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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!

Daily Dose

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.

I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!

 

Daily Dose

No More Food Battles

1.30 to read

Seems that I spend several times a day discussing “food battles” with my patients and their families.  I guess the longer I practice the more I don’t think we should even have to discuss how often parents “battle” with their kids about eating.  

From the early days of parenting when a baby is first offered either breast or formula, they are not asked “do you like this?”.  It is taken for granted that an infant will eat and grow and  there you have it.  The easiest days of parenting, correct? (except for a few months of sleep deprivation).  But once that baby begins to eat the discussions start about “he makes a face when he eats spinach”, or “she will only eat chicken tenders from Chik-fil-a”, or “he only likes pasta and won’t eat meat”, or even “I make 3 diferent meals for my 3 kids”.  If you have a child older than 9 months you understand what I am talking about. 

Food is necessary to nutrition, growth and health. But, with that being said, parents have to trust that a child WILL EAT when they are hungry.  Really, hunger drives us all to eat, eventually.  That bowl or cereal, or the steamed vegetables or even the dreaded chicken breast will get eaten if your child gets hungry enough. I remember reading somewhere that , “ a parent’s job is to provide food for their children at appropriate meal times, and child’s job is to decide if they will eat it.”  In other words, make the meal whether for your toddler or teen and “forget about it”.  Meal time needn’t be a battle but more a gathering to enjoy being together eating is just a bonus.  

As an adult, when you go to a dinner party, you don’t ask what they are serving before you accept, nor do you tell the host/hostess, I hate lamb!!  (my example).  You just smile and find something to eat and there is not a battle.  We all need to approach family meals as a dinner party. Our children are our guests, and sometimes they like what we fix and other times they push some food around their plate and choose not to eat.  The good news for most children is that there is another meal to follow. 

So, think about it and don’t let certain food likes and dislikes dictate mealtime. The more foods young children are exposed to the better chance they have of EVENTUALLY becoming a well rounded eater.  Children’s taste buds change with time as well, so you will find some foods that a 3 year old loved is no longer the favorite at 13 years of age.   

Well balanced, nutritious, colorful meals are the family goal and “food battles” can be left out of the vocabulary.   

Your Baby

Fish Oil During Pregnancy May Reduce Baby’s Asthma Risk

2:00

A Danish study’s results suggests pregnant women that take a fish oil supplement during the final 3 months of pregnancy may reduce their baby’s risk of developing asthma or persistent wheezing.

The study involved 736 pregnant women, in their third trimester. Half the women took a placebo containing olive oil and the other group was given 2.4 grams of fish oil. The women took the supplements until one week after birth.

Among children whose mothers took fish-oil capsules, 16.9 percent had asthma by age 3, compared with 23.7 percent whose mothers were given placebos. The difference, nearly 7 percentage points, translates to a risk reduction of about 31 percent.

In the study, the researchers noted that they are not ready to recommend that pregnant women routinely take fish oil. Although the results of the study were positive, several experts have noted that more research needs to be done before higher doses of fish oil supplements are recommended over eating more fish.

Researchers found no adverse effects in the mothers or babies, the doses were high, 2.4 grams per day is 15 to 20 times what most Americans consume from foods.

One in five young children are affected by asthma and wheezing disorders. In recent decades, the rate has more than doubled in Western countries. Previous research has shown that those conditions are more prevalent among babies whose mothers have low levels of fish oil in their bodies. The new large-scale test, reported in The New England Journal of Medicine, is the first to see if supplements can actually lower the risk.

Before doctors can make any recommendations, the study should be replicated, and fish oil should be tested earlier in pregnancy and at different doses, Dr. Hans Bisgaard, the leading author of the study, said in an email to the New York Times. He is a professor of pediatrics at the University of Copenhagen and the head of research at the Copenhagen Prospective Studies on Asthma in Childhood, an independent research unit.

Dr. Bisgaard said it was not possible to tell from the study whether pregnant women could benefit from simply eating more fish. Pregnant women are generally advised to limit their consumption of certain types of fish like swordfish and tuna because they contain mercury. But many other types are considered safe, especially smaller fish like sardines that are not at the top of the food chain and therefore not likely to accumulate mercury and other contaminants from eating other fish.

“It is possible that a lower dose would have sufficed," the Bisgaard team said.

The supplements didn't seem to affect the odds of a baby or toddler developing the skin condition eczema, or an allergy such as a reaction to milk or egg products, or a severe asthma attack.

An editorial in the same journal by an expert who was not part of the study praised the research, saying it was well designed and carefully performed. The author of that editorial, Dr. Christopher E. Ramsden, from the National Institutes of Health, said the findings would help doctors develop a “precision medicine” approach in which fish-oil treatment could be tailored to women who are most likely to benefit.

If the findings are confirmed in other populations, doctors could test to see who would mostly likely benefit from fish oil supplements. "The health care system is currently not geared for such," Bisgaard said. "But clearly this would be the future."

If you are considering taking fish oil supplements during pregnancy, be sure and check with your OB/GYN for a recommended dose.

