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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

Diagnosing Food Allergies

1.15 to read

Food allergies continue to be a problem in the pediatric population and I often get calls or see a patient for an office visit with a parent who has a concern that their child “may have” reacted to something they ate. Their question is, are they allergic?  

There is a great resource for physicians entitled “The Guidelines for the Diagnosis and Management of Food Allergy in the United States”.  Not all adverse reactions to foods are allergic and it sometimes takes a bit of “detective work”, which is a good history and physical exam, to begin to determine if a child has a food allergy.   

So, when a parent tells me that their child gets a rash on their chin or cheek after eating “xyz” food the questions begin.  Was it the first time they had ever been exposed to that food? Describe the rash and how the child was acting?  Did they have other symptoms with the rash? Was the rash just on a cheek or was it all over? Was it hives? This list of questions go on and on.   

The most common food allergens are egg, milk, peanut, tree nuts, wheat, shellfish and soy. I also ask if this was a one time occurrence, and  If they have tried the food again did it happen every time? Many times hard to tease out what a child has had to eat when they have a mish-mash of food on their plate and nothing is new!  

Is there a family history of allergy or asthma?  Does your child have eczema as well?  If so there is a greater chance of developing a food allergy.  

After a detailed history, and if I do think that the child has a good history for a food allergy, there are tests (skin prick and blood) that may help determine if an allergy may exist.  BUT, with that being said, there are several caveats.  Number one, your doctor should not test for “every” food allergen, only for the suspected food or foods, as there are many false positive tests when you just check all of the boxes for testing IGE levels for an allergy.  For example, if your child eats eggs and has had no problem but the IGE level comes back a bit high for egg allergy, what does that really mean?  In other words, I just test for the suspected culprit. So, I do not test for tree nuts if the parents only had concerns with a peanut product.   More to come on this topic. 

Your Baby

Starting Baby on Solid Foods

Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.Starting baby on solid foods can be an exciting and perplexing time for parents. What foods should I start with? How much? How often?

The American Academy of Pediatrics currently recommends gradually introducing solid foods when a baby is about 6 months old. Your pediatrician, however, may recommend starting as early as 4 months depending on your baby's readiness and nutritional needs. Be sure to check with your pediatrician before starting any solid foods. Is your baby ready? Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support — essential skills for eating solid foods. If you're not sure whether your baby is ready, ask yourself these questions: •       Can your baby hold his or her head in a steady, upright position? •       Can your baby sit with support? •       Is your baby interested in what you're eating? If you answer yes to these questions and you have the OK from your baby's doctor or dietitian, you can begin supplementing your baby's liquid diet. What Foods to Start With. Continue feeding your baby breast milk or formula as usual. Then: •       Start with baby cereal. Mix 1 tablespoon (15 milliliters) of a single-grain, iron-fortified baby cereal with 4 to 5 tablespoons (60 to 75 milliliters) of breast milk or formula. Many parents start with rice cereal. Even if the cereal barely thickens the liquid, resist the temptation to serve it from a bottle. Instead, help your baby sit upright and offer the cereal with a small spoon once or twice a day. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid. For variety, you might offer single-grain oatmeal or barley cereals. Your baby may take a little while to "learn" how to eat solids. During these months you'll still be providing the usual feedings of breast milk or formula, so don't be concerned if your baby refuses certain foods at first or doesn't seem interested. It may just take some time. Do not add cereal to your baby's bottle unless your doctor instructs you to do so, as this can cause babies to become overweight and doesn't help the baby learn how to eat solid foods •       Add pureed meat, vegetables and fruits. Once your baby masters cereal, gradually introduce pureed meat, vegetables and fruits. Offer single-ingredient foods at first, and wait three to five days between each new food. If your baby has a reaction to a particular food — such as diarrhea, a rash or vomiting — you'll know the culprit. •       Offer finely chopped finger foods. By ages 8 months to 10 months, most babies can handle small portions of finely chopped finger foods, such as soft fruits, well-cooked pasta, cheese, graham crackers and ground meat. As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will become your baby's main fare. Continue to offer breast milk or formula with and between meals. Foods to Avoid for Now. Some foods are generally withheld until later. Do not give eggs, cow's milk, citrus fruits and juices, and honey until after a baby's first birthday. Eggs (especially the whites) may cause an allergic reaction, especially if given too early. Citrus is highly acidic and can cause painful diaper rashes for a baby. Honey may contain certain spores that, while harmless to adults, can cause botulism in babies. Regular cow's milk does not have the nutrition that infants need. Fish and seafood, peanuts and peanut butter, and tree nuts are also considered allergenic for infants, and shouldn't be given until after the child is 2 or 3 years old, depending on whether the child is at higher risk for developing food allergies. A child is at higher risk for food allergies if one or more close family members have allergies or allergy-related conditions, like food allergies, eczema, or asthma. Introducing Juice. Juice can be given after 6 months of age, which is also a good age to introduce your baby to a cup. Buy one with large handles and a lid (a "sippy cup"), and teach your baby how to maneuver and drink from it. You might need to try a few different cups to find one that works for your child. Use water at first to avoid messy clean-ups. Serve only 100% fruit juice, not juice drinks or powdered drink mixes. Do not give juice in a bottle and remember to limit the amount of juice your baby drinks to less than 4 total ounces (120 ml) a day. Too much juice adds extra calories without the nutrition of breast milk or formula. Drinking too much juice can contribute to obesity can cause diarrhea. Infants usually like fruits and sweeter vegetables, such as carrots and sweet potatoes, but don't neglect other vegetables. Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.

