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Daily Dose

Don't Let Your Child Become an Obesity Statistic

Healthy eating begins with the first foods that you feed your infant.An alarming statistic was released today which shows that one in five 4-year-old children are obese and these numbers are even higher in minority children. This study was just published in The Archives of Pediatric and Adolescent Medicine, and followed over 8,000 children looking at height and weight. The findings were quite concerning, showing a trend toward obesity at an age younger than predicted, and numerous long term health problems associated with obesity, such as heart disease, diabetes, high blood pressure and bone and joint problems.

This is a national health issue and a call to action for all families to teach and model healthy eating. One of the problems is that many of the government sponsored food programs provide foods high in carbohydrates, and low in fresh fruits and vegetables, and this promotes obesity. School lunches have also been found to be high in fat and carbohydrate and continue to promote poor food choices. With the bad economy and recession, families have cut back on groceries and may be eating more fast foods, breads and pastas, again providing more carbohydrate than protein. Healthy eating begins with the first foods that you feed your infant. A well balanced diet with grains, fruits, vegetables and meats begins in the high chair and should continue at the family dinner table. The meals may be simple and healthy. Being a short order cook, or providing your child's favorite pizza and fried food on a daily basis, even in a young toddler will have deleterious effects for the rest of their life. Don't let your child become a statistic heading toward lifelong health issues secondary to childhood obesity. Change your own eating habits, improve your children's and remain committed to family meals. We, as parents, cannot afford to raise a generation where obesity is the norm: the change must begin now. That's your daily dose, we'll chat again tomorrow. More Information: 1 in 5 Preschoolers Obese

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.

 
Daily Dose

Surviving Picky Eating

It's been a busy day in the office and a lot of parents have had questions about picky eaters.It was a busy week in my pediatric office (always is!) and one of the hot topics surrounded picky eating.  The issue of picky eating seems to be on every parent's list from one to 18 years. Actually, picky eating is not as much of a subject in the older kids, seems that there are bigger issues and also hopefully the picky eating resolved when the child was younger.

I think that food is important for nutrition, nurturing, time spent together over a meal, etc....but it is not a big issue if you are relaxed about feeding your child. If you begin preparing your child healthy meals from the age of one year, provide them with many opportunities to experience different foods, and realize that most toddlers are picky regardless of what you feed them, they will eventually become good eaters. Parents worry that "they will starve" if I don't fix their favorite food every night. Children are SMART and they are smarter than we are, they self regulate and eat when they are actually hungry. If you provide a well-balanced meal three times a day, most younger kids will eat one fairly well and may pick at two. That does not mean that they need a different meal when they pick or refuse to eat, it just means they are not hungry at that time and should nicely be reminded that they might be hungry later, but not forced to eat. Along those same lines, when it is snack time later in the day, they should be given something healthy (even that sandwich or fruit that they refused at lunch) and not crackers and goldfish. Again, let them decide whether to eat it. IF you take the high road on this issue, hang in there for a LONG time, you will be pleasantly surprised that they become "good eaters", eat a wide variety of foods and know that you are not the short order cook at home. Those picky toddlers continue to gain weight, learn their colors and alphabet and grow into children that enjoy mealtime together. That's your daily dose, we'll chat tomorrow.

Daily Dose

When to Start Baby Food in Infants

I get numerous questions everyday from parents who are eager to start your-baby foods in their infants. It seems that there are a lot of “myths” about starting foods, things like “your your-baby will sleep through the night after you start your-baby food”, “it is important to start your-baby food sooner than later”, and “just put rice cereal in their bottles”.

The recommendation from the AAP is to begin your-baby food, typically rice cereal when your infant is between five and six months of age. An infant does not need any other nutrition besides breast or formula in the first six months. There are plenty, if not the majority of babies who will have been sleeping through the night long before beginning cereal, so there is no correlation between sleep and introducing your-baby food. The other thing that you will notice is that infants have a prominent tongue thrust in the first four and five months of life, so they are pushing things out of their mouths (like the pacifier we have discussed previously) and don’t do well with a spoon feeding until they are a little older. There is no magic to beginning cereal and you always want to start something new when your your-baby is in a good mood. This is often in the morning, a short while after having their morning bottle or breastfeeding. Think of it like having your cup of coffee and then having breakfast a little later on. I think it is easiest to feed a your-baby from their high chair, and by this age they are able to sit fairly well in the chair with a back supporting them. Mix a couple of tablespoons of rice cereal in a small bowl and with formula/breast milk to the consistency of cereal you would eat off of a spoon, not too thick, not too runny, but “just right”. As you start spoon feeding your your-baby their body language will tell you how much to feed them, let them lead the dance, a few bites to start or more if they want. There is no magic to first feedings, some babies take to it quickly and others take a few days or weeks to get used to spoon-feeding. Don’t be frustrated or worried if it takes awhile for your your-baby to get the hang of it, the adage “try, try again” comes to mind. Next step veggies, but more about that another time. That’s your daily dose, we’ll chat again tomorrow.

