed your infant.An alarming statistic was released today which shows that one in five 4-year-old children are obese and these numbers are even higher in minority children. This study was just published in The Archives of Pediatric and Adolescent Medicine, and followed over 8,000 children looking at height and weight. The findings were quite concerning, showing a trend toward obesity at an age younger than predicted, and numerous long term health problems associated with obesity, such as heart disease, diabetes, high blood pressure and bone and joint problems.

This is a national health issue and a call to action for all families to teach and model healthy eating. One of the problems is that many of the government sponsored food programs provide foods high in carbohydrates, and low in fresh fruits and vegetables, and this promotes obesity. School lunches have also been found to be high in fat and carbohydrate and continue to promote poor food choices. With the bad economy and recession, families have cut back on groceries and may be eating more fast foods, breads and pastas, again providing more carbohydrate than protein. Healthy eating begins with the first foods that you feed your infant. A well balanced diet with grains, fruits, vegetables and meats begins in the high chair and should continue at the family dinner table. The meals may be simple and healthy. Being a short order cook, or providing your child's favorite pizza and fried food on a daily basis, even in a young toddler will have deleterious effects for the rest of their life. Don't let your child become a statistic heading toward lifelong health issues secondary to childhood obesity. Change your own eating habits, improve your children's and remain committed to family meals. We, as parents, cannot afford to raise a generation where obesity is the norm: the change must begin now. That's your daily dose, we'll chat again tomorrow. More Information: 1 in 5 Preschoolers Obese

Daily Dose

Do You Have a Happy Spitter?

1.15 to read

New parents often come in concerned about their baby spitting up.  They typically  ask, “does my baby have gastroesophageal reflux (GER)?”.  I reassure them that “spit happens” and it occurs in more than 2/3 of perfectly healthy infants.  Whether you want to call it GER or spit up, it is regurgitation and in most cases it goes away with time. 

GER is defined as “the physiologic passage of gastric contents into the esophagus”, while GERD is “reflux associated with troublesome symptoms or complications”.  GER in infants is typically painless and does not affect growth. We call these babies “happy spitters”.  

For a “happy spitter” parents need to know that spitting gets worse before it gets better and typically lasts for 5-6 months, with the worst spitting occurring around 3-4 months of age.  

The best treatment for benign GER is lifestyle management.  Small things like thickening feedings with either rice or oatmeal cereal will often decrease the volume of spit up ( parents get sick of wearing towels over their shoulders). Thickening feedings does increase the calories a baby receives. There are also formulas available that contain thickening agents if parents prefer trying them that have the same amount of calories as other formulas.  Thickening feeds has been shown to decrease crying time in some irritable infants with GER and also increases sleep time for fussy babies.  It is always worth trying.

While many parents try putting their baby in a car seat to help with reflux and spitting, car seats may actually make the problem worse. Infants have less reflux when in the prone (tummy) position, but remember your baby must NEVER sleep on their TUMMY!

Babies who are spitters may also benefit from smaller more frequent feedings. When a baby is fussy, parents may try to keep feeding their baby and overfeeding may actually make the spitting worse. Just because a baby is crying, does not always mean they are hungry, especially if they have just been fed.  Sucking in and of itself may help reflux, so a pacifier may be the trick and provide non nutritive sucking.

For babies with GERD who are extremely irritable, may refuse feedings and even lose weight further work up and management with pharmacotherapy may be necessary.  Talk to your doctor about options if lifestyle management does not seem to help. 

Daily Dose

Baby's First Foods

1:30 to read

Have you heard of “baby led weaning” (BLW)? Many of my patients who have infants that are ready to start “solid foods”, also called complementary foods, have questions about this method. Most babies begin eating foods along with breast milk or formula somewhere around 5 - 6 months of age.  So BLW is not really “weaning”,  as your infant will continue to have breast milk or formula in conjunction with foods…so this really should more aptly be named “baby self feeding”. 

In this method you never offer your baby “mush” or pureed foods, but rather offer them foods from the table.   While I am a huge advocate of self feeding (old term is finger feeding), I also think that early on offering a baby “mushy” food on a spoon is an important milestone. In fact, for most babies at 5 -6 months, it is difficult to pick up a small piece of food to self feed as the pincer grasp has not developed. So, a baby is trying to get food to their mouths by cupping it or hoping it sticks to their hand while pushing pieces around their tray. Some parents will put the food into their baby’s hand.  But, by 8-ish months most babies have developed their pincer grasp and the finger feeding should be preferred.  

