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Daily Dose

Is Fruit Juice Healthy?

1:30 to read

I remember when my children were small that it was “routine” to begin offering infants dilute juice around 6-9 months of age.  Over the years the AAP (American Academy of Pediatrics) continued to advise against offering fruit juice to children under the age of 6 months.  Now…decades later, the AAP has just issued new guidelines including the recommendation “not to offer juice to children under the age of 1 year”.

 

The new recommendations will be published in the June issue of Pediatrics in which they write, “while parents may perceive fruit juice as healthy, it is not a good substitute for fresh fruit and just packs in more sugar and calories.”  The article continues to state, “small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1 year.”

 

I always diluted juice for my children, even when they were older.  I would just add a few cans of water to concentrated juice and they never even knew it. It just seemed logical to me at the time. But while 100 percent fresh or reconstituted juice may be healthy, it should still be limited depending on a child’s age.  The concern over steadily increasing obesity rates as well as dental health and the risk of cavities makes even fresh fruit juice a culprit for added calories and sugar.

 

The recommendations include:  toddlers should never be given juice from a bottle or in a sippy cup that allows them to consume juice (even diluted) throughout the day. I continue to recommend that the bottle “goes bye-bye” at the 1 year birthday party and a child only drinks from a sippy cup at meals and snacks after that.  

 

The child should also not have a sippy cup to “wag around all day”.   Parents often tell me that “their child drinks water all day long” but again that may keep them from eating a healthy meal if they drink throughout the day. You know how many adult diets recommend “drink tons of water all day” so you won’t feel hungry…same may be said for a toddler who is already a picky eater.  

Small children get plenty of fluids at meals and snacks and are not hydrating for athletics like my older patients. There are no recommendations that young children drink a certain amount of water everyday….although parents swear their child needs 16 ounces a day?

 

In reality children of all ages should be encouraged to eat whole fruits and be educated about the difference between the fruit they choose and juice.  With “juicing” being so popular, they need to know that even “green juice” lacks dietary fiber and may contribute to excessive weight gain.  I agree that fruit juice is better than no fruit…but for toddler ages 1-3 years, no more than 4 ounces of juice a day, children age 4-6 only 4-6 ounces a day and for children 7-18 years only 8 ounces (1 cup) of juice. The recommendation is that a child should have 2-2.5 cups of whole fruit per day. 

 

I still recommend that my young patients only consume milk (low fat is fine) and water on an everyday basis and add juice later on…when their friends happen to tell them about juice boxes etc. If I am going to buy juice at all I recommend 100% fresh fruit juice and if you can, get juices with added calcium (a little extra never hurts!).

Lastly, juice is not appropriate for re-hydration or for the treatment of diarrhea. For those instances it is necessary to use an “oral re-hydration solution”.

Daily Dose

Do Your Kids Drink Milk?

1:30 to read

I have noticed over my years in practice that fewer and fewer patients  drink milk every day. You may wonder why I ask the question, “does your child drink milk?”.  Calcium is an important nutrient which in necessary for healthy bones. But you have to put that calcium into your bones when you are a child and adolescent which means milk at meals. By age 18 years about 90% of your peak bone mass has been laid down.

Most children that I see are not drinking many soft drinks...in fact, many tell me they don’t like “fizzy drinks” at all...even on special occasions they would prefer “fancy waters”.  But, when I ask them what they drink at dinner they often say, “water”. I then ask their parents if they even pour milk for their children and they too say their child prefers water.

I am not sure how water became the preferred drink among many of my patients. When and how did parents and children decide that children need to drink a certain amount of water a day. I have never found any recommendations about water consumption in healthy children.  But there are recommendations regarding calcium and Vitamin D intake.

Children between 1-3 years of age need 700 mg/day of calcium, while 4-8 year olds need 1,000mg/day and 9-18 year olds need 1,300mg/day.  It is also recommended that all children between ages 1-18 years receive 600IU of vitamin D a day.  The best way to meet calcium and vitamin D needs is through food sources, including milk.  

With statistics showing that less than 15% of adolescent girls in the United States meet the recommended dietary allowance for calcium, many young girls may be setting themselves up for osteopenia and osteoporosis in their adult years. 

Exercise is equally important for maintaining bone health...which means more time outside or in the gym, rather than in front of a screen!

Change your habits and start pouring milk with your child’s meals and then go outside and get some vitamin D and exercise.

Your Baby

1 Egg a Day Improves Growth in Babies

1:30

While not as common in the United States, an astounding number of children worldwide suffer from stunted growth; mainly due to malnutrition or disease. It is a serious problem that impacts about 162 million children under the age of 5.