Your Child

July 4th Food and Fireworks Safety Tips

2:00

This July 4th may be even more special than usual for a lot of families. Besides the excitement and patriotic fervor of celebrating our country’s official Independence Day, it may finally stop raining long enough for people to enjoy being outside.

However the day unfolds, you can bet there will be plenty of families and friends celebrating with good food!

Grilling is particularly popular on the Fourth as well as picnics. To make sure that the food you prepare is safe and stays safe for consumption, the USDA and the FDA offers these food preparation tips:

•       Clean: Make sure you clean all surfaces, utensils, and hands with soap and water.

•       Separate: When grilling, use separate plates and utensils for raw meat and cooked meat and ready-to-eat foods (like raw vegetables) to avoid cross-contamination.

•       Keep cold food cold. Place cold food in a cooler with ice or frozen gel packs. Cold food should be stored at 40°F or below to prevent bacterial growth. Meat, poultry, and seafood may be packed while still frozen so that they stay colder longer. 

•       Organize cooler contents. Consider packing beverages in one cooler and perishable foods in another. That way, as picnickers open and reopen the beverage cooler to replenish their drinks, the perishable foods won’t be exposed to warm outdoor air temperatures.

•       Clean your produce. Rinse fresh fruits and vegetables under running tap water before packing them in the cooler - including those with skins and rinds that are not eaten. Rub firm-skinned fruits and vegetables under running tap water or scrub with a clean vegetable brush while rinsing with running tap water. Dry fruits and vegetables with a clean cloth towel or paper towel. Packaged fruits and vegetables that are labeled "ready-to-eat," "washed," or "triple washed" need not be washed.

•       Cook: Cook foods to the right temperature by using a food thermometer. That’s the only way to know it’s a safe temperature.

•       Remember: Ground beef and egg dishes should be cooked to 160°F. Steaks, roasts, pork and fish should be cooked to 145 degrees F, and Chicken breast and whole poultry should be cooked to 165 degrees F. Shrimp, lobster, and crabs  cook until pearly and opaque. Clams, oysters, and mussels cook until the shells are open

•       Chill: Chill raw and prepared foods promptly if not consuming after cooking. You shouldn’t leave food at room temperature for longer than two hours (or 1 hour if outdoor temperatures are above 90° F), so if you’re away from home, make sure you bring a cooler to store those leftovers.