Parents are also concerned about starting solid foods and the possibility of choking.  I am always discussing how to make sure that your child avoids choking hazards with foods. In other words, no whole grapes, or hot dogs, or popcorn or chunks of meat.   Other hazards are raw carrots, apples, celery and any “hard” food that your baby might be able to bite a chunk of and then choke. But, if you cook the carrots and then cut them in small bites they are easily handled by a baby who is self feeding.  It is really all about the consistency of the food as once your baby has lower teeth they can easily bite/pry off a big “chunk” of food that could lead to a choking hazard.

Interestingly, there was a recent study that looked at the incidence of choking in children who started with self feeding vs those fed traditionally with pureed foods from a spoon. In this study of about 200 children between 6 - 8 months of age the incidence of choking was similar, while there were more gagging events in the BLW group.  Fortunately, “the choking events resolved on their own”. Gagging is quite different than choking. Some children will gag on pureed foods just due to texture issues. 

I am an advocate of what I am going to call parent led feeding followed by early self feeding of appropriate foods. By the time a child is 9 months of age they should be able to finger feeding the majority of their meals. But there are some foods that are just not conducive to finger feeding at all….yogurt, apple sauce, puddings…and they will be spoon fed until your child is capable of using a spoon which is anywhere from 12 -18 months.   But as a reminder, whenever you offer your child a finger food you should remember two things, #1 is the piece small enough that my child cannot choke and #2 is the food cooked well enough to not pose a choking hazard.  

Several years ago there was a 1 year old in our practice who was given a piece of an apple to chew on… she bit off a chunk of the apple, aspirated and died. It was a terrible accident.  I will never forget that….and re-iterate to all of my patients…a pork chop, or chicken leg or any number of foods can become a choking hazard if your child bites off a chunk. Children really don’t chew until they are around 2 years, they just bite and try to swallow so I pay a great deal of attention to what foods they are offered.

Old school and new school…the combo seems to make sense to me. 

Daily Dose

Rice Cereal & Childhood Obesity

Does white rice cereal cause childhood obesity? One pediatrician thinks so.I recently saw Dr. Alan Greene on TV discussing infant feeding practices and how that may relate to the problem of childhood obesity. Dr. Greene, like most pediatricians, has long been a proponent of healthy eating. He recently launched his “White Out” campaign to change how babies are introduced to solid foods.

His argument is that an infant’s first food has long been rice cereal.   Rice cereal is typically introduced to a baby between 5 – 6 months of age when they are just beginning to sit up in a high chair, and may be fed with a spoon. Rice cereal  typically comes in a box and breast milk or formula is added to the dried flakes in order to make it the consistency where the  baby may be  offered a few bites from a spoon. Although rice is a “white grain” there are also other infant cereal products available, and there are no “directives” that say that a brown rice or mixed grain cereal may not  be used. As I understand it, the whole idea is really just to get the baby used to spoon feeding and then I begin introducing my infant patients to vegetables and fruits. So, the idea that the baby rice cereal is somehow linked to the entire problem of childhood obesity seems somewhat shortsighted to me. An infant is only fed rice cereal one or two times a day while still receiving either breast milk or a formula. Remember that breast milk and formulas contain carbohydrates too. Infant cereal whether it be brown or white rice should not be the only food a baby is introduced too, nor should they eat cereal all day long. While Dr. Greene is concerned that babies will “get hooked on the taste of highly processed foods”, I'm more concerned that parents will quickly forgo rice and whole grain cereals, fruits, veggies and meats and begin feeding their children frosted or honey nut cheerios (a favorite early finger food),  as wells as goldfish and puffs, pasta and other white foods.  These are the foods I  am most likely to see in my office, not a bowl fruits and vegetables. Babies really get the  majority of their calories from breast milk or formula until about 9 – 12 months of age. Parents should be encouraged to feed their babies a wide array of healthy foods including cereals, vegetables, fruits and meats.  Dr. Greene is right,  a baby doesn’t tell you he won’t eat brown rice, or oatmeal or spinach or prunes. For the most part an infant happily opens their mouths and will take what is fed to them. The problem occurs a little later as babies start to show a preference for foods , whether that is by making a face, or pushing food away, they definitely show preferences. This is when the idea of getting “hooked on foods” really begins. It is not uncommon for me to hear a parent of a one year old say, “my baby doesn’t like…… squash, or cereal, or peaches.”  Soon thereafter you hear, “my toddler will only eat…..fill in the blank”. Those are the words that send shivers down my spine. Trying to get those parents to buy into the fix the meal and they will eat it if they are hungry is quite a difficult concept at times. The issue is not only beginning a baby on rice cereal, the problem is more complex. It is getting parents to understand that our children will always have food preferences, that does not mean that we need to acknowledge them or submit to them. It means that we need to make good healthy meals for our families, white rice or brown rice is only the beginning of the story. That's your daily dose for today. What do you think? Leave your comments below!