A new study from the Brown School at Washington University in St Louis, suggests that just one egg daily may significantly increase growth and reduce stunting in children.

"Eggs have the potential to contribute to reduced growth stunting around the world. They are also a good source of nutrients for growth and development in young children," said Lora Iannotti, an author and researcher in the Washington University study.

Researchers gave eggs to 80 infants between six and nine months of age for one year. Another 84 weren’t given eggs and served as a control group. Compared to these controls, the egg-eating youngsters had a 47 percent lower prevalence of stunting, which is defined as being too short for one’s age. Their length-for-age measurement also shot up by a significant margin.

Why would a daily egg have such a dramatic effect? Eggs are often referred to as “the perfect food.” They contain all of the necessary amino acids, as well as choline, various growth factors and DHA, a polyunsaturated fatty acid important for the brain. All of these are necessary for proper growth and development, and the normal function of the body.

There has been some concern in the past, that eggs may raise an infant’s cholesterol level or induce an allergic reaction.  However, research has not shown these hypotheses not to be true. The food appears to be safe and healthy for infants, says Iannotti.

Eggs are easily available for parents and affordable as a food option. Lots of families are even experimenting with raising chickens for their eggs in communities across the country.

Iannotti believes this study shows that just one egg a day could have a dramatic impact, globally, on the number of children suffering from stunted growth.

The study was published in the June edition of the journal Pediatrics.

Story sources: Pawel Kopczynski / Reuters, http://www.newsweek.com/one-egg-day-boosts-growth-infants-621266

Neil Schoenherr, https://source.wustl.edu/2017/06/eggs-can-significantly-increase-growth-young-children/

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!

Your Child

Unhealthy TV Snack Ads Work on Preschoolers

1:30

Kids love snacks and advertisers count on that to sell products.  That’s why so many commercials on children’s TV shows promote snacks packed with sugar and salt. According to a new study, preschoolers who are exposed to these types of ads will eat more of those foods, even if they are not hungry.

The study, led by Jennifer Emond, an assistant professor of pediatrics at Dartmouth College, in Hanover, New Hampshire, involved a small study of 60 children, 2 to 5 years old. Emond’s team monitored the kids as they watched a 14-minute segment of “Sesame Street.”

The preschoolers got a filling snack before the show, so they were not hungry, and then had unlimited access to snacks during it.

Some of the children watched the "Sesame Street" segment without food commercials, while others watched the show with commercials for a popular salty snack. The ads depicted kids happily playing and eating the snack.

While viewing the segment, the children were provided with two snacks: corn snacks and graham snacks. The same corn snacks provided were featured in the food advertisements shown to some of the children.

The researchers found that the preschoolers who watched the segment embedded with food ads consumed more calories in snacks on average than those who watched the department store ads.

Additionally, the children who watched the food ads ended up eating more of the advertised corn snack than the graham snack -- even if they had never eaten the corn snack before and, therefore, were not familiar with it.

"That was surprising because it demonstrated the powerful effect food advertising can have on priming potentially unhealthy eating behaviors at a young age," Emond said.

The results of this small study replicate the findings of other studies with older children.

About 40% of all food and beverage ads that children and teens see on television are for unhealthy snacks, according to a 2015 report by the University of Connecticut's Rudd Center for Food Policy and Obesity (PDF).

"Parents should not shrug off food marketing. These ads really do influence children," said Marlene Schwartz, director for the center and a professor of human development and family studies at the University of Connecticut, who was not involved in the new study.

"If the ads were for healthy foods, that would be an asset to parents, but when the ads are for unhealthy foods, they make parents' job harder," she said.

Story sources: Jacqueline Howard, http://www.cnn.com/2016/11/21/health/food-ads-kids-preschool/

https://consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/tv-snack-food-ads-get-preschoolers-snacking-more-study-shows-716956.html

Parenting

Vegetarian Diet Is Good For the Whole Family

1:456

Has your teen or little one brought up the idea of going vegetarian? In the current age of online videos and social media groups, a lot of kids are seeing and learning about animal product processing and are experimenting with the idea of changing what they eat. While it may seem like a silly idea at first, you might want to give it further consideration.

For years, some people have thought that vegetarian and vegan diets may not be healthy enough for children.

A new study published by the Journal of the Academy of Nutrition and Dietetics (AND), says not to worry, vegetarian and vegan diets can be safe and healthy for people of any age.

In fact, several studies show that vegetarians generally have lower risks of obesity and chronic diseases such as type 2 diabetes, heart disease and certain cancers, according to the AND. That includes vegans -- who avoid not only meat and fish, but also all animal products, including dairy.