All fish oils are not the same. Some brands of fish oil are of higher quality than others. A reputable fish oil manufacturer should be able to provide documentation of third-party lab results that show the purity levels of their fish oil, down to the particles per trillion level. Also, if the supplements smell or taste fishy, they shouldn’t. High quality fish oil supplements don’t. Avoid fish oils that have really strong or artificial flavors added to them because they are most likely trying to hide the fishy flavor of rancid oil.

Story sources: Denise Grady, http://www.nytimes.com/2016/12/28/health/fish-oil-asthma-pregnancy.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl

Gene Emery, http://www.reuters.com/article/us-health-asthma-fish-oil-idUSKBN14H1T3

http://americanpregnancy.org/pregnancy-health/omega-3-fish-oil/

 

Daily Dose

Healthier School Lunches

1.00 to read

With everyone back in school after a nice summer break, what better time to discuss school lunches, especially as they relate to healthy choices.  The USDA (Department of Agriculture) has just issued new national guidelines for school lunches which will begin this school year.  The new guidelines include calorie and sodium limits for foods served on the school lunch line and are age dependent.   

The new guidelines also include the recommendation for more whole grains, and dark green, orange or red vegetables (color on the plate). Students buying school lunches must choose at least one fruit or vegetable at every meal.  Portion sizes may also be smaller as well. 

These changes are all geared at helping students understand the importance of healthy eating and making good nutritious food choices.  It is hoped that as students get “used” to seeing and eating healthier school lunches, the choices that they make at home may become better as well.  

Students will also be able to choose from fat-free, low-fat and lactose-free milk and will be required to have 1 serving a day.  Flavored milk will be required to be fat free. 

Lastly, half of the grains served in a school lunch must be whole grain and by 2014 school year all grains must be whole grain rich. 

So, if you are planning on packing your child’s lunch this year, remember these guidelines as well. I think that a combo of packing healthy lunches on some days, while letting your child buy a school lunch on other days seems to be the perfect balance.  Let your children help pick out healthy food choices to put in their packed lunch and they might even pick up a few ideas from the new school lunches this year too. 

You can find the new guidelines at http://1.usa.gov/Qzd5Z7

 

 

Daily Dose

Your Child's Lunch

1:15 to read

I have been interested in the recent news article about a mother who had packed Oreo cookies in her child’s lunchbox. It seems that although she had also packed other lunch items, the school her child attended deemed the lunch “unhealthy” and not only did not allow her to eat the cookies, they  sent her mother a note encouraging her to “pack a nutritious lunch”.

WHAT??  Are schools and daycare centers now deciding what a parent may put in a child’s lunchbox?  I understand the need for nutritious lunches for our children. I talk about this everyday in my practice. But are there not bigger issues facing our schools than policing every child’s lunch. This mother did not “just” pack Oreos, her child had a sandwich and string cheese as well. Her mother stated that, “she was out of fruits and vegetables that day”, so she added some cookies.  

Schools are in the throes of changing menus in an effort to help our children make good choices at lunch. But, even without serving fried foods or soft drinks, they do still offer dessert during school lunch.  They have ice cream, frozen yogurt, pies, cookies....and unfortunately many children probably eat more than one.  

I once headed a committee at our sons’ school to change the school cafeteria’s policy to have a “soda fountain”.   I realized that even if I talked to my children about nutrition and health, and did not have soft drinks in our home, if they were offered a choice between soft drinks and milk I knew  that they would sometimes choose a soft drink (with free refills I might add). 

After about a year of discussions and some very unhappy parents and students our school did stop serving soft drinks. As I pointed out even then, this was for children who were buying school lunch and drinks....we were not telling parents what they could and could not send or have in their own homes.

At the minimum I think this poor 4 year old should not have been put in the middle of this discussion. Would it not have been more appropriate to send the mother a note asking her not to send cookies for lunch again?  Was there a notice of acceptable lunch items that had been posted at the beginning of school?  Is there a “zero tolerance” for cookies rule?

I guess schools will be sending sandwiches home that have white bread or bologna, or who knows what else. While I am a huge advocate for healthy eating habits and making changes in all of our homes...let’s not take it out on a 4 year old.

 

Daily Dose

Babies Do Not Need Water?

1.00 to read

With the temperatures sizzling across the country, I have started to get the question, “how much water does my baby need to drink during the hotter months?” 

I have to admit, I am still confused as to where this medical myth was started?  Babies, even in warm to hot weather can stay hydrated just by their breast milk or formula intake. An infant does not “need/require” extra water in order to stay hydrated during spring and summer months. Many young moms tell me that the grandparents are asking about more water. 

An infant can get all of the hydration they need from their mom’s breast milk or formula intake as there is free water in the milk.  The best source of hydration for a healthy baby is via their milk intake. This is true for babies who are eating baby foods but are still taking a bottle or getting breast fed as well.  

I know that when the weather warms up we may drink more water with exercise or when out in the heat. But a baby is not an athlete (yet) and they are not really losing more water via sweating etc like our older children do. 