Daily Dose

Why Family Meals Are Important

It seems so easy to have meal time together, but it needs to begin when your child are younger, so that you will continue to have family dinner time once your children are older and busier.On our last radio show I was fortunate to have the opportunity to interview Dr. Dan Kindlon the author of Too Much of a Good Thing, where he discusses the problems with overindulged children. One of the many interesting points in his book is that he reiterates the importance of family mealtimes.

During Dr. Kindlon's research he looked at common attributes among the teens that he felt were "well adjusted" and successful at both school and outside the home. One of his findings was that these students had regular family meals. It seems so easy to have meal time together, but it needs to begin when your child are younger, so that you will continue to have family dinner time once your children are older and busier. Too many families find too little time to gather for a family meal. The excuses for all of us are many: after school and evening activities, parents work schedule, homework, etc. But there are really very few reasons to skip weeknight and or weekend family meals. It may be more convenient to have meals as a family three school nights and one weekend or all school nights or some combination. But, the bottom line is, the more often families gather for meals and spend time together engagedin dinner table conversation, the better adjusted, more successful and happier the children and teens seem to be. The other great thing about family meals is that they tend to be healthier and cheaper! If youneed recipe ideas, check out What's Cooking with Chef Dad on our Web site. A family dinner is just a click away!

That's your daily dose, we'll chat again tomorrow.

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Daily Dose

No Tech at the Table

1.15 to read

I am a huge proponent of family meals and Chef Dad Tom Fleming is always supplying The Kid’s Doctor with new family friendly recipes. I think many families are now trying to “make the time” to eat together at least several nights a week.  Kudos to those families! 

The problem that I am now seeing is that while families are trying to make a point to eat together, the meal is suddenly being invaded by technology! What I mean by this is that everyone is coming to the table with their smartphone, tablet, iPod, Nintendo DS or any other gadget or gizmo which allows one to be “disengaged” during mealtime. 

I certainly remember many a family dinner where I could barely get three words out of any of the boys (they would tell me that they had already used up their 700 words that day), despite the numerous “open ended” questions that I peppered them with.  We would even try to play those games like, “best thing that happened today” or “worst thing that happened”, I think the Obamas call this “thorns and roses” as they too enjoy families meals. 

With 3 sons and a husband I sometimes felt like it might be possible that those 4 males would eat together and never even say a word. (they tell me that when I was gone this was often the case and they did not view that as a problem!) 

At any rate, part of the value of the family meal is conversation and that means with those who are gathered at the table. Emailing, texting, game playing etc. during dinner needs to be not only discouraged but forbidden. That goes for both the adults (me included) and the children. 

I realize that there are many important world events happening during meal time…one might miss some one’s post on facebook, or a tweet or a text for a few minutes. But the need for continuous information from a gadget, or constant communication via texting does not have a place at the family meal. 

It used to be that we talked about no TV during meals. I remember that rule was rarely broken during my childhood except for events like the Kennedy assassination or the men landing on the Moon.  For our family we tried to continue the same rule and it was broken for events like Super Bowl, early space shuttle launches and landings and for terrible tragedies like 9/11. But we tried to keep the TV out of the dining area.  

I now I find that I have to remind my children and myself to “check all electronics” at the door before coming into dinner. If I don’t, I sometimes look down the family table and see heads bent looking at a sports score, or replying to a text about a party later that night or reading an email about work (me included). But if we all just leave the gadgets turned off/silenced and away from the table the conversation gets going. 