Warm weather events present opportunities for foodborne bacteria to thrive. As food heats up in summer temperatures, bacteria multiply rapidly. Safe food handling and cooking when eating outdoors is critical for your family’s health.

Most cities have banned fireworks within the city limits except for controlled displays. However, rural and unincorporated areas still allow the sale and use of fireworks by citizens.

Fireworks are now much more sophisticated and larger than mere firecrackers and sparklers; injuries associated with fireworks can be devestating. 

In 2013, U.S. hospital emergency rooms treated an estimated 11,400 people for fireworks related injuries; 55% of 2014 emergency room fireworks-related injuries were to the extremities and 38% were to the head. The risk of fireworks injury was highest for young people ages 0-4, followed by children 10-14.

On Independence Day in a typical year, far more U.S. fires are reported than on any other day, and fireworks account for two out of five of those fires, more than any other cause of fires.

The Consumer Product Safety Commission recommends these fireworks handling safety tips:

•       Never allow young children to play with or ignite fireworks.

•       Avoid buying fireworks that are packaged in brown paper because this is often a sign that the fireworks were made for professional displays and that they could pose a danger to consumers.

•       Always have an adult supervise fireworks activities. Parents don't realize that young children suffer injuries from sparklers. Sparklers burn at temperatures of about 2,000 degrees - hot enough to melt some metals.

•       Never place any part of your body directly over a fireworks device when lighting the fuse. Back up to a safe distance immediately after lighting fireworks.

•       Never try to re-light or pick up fireworks that have not ignited fully.

•       Never point or throw fireworks at another person.

•       Keep a bucket of water or a garden hose handy in case of fire or other mishap.

•       Light fireworks one at a time, then move back quickly.

•       Never carry fireworks in a pocket or shoot them off in metal or glass containers.

•       After fireworks complete their burning, douse the spent device with plenty of water from a bucket or hose before discarding it to prevent a trash fire.

•       Make sure fireworks are legal in your area before buying or using them.

The Fourth of July is definitely one of the most treasured holidays for Americans, make sure your family has a safe one!

Sources: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm109899.htm

http://www.cpsc.gov/en/Safety-Education/Safety-Education-Centers/Fireworks/

 http://www.nfpa.org/safety-information/for-consumers/holidays/fireworks

 

 

Your Teen

Energy Drinks

Just about every store you go into these days has a shelf of energy drinks, many of them marketed towards our teenage children. “Many are marketed as energy drinks but should be called stimulant drinks” says pediatrician Dr. Sue Hubbard. Many of these drinks contain large amounts of caffeine.”

Dr. Hubbard warns that too much caffeine in a teenager’s system can cause anxiety, rapid heartbeat, insomnia, nervousness and upset stomachs. “It can also mess up a child’s sleep cycle, which is not good” she says. Dr. Hubbard recommends that parents read the labels of the drinks their children are consuming. She also recommends that if you need to hydrate your child during sports or other physical activity, give them water or a true sports drink, like Gatorade, and not energy drinks.

Daily Dose

Diagnosing Food Allergies

1.15 to read

Food allergies continue to be a problem in the pediatric population and I often get calls or see a patient for an office visit with a parent who has a concern that their child “may have” reacted to something they ate. Their question is, are they allergic?  

There is a great resource for physicians entitled “The Guidelines for the Diagnosis and Management of Food Allergy in the United States”.  Not all adverse reactions to foods are allergic and it sometimes takes a bit of “detective work”, which is a good history and physical exam, to begin to determine if a child has a food allergy.   

So, when a parent tells me that their child gets a rash on their chin or cheek after eating “xyz” food the questions begin.  Was it the first time they had ever been exposed to that food? Describe the rash and how the child was acting?  Did they have other symptoms with the rash? Was the rash just on a cheek or was it all over? Was it hives? This list of questions go on and on.   

The most common food allergens are egg, milk, peanut, tree nuts, wheat, shellfish and soy. I also ask if this was a one time occurrence, and  If they have tried the food again did it happen every time? Many times hard to tease out what a child has had to eat when they have a mish-mash of food on their plate and nothing is new!  

