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Daily Dose

Transitioning to Whole Milk or Toddler Formula

Is it best to transition to whole milk or use toddler formula instead?I received a question from our iPhone App regarding the use of a toddler formula, such as Enfagrow. The mother wondered if this was preferred over switching to cow’s milk when a child reaches 12 months of age.

While there have been several products that have been brought to market in the last few years, so called toddler’s formulas, there is really no evidence to show that these are preferable to using cow’s milk you’re your child reaches 1 year of age. The toddler’s formula does contain more calcium and phosphorous than infant formulas, but beyond that there is really no advantage to using a toddler formula over milk.  It really seems to be an expensive marketing ploy directed to parents who are concerned about calories and vitamins. The American Academy of Pediatrics recommends that 1 year old children either continue breast feeding or make the transition to whole milk.  It is also recommended that child transitions from bottle to a cup (sippy cup is fine). At that time a toddler should reduce their milk intake to approximately 16 ounces a day, as they are getting the majority of their nutrition from eating a wide variety of solid foods, with less calories coming from breast milk or whole milk.  If a parent is offering their toddler a variety of healthy foods, you will be amazed at what they will and will not eat, but they do manage to gain weight and grow, which often surprises their parents. The most interesting thing about a toddler, is that they self-regulate, and unlike adults, they eat when they are hungry, rather than out of boredom or due to stress.  So, if you offer your toddler healthy meals and snacks accompanied by whole milk from a cup, they will meet their nutritional requirements and also get enough calcium and vitamin D. On the other hand, for parents that have a difficult time dealing with a child’s whims for eating, and will indulge their child’s  food preferences,while also allowing them to have juice instead of milk, the idea of a toddler formula seems to be just the ticket! Just let them drink their nutrition (somewhat like an adult who might need a nutritional supplement like Ensure while they are sick), but this may not be the answer as this really just reinforces poor eating habits. Like many things in parenting, the “perceived” easy solution, may not always be the best. So, at the end of the day there is little need for “follow up  formulas” for the otherwise healthy toddler.  Save the money, buy whole cow’s milk unless otherwise directed by your pediatrician.  Make sure that your child is getting about 16–18 ounces of milk a day and several other servings of dairy products.  If you are really concerned about calcium and vitamin D as well as other vitamins, then offer them an over the counter vitamin supplement. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue.

Daily Dose

Kids Should Drink Milk, Even If It Is Chocolate

I have always be a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.I have always been a huge advocate of children drinking milk. From the time “my” babies go from breast or formula to milk at the age of one year, I discuss the need for dairy products to ensure adequate calcium and Vitamin D in a child’s diet.

It is easy to have children drink milk when they are toddlers, but as children get older and decide that they “prefer” water or even juices or soft drinks it may be harder to get them to choose milk. Unfortunately, once a child enters the “real” world with school and sports, they realize that there are other beverages offered besides milk. So, what to do?  Well, I think it is preferable to have children and adolescents continue to drink milk, even if it means having chocolate or strawberry milk. There have actually been studies in the pediatric literature that have shown it is preferable to have a few extra calories from the sweetener in flavored milks, than to forgo drinking milk. Like many things, it is a trade off. It is difficult to provide a child’s daily calcium and vitamin requirements without having several glasses of milk a day as well as other dairy products. When looking at the calorie content for low fat chocolate milk compared to low fat milk we are only talking about 30 – 50 calorie difference per cup of milk (it seems to depend on the brand). I know that the calories may be cumulative, but if you take away a sugary cereal in the morning, or that after school fast food, the calorie difference would never be noticed. One could also argue that if we our children spent more time playing outside rather than on their play stations or computers, the extra calories from chocolate milk would never be noticed. Bottom line, it’s all about choices. Over the years I have also found that many children want to drink chocolate milk for the short-term and then will come back to regular white milk. If they continue to drink milk throughout their childhood they are also more likely to drink milk as young adults, which is still an important time for “banking calcium”. Bone health and many of the exciting new studies regarding vitamin D continue to outweigh the debate about calories. I really don’t think that my overweight patients are getting their extra calories from milk, but rather cookies, fast foods, and soft drinks. I wish milk was the culprit. Lastly, I did have chocolate milk in our house, but if you are really worried about the calories, I have been known to “dilute” chocolate milk with white milk and it is still chocolate. There are lots of little things like that we can do as parents and it seems to work well for everyone. I will have other Mommy secrets later; remind me about trying that with cereals. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Health Effects of Vitamin D Continue to Evolve

As I am headed to the medicine cabinet to take my evening dose of calcium and vitamin D, I am also multitasking and reading the latest article in Pediatrics regarding vitamin D levels in children.As I am headed to the medicine cabinet to take my evening dose of calcium and vitamin D, I am also multitasking and reading the latest article in Pediatrics regarding vitamin D levels in children.

