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Daily Dose

Spoon-feeding Your Baby

1.15 to read

I continue to see a lot of new babies (so fun) and there seem to be a lot of questions and concerns around when to start feeding a baby solids and how to actually do it as well. 

The consensus about beginning solid foods has really not changed in the last 30 years. Infants do not need to begin solid foods until somewhere around 6 months of age, give or take a few weeks. 

It has also long been recommended to start feeding a baby rice cereal as their first solid food. Again, there is no real data on this and the AAP is at work on new feeding guidelines as I write this. We may be changing things around and starting protein before cereal? 

Never the less, I typically recommend starting a baby with some type of cereal as it is easy to make and easy to wipe up if your baby does not like it!!  One of the biggest things about beginning foods is it can tend to be messy, and this is an important part of a baby’s feeding experience as well. 

I start feeding a baby cereal from the spoon, typically as a breakfast meal, after the baby has had their morning breast or bottle feeding. I pick the mornings as most babies are happy in the morning, so you can pick the best time to feed your own baby. You don’t want to start a new project with a fussy baby. 

Put your baby in the Bumbo chair or high chair, so they are sitting up, and mix up the cereal (with either breast milk or formula) to the consistency that you can spoon feed it. Not so thick your child gags and not so thin it runs off the spoon.  Then you just do the airplane to the mouth game (somehow I always find myself also saying “yum, yum”) and see how your baby feels about eating cereal. Some babies love it and others will seal those lips and scream. There is no magic about beginning solid foods and don’t try to “make your baby open their mouth”, it is practice practice. 

After several days to weeks you will see that your baby is enjoying the high chair and is interested in spoon feeding and you can begin to feed other pureed foods. I also add more solid feedings to their day so that they are ultimately getting 3 solid meals (breakfast, lunch and dinner) as well as their bottle or breast feedings. Yes, that often means you are actually spending more time feeding than before. 

I usually begin veggies, then fruits then meats, but again there is no “perfect” way to add additional solid foods. Just feed your baby lots of different pureed foods with different tastes, as you will see they will eat almost anything at this age. Enjoy that as it all changes once they are a toddler! 

Spoon feeding is fun and is not the biggest source of a babies calories until they are older. It is just the beginning of getting your baby interested in the spoon and new textures in their mouths. Another new experience for both parent and baby. 

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

Daily Dose

Common Newborn Questions Answered!

Dr. Sue answers common questions about newborn babies.Well, it seems like it takes more than one column to discuss the first days home with a newborn baby.  After discussing the nuances of breast feeding, there are also many questions regarding all of the noises that babies make.