"No one should doubt that vegetarian diets are safe at all life stages, including infancy, childhood and adolescence," says Susan Levin, one of the report authors and director of nutrition education at the nonprofit Physicians Committee for Responsible Medicine in Washington, D.C.

Levin also noted that studies show children on vegetarian diets eat more fruits and vegetables, and fewer sweets and salty snack foods. They're also less likely to be overweight or obese.

The academy also noted that vegetarian and vegan diets can be safe during pregnancy and lactation. These diets can also be fine for athletes and the elderly, the report said.

While all this information sounds promising, what you include in your vegetarian diet is the key to staying healthy. If you subsist on white rice, Levin pointed out, that might be technically vegetarian, but not nutritious.

So it's important to eat a variety of foods, including a range of whole grains, beans, fruits and vegetables, and nuts and seeds.

Vegetarians and vegan diets do lack one important nutrient found in animal products– vitamin B-12.

According to the AND report, vegans should take supplemental vitamin B12. Vegetarians usually need supplements or B12-fortified foods, too, the group said -- since their dairy intake may not supply enough of the nutrient.

But, Levin said, B12 is the only supplement vegans need. They can get all of their other nutrient needs from food.

Getting enough protein, calcium and iron has been another concern about vegetarian diets and particularly vegan diets. That shouldn’t be a problem, Levin says, as long as you make wise food choices.

The report noted, it's imperative to make wise food choices: Calcium from vegetables like kale, turnip greens and bok-choy is much better absorbed than calcium from high-oxalate vegetables such as spinach and Swiss chard, for example.

As for the potential health benefits, studies have found that vegetarians and vegans tend to weigh less and have lower cholesterol levels than omnivores do. They also tend to have lower risks of high blood pressure, heart disease, type 2 diabetes and certain cancers, such as cancers of the prostate and gastrointestinal tract.

"If there were a pill that did all of that," Levin said, "everyone would be taking it."

Lots of families aren’t necessarily willing to give up all animal products, but would like to cut down on their meat consumption. Vegetarian and vegan recipes can help fill the void on meatless lunch and dinners while offering a nutritious substitute.

The AND report also notes that vegetarian diets are kinder to the environment.

It takes far fewer resources -- land, water, fuel and fertilizer -- to produce a pound of kidney beans than a pound of beef, for example.

"Vegetarian diets leave a lighter carbon footprint," said Levin.

The ADA suggests that families interested in going completely vegetarian or vegan should seek assistance from a registered dietician to help them learn about the various sources of protein and other vital nutrients. Vegetarian cookbooks and classes are also available for families thinking of making a dietary switch. There are also very good informational resources online.

Story source: Amy Norton, https://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/vegetarian-diets-benefit-people-and-the-planet-717307.html

Daily Dose

Picky Eaters

1:15 to read

There is an interesting article in Pediatrics which looks at children who were identified by their parents as picky eaters. It seems that being a picky eater (now also called selective eating), may not just be a phase for some children. Selective eating and a child’s  food preferences may be an indicator of other psychological problems.

Picky eating affects about 20% of children. In this study from Duke University, 917 children ages 2-6 who were identified as picky eaters by their parents were followed over 3 years.  The author found that those children with “moderate picky eating habits” were more likely to have symptoms of anxiety, depression and ADHD.  Children who had severe selective eating ( those children who had intense aversions that made it difficult to eat outside of their home) were even more likely to have social anxiety and depression.

I found this study to be fascinating as it does not show that picky eating causes psychological issues or even vice versa…..but it does show that there is a correlation between the two. I think this only substantiates what I have seen in my own practice and I often ask parents is this a “nature or nurture issue”, or both?

While many children go through phases when they only want peanut butter and jelly for lunch or could live on chicken nuggets and pizza, some children seem to develop more intense feelings related to food choices.  Many parents that I see say , “we just try to ignore it” and their child seems to “move on”. But over the years other parents have said that “their child would starve to death if they did not capitulate to their picky eating”, and that the struggles it caused were “just not worth the anxiety”.  Even before this study, it seemed that some children “are just wired” differently.

These children also seemed to have heightened issues with textures and tastes, that you sometimes even notice in a child as they begin to eat soft table foods between 9-12 months of age. Are these the children that go on to become extremely picky eaters? Could it be that these children are just born with heightened sensitivity to taste, texture and smell?

All in all this is an interesting study which actually raises more questions about how to handle a picky eater. Is there one right answer….like most things the answer is NO. But having family meal time is still important and I always start with the statement, “a parents job is to provide their children with a healthy well balanced meal, and their child will decide if they want to eat it” . Sounds easy enough…..but for some it may not be.