In the last several decades there has been a lot of discussion in the adult literature about osteopenia and osteoporosis as well as the prevention and treatment of these conditions. The latest studies involving vitamin D and calcium metabolism are now appearing in the pediatric literature as newer information about the long-term health effects of vitamin D continues to evolve.  It is certainly a hot topic these days, with more studies to come. The association between low levels of calcium and vitamin D has long been known as a cause of rickets. But rickets was thought to have been a bone disease of years ago (at least that was what I was taught) until recent studies showed that there were indeed still children who were developing rickets. An editorial in Pediatrics stated that the strongest evidence about the effects of vitamin D deficiency was related to the risk of developing rickets. Upon further evaluation it was found that rickets could be prevented and treated by increasing the daily amount of vitamin D a child received and subsequent recommendations were made that all children should receive 400 units of vitamin D daily. It was previously thought to be about half that much. The current study in Pediatrics shows that only one in five children between the ages of one and 11 receive adequate daily vitamin D. In African American and Hispanic children as many as 80 to 90 percent may be vitamin D deficient. Not only is vitamin D important in bone metabolism and heath, other studies have suggested that vitamin D may play a role in preventing infectious diseases, diabetes and even some types of cancer. Some other pediatric studies have shown that teens with low vitamin D levels had higher blood pressure and cholesterol levels, and also had a greater tendency to be overweight. I am sure there will be continued investigational studies into all of the above. How does all of this fit together? As a child’s diet changes and they no longer receive formula, their daily milk intake may be reduced and in turn their calcium and vitamin D intake is inadequate. In my personal experience and practice I find many children do not “like” milk and are allowed to choose other beverages, such as water, juice and even soft drinks. Although many parents think their children are getting their dietary calcium and vitamin D from other dairy products (yogurt cheeses, fortified juices), it is difficult to do without some daily milk intake. Even two glasses a day needs to be supplemented by other dairy products and many children have no milk. Additionally, vitamin D is made after our skin is exposed to sunlight. Due to the recommendations for routine sunscreen use in children and adults, we may not make as much vitamin D from sun exposure. It is also known that dark skinned children, especially in more northern latitudes are more likely to be vitamin D deficient. At the same time, children do not play outside as often and this too may contribute to obesity and lower vitamin D levels. All of these variables need further study and may be somehow intertwined. While the data continues to be accumulated and additional studies determine age appropriate blood levels of vitamin D, one thing is for sure: daily milk intake and dairy intake is vital to our growing children for a multitude of reasons. It is far easier to remember to pour your child, tween or teen a glass of milk than to remind them to take a vitamin or two every day for the rest of their childhood. I can barely remember to take my own! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Teaching Your Child About Calcium is An Important Lesson

A recent study confirmed what I had seen in my practice for many years, adolescents and young adults are not getting adequate amounts of calcium.A recent study in The Journal of Nutrition Education and Behavior confirmed what I had seen in my practice for many years, adolescents and young adults (high school and college kids) are not getting adequate amounts of calcium. This is hugely problematic as this is an important time to store calcium in bones that will be needed later in life.

The process of storing calcium is complicated, but it is known that by your 30’s you begin using bone calcium rather than storing it. In this study, more than half of the males and two-thirds of the females consumed less than the recommended 1,000

Daily Dose

The Importance of Vitamin D

New research is showing that vitamin D is equally important in preventing heart disease and diabetes.Doctors have known the importance of calcium and vitamin D for children's bone health and for preventing osteopenia and osteoporosis later in life. Now new research is showing that vitamin D is equally important in preventing heart disease and diabetes. Infants are breast-fed or formula fed until their first birthday and then begins drinking milk as their main source of calcium and vitamin D.

For many children who "choose" (I don't get the choice thing) not to drink milk they may substitute soft drinks, juices or water. Unfortunately none of the other beverages contains the necessary calcium and vitamin D and this may lead to vitamin D deficiency. Recommendations in the last year have added that babies that are exclusively breast fed should be given a daily vitamin supplement, like poly vi sol or tri vi sol, to ensure that they are getting at least 400 IU of vitamin D per day. The recommendations also suggest that all children need at least 400 IU of vitamin D per day, and studies are being to conducted to see if the requirements are even higher. In addition children need to continue getting somewhere between 1,000 mg - 1,500 mg of calcium per day, depending on their age. The current research by the American Heart Association looked at teens and vitamin D levels. Their findings showed that teens with the lowest vitamin D levels had a four times greater chance of developing metabolic syndrome (putting them at risk for diabetes) and a 2.4 times greater risk of developing high blood pressure. How do you ensure adequate vitamin D and calcium for your family? A healthy diet should contain fortified milk and orange juice, as well as other dairy products with added vitamin D, egg yolks, tuna and salmon and some ready to eat breakfast cereals. Read the labels; look for vitamin D and calcium in foods. Sunshine is also a good source of vitamin D, but wear your sunscreen! That's your daily dose, we'll chat again tomorrow.

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!

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Are vaccines safe for pregnant moms?

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