Is there a family history of allergy or asthma?  Does your child have eczema as well?  If so there is a greater chance of developing a food allergy.  

After a detailed history, and if I do think that the child has a good history for a food allergy, there are tests (skin prick and blood) that may help determine if an allergy may exist.  BUT, with that being said, there are several caveats.  Number one, your doctor should not test for “every” food allergen, only for the suspected food or foods, as there are many false positive tests when you just check all of the boxes for testing IGE levels for an allergy.  For example, if your child eats eggs and has had no problem but the IGE level comes back a bit high for egg allergy, what does that really mean?  In other words, I just test for the suspected culprit. So, I do not test for tree nuts if the parents only had concerns with a peanut product.   More to come on this topic. 

Daily Dose

E. coli Outbreak Continues

E. coli bateria is spreading across Europe with more deaths reported. What you need to know about this deadly bacteria.I was on the treadmill this morning simultaneously watching a plethora of channels on the flat screens TV’s at the gym. One of the headlines at the bottom of the MSNBC screen caught my eye as it read, “deadly virus spreading across Europe”, while the next headline read, “e. coli continues to spread in Europe.”

Unfortunately, there does continue to be concern over the deadly BACTERIA that has been spreading across Germany and has caused illness in at least 10 other European countries as well as several cases in the United States. But the concern is not due to a virus, but a bacterial infection!  Viruses and bacteria essentially have nothing to do with one another except that they can both cause illness. The bacteria, a new strain of Escherichia coli (E.coli), have caused an outbreak of diarrheal disease with over 2,900 people being infected. Of these, over 500 have suffered life-threatening complications, and there have been 30 deaths reported. The sickest patients have developed hemolytic uremic syndrome, a kidney disease which may result in renal failure. It seems that this “new” bacteria has caused the most serious illness among previously healthy women, including those that are pregnant. This is unusual as it is typically thought that children and elderly have more serious complications from hemorrhagic E.coli strains. Several of the cases of this specific type of E.coli have been reported in the U.S., with all persons except one having had recent travel to Germany. E. coli is a bacteria that had long been known to cause food borne gastroenteritis (vomiting and diarrhea). The bacteria may be found in fecal material and then may be spread via food that has been contaminated.  It was just announced that the most likely source of this E.coli infection is not cucumbers as was previously suspected, but rather by contaminated bean sprouts. The initial source of infection looks to be from a farm worker who has tested positive for E.coli and is thought to have spread the bacteria while working. The mainstay for preventing any food-borne illness is HANDWASHING!!  It is also important to thoroughly wash fruits and vegetables, especially those that are eaten without being cooked.  Peeling the produce is also a way of helping to prevent disease. The WHO and also the CDC have put U.S. doctors on alert for this disease. If you or your children develop bloody diarrhea it is important that you seek medical care, and if possible have a stool specimen available for your doctor. In the meantime, have your children practice good hand washing, especially after using the bathroom!  Remember, this is a bacterial rather than a viral infection. There is a difference. That’s your daily dose for today. We’ll chat again tomorrow.

Daily Dose

Low Carb Diets

1.15 to read

A recent study in Pediatrics caught my eye as it related to childhood obesity. I spend a good deal of time discussing healthy eating and exercise with my families but I too continue to see children who gain too much weight each year. Some of my patients even qualify as being obese. 

This study out of Cincinnati Children’s Hospital looked at 100 obese 7 -12 year old children and randomly assigned them to one of three different eating plans. One plan followed the wisdom of portion control, another followed a low-carb diet, and the last was a “reduced glycemic load” plan that cut down on certain carbs (like white bread and sweets and white potatoes). 

Over a one year period  all three of the plans worked equally well in helping to control a child’s weight gain. Researchers did find that the low carb plan was tough for kids to stick to. Most of the kids in this group really followed the low carb plan to an extent by reducing carbs and calories, but not to the “strict limits of the low carb plan”. In other words, they modified the plan. 