Everyone thinks that infants are pretty quiet, that is until you sleep with a newborn in the bassinet right next to your bed.  Newborns are noisy!!  They not only cry (that is a whole other topic) but they squeak, grunt, stretch, yawn, have weird breathing noises, hiccup and pass tons of gas. (Dad’s are so cute when they say, “there is something wrong with my baby girl as she FARTS and it stinks, this can’t be normal?”) The first thing that many parents will notice is that their infant has “weird” breathing patterns. The baby seems to take some rapid breaths and then pauses and it looks like “they have stopped breathing” for a few seconds, and then resumes their more normal breathing.   This is called periodic breathing and is quite normal for the first few weeks of a baby’s life.  I swear only first time parents notice this, as you have the time to watch your precious baby and count their breaths. Every subsequent baby in the family is equally loved, but is typically not under the microscope like a first born and we only notice that they are ‘’’breathing”.  As an infant matures so does the breathing pattern and the respiratory rate becomes more rhythmic. If your baby has any color changes, i.e  turns dusky, or blue with their breathing that is a cause for immediate concern and a call to the doctor or 911. Another common concern is often how many times a day a baby will hiccup. If you remember, the baby often hiccupped in utero, and this too continues after they are born. Babies seem to hiccup for an inordinate amount of time, which bothers parents, but usually seems not to faze the baby at all. It is fine to try and give your newborn water if they are hiccupping and it is really bothering either you or them, but is not necessary.  Just like an infant’s startle (Moro) reflex, babies seem to get the hiccups when they are younger and they slow down as the baby’s nervous system matures.  A baby may hiccup for minutes to an hour and then just stop and fall asleep, oblivious to the concern that this event has caused their parents. Babies also make a lot of stretching and grunting and groaning noises, and are perfectly comfortable.  But these noises will awaken a sleeping parent.  If your baby is not crying during all of these noises, I would not pick he/she up, but would wait to see if they then go back to sleep. Some of these noises occur even while a baby is sound asleep. In this case the adage, “never wake a sleeping baby” is good advice.  These noises do not necessarily mean a baby needs to eat, especially if you think they may have just eaten an hour ago. Again, your baby should not appear in any distress or have color changes, they are just noisy! Lastly, GAS!  All babies have gas, and no one knows that until they have cared for a newborn.  It does not matter if a baby is breast or bottle fed, they produce gas, and it is loud and may be stinky. I think that infants produce more gas in the first 3-4 months of life than they will again until they are old (grandparents age, ask them). It seems like so many things occur both early and later in life, and gas is just one example. As a newborn’s GI tract matures, they seem to produce less gas, and are also often more comfortable after a feeding. When a baby is “gassy” they often like to have movement, so they like to be rocked, or put on their tummy and patted (only if awake, never to sleep), and they may enjoy the swing, or the motion of riding in a car, or putting the infant seat on top or a vibrating washing machine or dryer.  There are many “home remedies” but maturation of the GI tract just takes time. In most cases, changing an infant’s formula or a mother’s diet will not change the gas, but many people will try it. Remember, this too shall pass! 
(no pun intended) That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Picky Eating: Magic Words Offer Food for Thought

1:15 to read

I am trying to clean up my desk and I have been looking through stacks of pediatric articles that I felt were really interesting. An article by Dr. Barbara Howard entitled “Three Magic Words Offer Food for Thought” made a wonderful point regarding family meals and eating habits.

She states that one of the best questions to ask a child during a “well-child” visit only requires three words, but offers so much insight into a family’s interactions. What are the magic words? “How are your meals?” I know you know how much I believe in, and promote, families eating together.

There has been a lot of data substantiating the many positive side effects that stem from family meals.  Not only does eating together as a family help improve food choices which may help prevent obesity, it also leads to children who have improved vocabulary and language skills, social skills and manners. Family meals have also been shown to lessen the chance of risk taking behaviors in adolescents. There has also been an association with fewer eating disorders among adolescents who have regular family meals. So, when I ask children about their meals, I also get parental feedback. The biggest complaint is that their children are “picky eaters”. Many children and parents will say that they don’t eat together as a family as everyone eats something different. I don’t think being a “short order cook” is a job requirement of any parent.

Social worker Ally Slater, delineates parent’s responsibilities with regard to food as “what, when and where” while leaving children, “how much and whether”. I love that!! Parents control the grocery cart, meal and snack choices and food offerings on the plate. It is nice to always offer at least one food that most family members like. Once that food is offered and we are gathered together to eat, parents need to back off. Is that easier said than done? Maybe in the beginning, but over time it actually simplifies family life. I think it is really fairly easy if you “buy into” the idea of family meals and know that children will make better and wider food choices if given that opportunity. It may take up to 100 times, and many months for your child to try different foods, but eventually you will be pleased that you have a child who is a healthy eater, and who also enjoys a wide variety of foods. Trust me, your children when raised this way, really turn out to be great eaters as adolescents and young adults.  I think my boys are less “picky” than I am! (No sushi for me).

Make family meal time a priority. Your children will respect the rules, learn table manners, and enjoy dinnertime conversation, while eventually developing a more mature palate. It just takes time. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Chubby Toddlers & Weight Gain

1.15 to read

So, what goes on behind closed doors? During a child’s check up, I spend time showing parents (as well as older children) their child’s growth curve. This curve looks at a child’s weight and height, and for children 2 and older, their body mass index (BMI). This visual look at how their child is growing is always eagerly anticipated by parents as they can compare their own child to norms by age, otherwise called a cohort. 