There is not such a rush to “go to the next event” and the work issues are put aside for 15 - 20 minutes. We can enjoy the rare occasion that all 6 of us get to be together and actually converse in real time. The time a family can spend together talking over breakfast, lunch or dinner is too important and precious to be shared with others not present until the meal is over. 

So, start the rule, No Tech at the Table, and enjoy family mealtime.   

Daily Dose

Lead Found in Baby Food

1:30 to read

I know many of the parents of the children I care for are concerned about the latest news from the Environmental Defense Fund which showed that about 20% of baby food samples tested over a 10 year period had detectable levels of lead.

 

This non profit group looked at data that the FDA had collected from 2003-2013 which included 2,164 baby food samples. While none of the baby food samples seemed to exceed the FDA’s “allowable” levels of lead, it is still quite concerning. At the same time the FDA is in the process of reviewing their standards to reflect the latest science surrounding the potential risks to young children who are exposed to lead.  

 

While lead testing is routinely performed in young children (1 and 2 yrs), the CDC currently  considers a blood lead level greater than 5 micrograms/deciliter as elevated, but no lead level is “safe”. 

 

Lead exposure has been shown to have neurocognitive effects - which means IQ, the ability to pay attention and academic achievement…and the effects cannot be corrected.

 

The study did not name baby foods by brand.  Root vegetables (carrots are one) had the highest rate of lead detection (65% of samples), followed by crackers and cookies (47%) and the then fruits and juices (29%). Only 4% of the cereal samples contained lead.

 

This report will cause a lot of parental anxiety, but really doesn’t tell us much about what to do?  Lead based paint is still the number one source of lead exposure, followed by water, which may also have contributed to lead in food…. but there is still lots of be determined.

 

In the meantime, the take home message is “feed your babies and toddlers a wide variety of baby foods” and when possible eat fresh foods. One hypothesis is that baby foods are more processed which may contribute to the higher lead content.  It is easy to cook and “mush” up your own food to feed your baby and it really does not require a fancy food processor.  If you can mush it your baby can eat it!!! The only concern about the introduction of food is basically it has to be soft enough not to be a choking hazard. So no whole nuts, chunks of meat, uncooked hard veggies…you get the idea.

 

Just because your baby doesn’t seem to like certain foods, don’t get stuck feeding them just a few foods…but continue to offer a variety of healthy foods..some of which they may eat more of than others. Every day will be different.

 

So…don’t go throw away all of your baby foods but think if you might be able to substitute fresh foods, don’t offer fruit juices to your babies and toddlers and most importantly eat healthy foods. That’s the best thing for you and your child.  

Daily Dose

The Importance of Vitamin D

As I start a new week and head to the office on a Monday morning there is some new news that will affect my daily practice. I have always been a big proponent in the need for children of all ages to drink milk to ensure healthy bones. We have talked about the concept of "banking your calcium" so that your calcium stores are growing while you are young and are "fully funded" by your 20s to ensure enough calcium for withdrawal later in life. The worry about this calcium issue is that many children do not drink milk or get enough dairy and that they may end up being adults with osteopenia and osteoporosis. Milk is also vitamin D fortified.

Now there is new data to show that children also need more vitamin D than previously thought as vitamin D may not only be involved in keeping bones healthy, but may also be beneficial in reducing risks of cancer, diabetes, and heart disease. It was previously recommended that children and adults to age 50 years needed 200 units of vitamin D daily. The new recommendations will be 400 units per day. So, exclusively breast fed babies will begin taking a vitamin supplement, and all of those children who are not drinking milk will also need calcium plus vitamin D supplement. The problem with this is getting mothers and children to remember to take a vitamin supplement. I have always recommended calcium for my patients who are not milk drinkers, but I have found that they rarely continue to take them more than several weeks to months and then they sit on the counter. This is especially true for tweens and teens who have rapidly growing bones too. Here is more information to support the need for vitamin D, so drink that milk, get some sunshine everyday and make sure you get 400 units of vitamin D a day. That's your daily dose, we'll chat tomorrow!

Daily Dose

Food Textures

1.30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

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DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

DR SUE'S DAILY DOSE

Lots of discussion about using prebiotics and probiotics in your child's diet. What is the difference between the two?

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