It seemed that the plan that “reduced the glycemic load” was essentially a modified low carb diet. Children could eat certain “unrestricted” carbs, like fruits and vegetables low in starch as well as whole grains. The limits were only placed on starchy carbs, but even some of those were not “forbidden”. 

The beauty of teaching these kids about modifying their diets early on is that they can see changes in their BMI (body mass index) more quickly than an adult. Why?  They are still growing!! I explain to the kids (and their parents) that a pre-pubertal child grows about 2 inches a year and should gain somewhere around 3 - 6 lbs a year.  All of that changes with puberty as their child’s growth velocity and weight gain both increase. 

But, since a child is growing that by just maintaining their weight, not losing weight, they will see changes in their body. Although children think this is “easy” it still requires effort and changes.   

Small changes like cutting portions and reducing carbs (rather than trying to eliminate them) will reduce total daily calories. Add in daily exercise and your child will see real results. It is still a matter of burning more calories than you consume! 

Lastly, the whole family has to be involved in the changes. You have to pick a plan that the entire family can follow and stick to as families come in all different sizes. 

That’s your daily dose for today.  We’ll chat again tomorrow. 

Your Child

Playing With Food May Help Picky Eaters

2:00

If your child is a picky eater, encouraging them to play with their food may help them overcome the reluctance to try new foods according to a new study.

Researchers in the United Kingdom asked a group of 70 children – ages 2 to 5 – to play with mushy, slimy food while their parents observed, watching to see if kids would happily use their hands to search for a toy soldier buried at the bottom of a bowl of mashed potatoes or jelly. Children who wouldn't use their hands were offered a spoon.

Parents and researchers each rated how happy the kids were to get their hands dirty on a scale of one to five, with a higher number indicating more enjoyment. Children could get a total score as high as 20, a tally of the scores from researchers and parents for play with both the mashed potatoes and the jelly.

Researchers also gave parents a questionnaire to assess children's so-called tactile sensitivity, quizzing them about things like whether kids disliked going barefoot in the sand and grass or avoided getting messy.

The study found that kids who liked playing with their food were less likely to have food neophobia (the fear of trying something new) or tactile sensitivity.

"Although this is just an association, the implication is that getting children to play with messy substances may help their food acceptance," lead study author Helen Coulthard, a psychology researcher at De Montfort University in Leicester, U.K., told Reuters Health by email.

Previous research has linked food neophobia to limited fruit and vegetable consumption. Courtland and her team wanted to see if they could establish a link between touching food and tasting unfamiliar foods.

Courtland suggested that parents of picky eaters begin introducing new foods to their child by creating “food art.” Food art is making pictures or images with different foods on a plate.  The first step is letting your child make a picture or design by arranging various colored foods on the plate.  Don’t pressure them to taste their creation, but wait till they are ready to give it a try. Make it a game and eventually begin encouraging them to taste what they have created. Start small and expand to larger food groups and pictures.

Offering as much variety as possible from a young age also helps children experience lots of textures and flavors, which may minimize their fear of unfamiliar foods.

You’re probably going to have to join in on the taste experimentation to show how good these food pictures taste! You might also take a picture of your child with their creation on your phone and then show it to them – to make it a little more fun.

It’s fairly normal for kids to go through a period of refusing to try new foods, though most kids will grow out of this phase by the time they start school. However, there are some children that carry new food aversion on into adulthood. It isn't necessarily harmful as long as the children maintain a healthy weight for their height, pediatricians say.

But over time, neophobia can make it very difficult to enjoy social engagements. Parents that have a hard time trying or enjoying new foods themselves too often pass that trait onto their own children.  Most of the time it’s just a phase that kids go through and finding creative ways to help them work through it eliminates the problem.

Source: Lisa Rapaport, http://www.reuters.com/article/2015/05/19/us-food-fears-children-idUSKBN0O41MD20150519

 

 

 

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