I often then use the growth curve as a segue into the discussion about weight trends and a healthy weight for their child. I really like to start this conversation after the 1 year check up when a child has  stopped bottle feeding and now getting regular meals adn enjying table food. 

This discussion becomes especially important during the toddler years as there is growing data that rapid weight gain trends, in even this age group, may be associated with future obesity and morbidity. Discussions about improving eating habits and making dietary and activity recommendations needs to begin sooner rather than later. 

I found an article in this month’s journal of Archives of Pediatrics especially interesting as it relates to this subject.  A study out of the University of Maryland looked at the parental perception of a toddler’s (12-32 months) weight. The authors report that 87% of mothers of overweight toddlers were less likely to be accurate in their weight perceptions that were mothers of healthy weight toddlers. 

They also reported that 82% of the mothers of overweight toddlers were satisfied with their toddler’s body weight. Interestingly this same article pointed out that 4% of mothers of overweight children and 21% of mothers of healthy weight children wished that their children were larger. 

Part of this misconception may be related to the fact that being overweight is becoming normal.  That seems like a sad statement about our society in general. 

Further research has revealed that more than 75% of parents of overweight children report that “they had never heard that their children were overweight” and the rates are even higher for younger children. If this is the case, we as pediatricians need to be doing a better job.  

We need to begin counseling parents (and their children when age appropriate) about diet and activity even for toddlers. By doing this across all cultures we may be able to change perceptions of healthy weight in our youngest children in hopes that the pendulum of increasing obesity in this country may swing the other way. 

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

Daily Dose

Don't Give-In To Picky Eating

I am trying to clean up my desk and I have been looking through stacks of pediatric articles that I felt were really interesting.

An article by Dr. Barbara Howard entitled “Three Magic Words Offer Food for Thought” made a wonderful point regarding family meals and eating habits. She states that one of the best questions to ask a child during a “well-child” visit only requires three words, but offers so much insight into a family’s interactions. What are the magic words? “How are your meals?” I know you know how much I believe in, and promote, families eating together. There has been a lot of data substantiating the many positive side effects that stem from family meals. You can look at some of the studies by going to The Promoting Family Meals Project, http://www.cfs.purdue.edu/CFP/promotingfamilymeals. Not only does eating together as a family help improve food choices which may help prevent obesity, it also leads to children who have improved vocabulary and language skills, social skills and manners. Family meals have also been shown to lessen the chance of risk taking behaviors in adolescents. There has also been an association with fewer eating disorders among adolescents who have regular family meals. So, when I ask children about their meals, I also get parental feedback. The biggest complaint is that their children are “picky eaters”. Many children and parents will say that they don’t eat together as a family as everyone eats something different. I don’t think being a “short order cook” is a job requirement of any parent. Social worker Ally Slater, delineates parent’s responsibilities with regard to food as “what, when and where” while leaving children, “how much and whether”. I love that!! Parents control the grocery cart, meal and snack choices and food offerings on the plate. It is nice to always offer at least one food that most family members like. Once that food is offered and we are gathered together to eat, parents need to back off. Is that easier said than done? Maybe in the beginning, but over time it actually simplifies family life. I think it is really fairly easy if you “buy into” the idea of family meals and know that children will make better and wider food choices if given that opportunity. It may take up to 100 times, and many months for your child to try different foods, but eventually you will be pleased that you have a child who is a healthy eater, and who also enjoys a wide variety of foods. Trust me, your children when raised this way, really turn out to be great eaters as adolescents and young adults.  I think my boys are less “picky” than I am! (No sushi for me). Make family meal time a priority. Your children will respect the rules, learn table manners, and enjoy dinnertime conversation, while eventually developing a more mature palate. It just takes time. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Diagnosing Celiac Disease

How do you diagnose celiac disease. I received an email via our iPhone App from a mother who was concerned because her 2 year old son had skinny arms and legs, but a “big tummy” and she thought this might be a symptom of celiac disease.  Most toddlers have “big tummies” even if they are skinny kids as their abdominal musculature (future 6 pack) is not developed.