So, if you find that your child is getting more selective, food choices are more intense and this is causing anxiety for both parent and child, make sure you discuss this with your pediatrician.  

Daily Dose

New Dietary Guidelines

1:30 to read

The United States Department of Agriculture has just issued their new dietary guidelines for 2015-2020.  (Isn’t it 2016 already as well?). At any rate, this seemed like a good time to re-visit the topic of healthy eating habits for families…..always a topic of conversation with my patients.

While so many of us talk about healthy eating and reducing needless calories, the government is now also focusing on one of the main culprits, SUGAR.  The new guidelines recommend that we limit sugar intake to about 12 tsp of sugar a day which may sound like a lot until you realize that a can of Coke contains nearly 10 tsp of sugar.  Studies have shown that the “average” (not defined) American currently consumes 22 tsp of sugar /day.  It seems that nearly half of the sugars in our diets are from sweetened beverages and sports drinks. While I know that many the families in my practice have cut out soft drinks, their kids do drink a lot of sports drinks. If it’s a sticky drink it probably has sugar.

At the same time the FDA is also proposing that food labels be changed yet again, to list added sugars. While the current labelling lists “total sugar”, this is a combination of added and natural sugars.  There is a difference between natural sugars found in fruits such as apples and berries, than there is in the processed added sugar found in a chocolate chip cookie or granola bar.  Kids can attest to that all day long!  There are also added sugars in many of the pouches that are marketed for babies and young children…despite the fact that they may be “organic” some have a lot of sugar that also sticks to their teeth as they “suck” on the yogurt or applesauce rather than eat it from a spoon.

The new guidelines also state that teenage boys and men are eating too much protein. The guidelines now recommend, “men and boys reduce their overall intake of protein foods such as meat, poultry, and eggs”.  This group (and all of us I think) should add more vegetables to their diet.

The newest guidelines really seem to focus more on healthy eating habits, rather than on individual nutrients, which seems to have been the take home message. I think we all “know” that eating more fruits and vegetables is good for you, but many people need more guidance than that broad statement. Eating a diet that is colorful which means more fruits and veggies and less carbs and meat has been the goal for a long time.

These guidelines are especially important as they affect the foods that are chosen for our children’s school lunch programs which feed more than 30 million children each day.  The guidelines also contribute to how food assistance programs like WIC are determined.

But, back to basics….eating family meals at home is always important. Making even small changes towards a broader, colorful diet rich in lean meats, fruits, veggies and whole grains will be beneficial to everyone. Lastly, why not try a meat free night once a week as well…have you tried cauliflower steaks yet?

Daily Dose

Marketing Healthy Foods to Kids

1:15 to read

The marketing of foods to children continues to be a hot topic.  As any parent knows…by the time your child is 3, 4 or 5 years old…they can often point to the box of sugary cereal with their favorite cartoon character on it, or identify a sign (McDonalds, Chic-Fil-A, Pizza) although they are not yet reading.  Companies are very clever when it comes to marketing…especially to children who drive a lot of consumer choices.

But, a recent article in Pediatrics shows how marketing may also drive healthy food choices. The study entitled, “Marketing Vegetable in Elementary School Cafeterias to Increase Uptake”, looked at the number of students who chose fresh vegetables from the salad bar at 10 elementary school cafeterias in a large school district over a six-week period.

The study included four different groups. In the first group the schools displayed vinyl banners with branded cartoon vegetable characters. These banners were then wrapped around the salad bar bases. The characters displayed “super human” strength related to eating vegetables (the Popeye of my generation - with his spinach).  The second group of schools showed short television segments which had vegetable characters delivering healthy nutritional advice. In the third group of schools both the salad bar banners and TV segments were used to promote healthy nutrition and food choices.  The fourth group was the control group and received no intervention.  The intervention schools also had decals with the vegetable characters placed on the floor which directed the children to the salad bars.

The results?  Nearly twice as many students ate vegetables from the salad bar when they were exposed to the banners.  More than 3 times as many students who were exposed to both banners and TV segments went to the salad bar (more girls than boys ). Interestingly, the marketing campaign also increased the number of students who chose a vegetable serving in the regular lunch line as well. 

So, it seems that branded marketing strategies may be used in a positive way to promote healthier food choices among young children.  Now we just have to get the advertisers to change some of their branded messaging aimed at young children from the “junk” to the healthy foods, as we have data to show that kids will choose good foods…especially if their super heroes like it too!

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