It is okay to offer a baby a bottle of water, but they don’t “need” extra water. In many cases an infant won’t even drink plain water as they prefer their mother’s milk or formula and the water just dribbles out of their mouth as you try to get them to drink it. Don’t think that they “need” 8 12 ounces of extra water a day. Someone started this little rumor. 

The bottom line? If you think you need to change your baby’s fluid intake for the warmer weather you can cross that one off your worry list! But, if you have children who are going outside and playing, or adolescents who are participating in outdoor sports, it will soon be time to start thinking about keeping them hydrated during the heat.  More on hydrating your active kids and athletes to come.  Stay tuned! 

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

Your Baby

Eating During Labor May Speed Up Delivery

1:45

In many hospitals, when a woman is in labor, all she is allowed to eat are a few ice chips. That rule may need updating, according to a new study that finds women who were allowed to eat before delivery had a slightly shorter labor than those who were restricted to ice chips or sips of water - although the study can't prove that eating caused deliveries to happen sooner.

The practice of limiting food during labor goes back a study in the 1940s in which women who delivered under general anesthesia were at risk of inhaling their stomach contents and choking in it, writes senior author, Dr. Vincenzo Berghella, of Thomas Jefferson University in Philadelphia, and his colleagues in Obstetrics and Gynecology.

“We really don’t know how much if anything people can eat or drink in labor," said Berghella,.

Whether women can have more than water or ice chips as they labor to give birth is a common discussion among healthcare providers, he told Reuters Health.

General anesthesia is not commonly used during delivery these days, but the old guidelines are still in use.

For the new study, the researchers compiled data from randomized controlled trials that compared the labor outcomes of women who were allowed to eat only ice chips or water and those who were allowed to eat or drink a bit more.

For example, one study allowed women to drink a mixture of honey and date syrup. Another study allowed all types of food and drinks. A few others allowed women to drink liquids with carbohydrates.

Overall, the researchers analyzed 10 trials that included 3,982 women in labor. All were only delivering one child - not twins or triplets - and were not at risk for cesarean delivery.

The women with the less restrictive diets were not at increased risk for other complications, including vomiting or choking, during the use of general anesthesia.

And women who were allowed to eat and drink more than the traditional ice chips and water had labors that were shorter, by an average of 16 minutes, compared to women with the more restrictive diets.

Speaking from experience, 16 minutes less of labor pains is a real bonus. How does adding more liquid or food during delivery help reduce the time before delivery? The researchers presented some ideas.

"If we’re well hydrated and have adequate carbohydrate in our body, our muscles work better," said Berghella. A woman's uterus is largely made of muscle.

Another of his studies, which found women who received more fluid than normal delivered faster than other women, reinforces the finding.

Berghella said it's still common practice for women with uncomplicated births to be restricted to water or ice chips during labor.

"The evidence from well-done studies is they can have more than that," he said.

Do women really want to eat much during labor? Probably not, there’s a lot going on in the body as labor progresses.  But more liquids and some light carbohydrates during the early part of labor may be welcomed – especially if they shorten the time between labor and when baby enters the world.

Story source: Andrew M. Seaman, http://www.reuters.com/article/us-health-pregnancy-labor-food-idUSKBN15O2ZR

 

Daily Dose

Does Your Baby Need Water?

2.00 to read

Since most of the country is sweltering with summer heat and temperatures well into the upper 90’s and even over 100 degrees, I guess I can understand parents’ concerns about giving their babies water. It seemed like a strange question to me when I first started hearing, “Dr. Sue, how much water does my baby need to drink every day?”  I know I am continuing to talk about staying hydrated during the heat wave, but we are really talking about those children and adults who are spending time outdoors, especially when involved in physical activity.

I have actually been telling parents with newborns that there is really no reason to take that sweet new baby outside for any length of time. I think it is too hot to enjoy being outside, and an infant doesn’t miss going to the playground like a 2 or 3 year old would.

But, when you have young children you have to get out (or go crazy inside everyday), so everyone just suffers through the heat. Remember to take your sunscreen and fluids and head out for an hour or two, in the morning or later afternoon if at all possible. These children need lots of water breaks, as do their parents and caregivers.

So, back to the water and baby question. Infants in the first 6 months are getting fed breast milk or formula which is made up of free water, so therefore a baby is staying hydrated by eating every  2 -3 hours. A baby doesn’t “need” water every day for any particular reason.

With that being said, it does not mean that your baby cannot have a bottle of water. This is especially true for a breast fed infant whose mother may have run out for an hour but is coming back to breast feed.  But what if the baby awakens or gets hungry 30 min or so prior to mother getting home.  This might be a good time to “stall” by giving the baby a bottle of water, rather than formula. In this case it is fine to use tap water (yes bottled water is not necessary, unless you have a well or something) in a bottle and see if the baby will even take it. Most babies don’t just gulp down 8 ounces of water!

If you are out in the heat with an infant, just remember to feed them every 2 – 3 hours and make sure they have nice drool in their mouths and wet diapers. If you are concerned about hydration take along a bottle of water for both you and your baby. You will probably need it more than your baby!

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

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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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