I often have questions from concerned parents whose children are growing perfectly normally, but their “belly sticks out”.  This is often a comment made about little girls (gender specific concerns already!) and I tell the parents that there are not many toddlers that don’t have protuberant little tummies. If you go to the pool in the next several months, check out the baby pool,  as this is not a good age to wear a bikini or “speedo” with that big tummy pushing down the bottoms,   save that look for later on. Now, what do you typically look for in  child who you suspect might have celiac disease?  Celiac disease typically causes failure to thrive in young children. I know this well,  as I got this question wrong on my oral boards many years ago, and have spent the last 20 years making sure never to miss a case. (maybe I should leave that little tidbit out?) At any rate, you see symptoms like persistent diarrhea, weight loss or failure to gain weight, a large protuberant abdomen, and a lack of appetite (no, being a picky eater does not count).   Because celiac disease is an auto-immune disease where the body responds abnormally to a protein (gluten) found in foods like wheat,  rye, barley and many other prepared foods, it differs from a food allergy.  A food allergy typically causes symptoms like hives, wheezing or vomiting. The first step in testing for possible celiac disease will be a blood test on your child.  This will show if there are elevated levels of antibodies, called tissue-trans-glutaminase (tTG), in the blood. If a child has high levels of these antibodies (tTG), then a biopsy of the small intestine may be taken to confirm the diagnosis. A small bowel biopsy is done while a child is sedated, through an endoscope, and actually takes a small piece of the lining of the intestine to see if the villi are flattened and damaged.  The gluten in the diet of a child with celiac disease causes these changes to the intestine, and once gluten is removed from the diet the villi will return to normal and normal absorption of food will take place. If a child is confirmed to have celiac disease (which is as lifelong problem) they have to remain on a gluten free diet, which means restricting many foods and drinks.  A gluten free diet, while seemingly difficult to adhere to at first, will allow the child to grow and develop normally and your child will typically have more energy and feel better in general.  After being on a gluten free diet another blood test may be done to confirm that the tTG level has come down. With the advent of more gluten free products it has become easier for parents and children to follow a gluten free diet. There are many websites that help teach a family to read labels (similar to those with a food allergy) and to also provide resources for recipes or products that are gluten free. Although I continue to look for a patient with celiac disease, I have yet to diagnose one, and remember to consider the diagnosis in any child who is having “failure to thrive”. That's your daily dose for today.  We'll chat again tomorrow! Send Dr. Sue your question now!

Daily Dose

Make Time For Family Meals

In order to have great family memories, families have to gather together and one of the most important times is over a meal.One of the best things about the holidays is that it brings families together. As stressful as that can seem at times, it is what makes the holidays memorable. Having the house filled with kids, parents and siblings is really what it is all about. Having our college boys home and the good natured bantering and arguing over the dinner table brings back memories of burps at the table, not using napkins, spilled milk, inappropriate comments, and growing up.

I am still amazed that everyone uses a napkin, knows the correct fork to use, (although when setting the table together the three of them argued about fork placement) and for the most part can carry on an interesting conversation whether it be with an older grand parent or a younger cousin. If you had asked me if this would ever happen I would have had to say, "not likely", as I know we spent countless hours repeating "put your napkin in your lap" and "don't talk with your mouth full", and " I can't believe you would say that at the table!!!" In order to have these memories, families have to gather together and one of the most important times is over a meal. This ritual of family meals may seem to be routine and unnecessary but numerous studies have shown that families who gather together for a meal have children who are more "connected" to family, have more self-esteem, are successful in school, have less problems with alcohol and drug abuse and also less obesity. In short, a family meal may be the easiest way to help raise healthy, and well-adjusted children. This meal does not need to be elaborate. It may be as simple as a roast chicken, spaghetti, hamburgers or stew. You name it, but it will most likely be healthier than driving through a fast food restaurant. The meal will also be a time to teach manners, conversation and good listening habits. It is also an opportunity to get the kids involved in setting the table, clearing dishes, loading dish washers and learning self help skills so necessary for later in life. Make it a point to eat together with a family, the rewards will be great. That's your daily dose, we'll chat again soon!