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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

New Iron Recommendations for Children

A new study says many U.S. children are iron deficient. How much iron do children need to stay healthy? New recommendations from the American Academy of Pediatrics.An article released in the journal Pediatrics from the American Academy of Pediatrics committee on nutrition, sets new guidelines for iron intake in infants and children.  The news is not good.  According to Dr. Frank Greer, who is the co-author of the report, “iron deficiency remains common in the United States”.

The effects of being iron deficient not only cause anemia, but may also cause “long term  irreversible effects on children’s cognitive and behavioral development.  Because of these findings it is imperative that adequate iron is provided in infancy and early childhood. Studies have shown that 4 percent of 6 month olds, and 12 percent of 12 month olds are iron deficient.  Children between the ages of 1-3 years of age have rates of iron deficiency between 6-15 percent. Preterm infants, infants who are exclusively breastfed and infants who are at risk for developmental disabilities seem to be at higher risk to develop iron deficiency. The committee recognized that the ideal way to prevent iron deficiency and iron deficiency anemia would be with a diet consisting of foods that are naturally rich in iron, but realized that in some cases “children will still need liquid iron supplements or chewable vitamins to get the iron they need. The AAP guidelines now recommend that: 1.  Term healthy babies that are exclusively breast fed should receive an iron supplement (1 mg per day) beginning at 4 months of age 2.  Whole milk should not be started until 12 months of age 3.  Infants 6–12 months of age need 11 mg of iron per day, which should be met via the use of “complementary” foods.  Red meat and vegetables with high iron content should be introduced early, as well as the use of iron fortified cereals. 4.  Toddlers ages 1-3 years need 7 mg of iron per day, and again this is best if iron comes from foods. 5.  Children should have their hemoglobin checked sometime between 9–12 months of age, and again between 15-18 months of age, and follow-up for iron deficiency treatment and testing is recommended 6.  Children who do not meet their iron needs via foods should receive a daily iron supplement The article contains a table which shows many foods from each food group that are good sources of iron.  Foods like meat, shellfish, beans, iron fortified cereals, and fruits and vegetables that contain vitamin C (which aids in iron absorption) are all encouraged. Thanks to my mother, I have always known that liver is a good source of iron (never my favorite dinner as a child), but who would have known that clams and oysters are also high in iron.  While oatmeal is a good iron source, molasses is also high in iron.  Tofu and wheat germ are also high in iron, as are edema me beans, which many kids love. By getting creative with foods that are high in iron beginning early in a child’s life, iron deficiency may be avoided.  You never know what your child will eat, unless you try it! That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Toddler Day at the Office

Today seemed to be "toddler" day in the office and I was just amazed that the questions from room to room and morning to afternoon were essentially all the same. Forget that these were all different kids with different parents; the concerns were echoed from room to room.

  1. He/she doesn't eat: Toddlers are notoriously picky eaters and they also are smart enough to self-regulate. In other words, they only eat when hungry (such a novel idea to us adults, as I sit here eating a four-day-old cupcake just because it was there). If you provide your toddler with a balanced meal three times a day, they may choose to eat it or not, but I promise you they will not starve. Toddlers seem to grow and gain weight on air alone, and they also really only eat once a day, and pick at the other meals. Who needs a trainer when you know when to stop? A parent's job is to provide the healthy, well-balanced meals and the child will learn to eat a wide variety of foods, over many years. No need to bribe, scream, beg or feel guilty.
  2. Toddlers hit/bite/spit/pinch/pull hair. You fill in the blank. This is what I call "age appropriate, in-appropriate behavior." We all go through this as parents, some more than others. But this is also the time to begin teaching your toddler appropriate expectations as to playing, sharing, and the social graces. Correct your child when they misbehave. Begin time-out and consequences. Learn to get on your child's level to redirect inappropriate behaviors. Use a firm voice when talking told a child about their behavior, no need to scream or yell, but voice inflection is important as your child learns to listen to you.
  3. Sleep is also a big concern, and most toddlers should be sleeping alone at night. Have a set bedtime and bedtime routine and begin a sticker chart for good bedtime behavior and for staying in their bed.

The toddler years are some of the most important for a child's development and long term well being. Start young, if not it only gets harder. That's your daily dose, we'll chat again soon.

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.

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!

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