Daily Dose

Family Dinners Help Fight Obesity

1.15 to read

Sadly, the problem with obesity in America does not seem to be going away, and is not even improving!! The latest data shows that adult obesity rates have risen in 23 states in 2009 and the trend continued through 2010 and 2011.

Obesity and the problems associated with it, type 2 diabetes, heart disease, joint problems etc. begin in childhood. If we cannot change our children’s eating and exercise habits we have no hope of stemming the tide of ongoing obesity. By 2020 the headlines might read, “Obesity rising in all 50 states” with the majority of the population dealing with this crisis. In that vein we must not only begin modeling better eating habits for our children, but do so by returning to the idea of family meals. Family meals were the “norm” when I was growing up. We were fortunate to have breakfast and dinner at home each day and we were expected to be present for those meals. I know it was hard for my mother to do this as she worked when I was young, and my father travelled a great deal of the time. But parental sacrifice has not changed over time, and we all know that we will often do things “just for the kids”. The good thing about preparing meals these days is that the grocery stores have made it quite easy for even a very busy family to be able to prepare a “home cooked” meal. All of the chains have rotisserie chickens available and also offer prepackaged meats such as meat loaf, pre-made hamburger patties, or fish filets. The salads are also prepackaged and you can even buy fruit already cut up. I am “thrifty” and don’t mind making my own hamburger patties or cutting up fruit, but picking up a chicken on the way home from work is often a quick way to begin a dinner. The chicken can be used in a salad or used as a main course. We parents just have to be a little more inclined to drive through the grocery store rather than the fast food restaurant. I am still convinced that our children will eat what we prepare and gather together for meals if that becomes the norm once again. Our kids are busy too, and they will appreciate knowing that dinner will be there every night, and that it will be healthy. Leading by example is the best way to begin. We can’t afford not to try! That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Preschool Nutrition Can Be Challenging

1.30 to read

Does your child eat three meals a day with healthy snacks along the way? I often find myself talking to parents about establishing healthy eating habits especially when you have a preschooler. Preschool children, specifically the two to five-year-old set are notoriously picky eaters, and parents need to recognize that this is developmentally appropriate, although frustrating for parents.

This is an appropriate time to begin teaching children the importance of healthy eating habits to encourage a lifetime of good health and prevent obesity. A good place to start to get information is “MyPyramid for Preschoolers”, a website sponsored by the U.S. Department of Agriculture. This website not only covers what your children should be eating, but also is full of good advice on handling picky eaters, how to monitor your child’s growth and ideas to encourage physical activity.

The website encourages parents to lead by example and let your children see you eating a wide array of foods including fruits, vegetables, and whole grains throughout the day. There are ideas for healthy snacks that can be eaten on the run, as you get back into carpools and after school activities. Even the toddler set is busy after school!

Remember: do not let food choices become a battle or an issue. Do not make negative food comments around your children, and keep trying new things. It may take up to 20 attempts or more before your child will try something new, but if you don’t keep trying you will never know if they might really like broccoli.

Also, no “yucky faces” for the adults and older children while at the table and eating their meal. That will only discourage your toddler from trying unfamiliar foods. Put on that happy face, even if it is not your favorite food, it might be your child’s.

The most important message is to make mealtime and snack time pleasant and healthy. Even a toddler can help with planning and preparing a meal. This website is really quite good and interactive as you can enter your child’s first name, age, gender and typical amount of activity and the site will generate a plan just for your child! Can’t be easier than that.

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

 

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