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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

The Importance of a Healthy Lunch

Now that our school-aged children have gotten back to class it is a great time to discuss school lunches. I like to ask my patients and their parents about their school lunches. It is interesting to hear what kids like to eat for lunch. Of course like so many things, there is a huge amount of variability surrounding school lunch choices.

It seems that elementary school aged children enjoy buying school lunch especially when the cafeteria experience is novel. But because the choices are typically not as plentiful in the elementary school cafeteria, some children will choose to the take their lunch. The one thing that I find to be most typical is that the pizza and chicken nugget lunch days are a lot more popular than grilled chicken and vegetable days. Unfortunately, school lunches are not typically the most “healthy” and are often loaded with fats. By the time children reach middle school and high school the cafeteria becomes more of a smorgasbord of choices and the “hot lunch” tray is not the only choice available. With the vast array of choices from salads, to sandwiches and many snack items, I often hear that the “tween” and teen set pick and choose their favorite foods and fall far short of anything that resembles a well balanced lunch. The combination of a hamburger and fries, or a bagel and yogurt may be the chosen lunch items. I rarely hear milk as the beverage of choice. By the time teens their junior and senior year in high school many campuses allow their students to have “off campus” lunches. In this case the “fast food world” awaits them around every corner. It is not unusual for this age group to enjoy a “super sized” combo meal and a large Coke. Most of the girls I see opt for a “diet” Coke to round out the meal. Probably not what most parents would consider a healthy lunch. The word fruit is rarely mentioned. To start teaching children about healthy eating habits we need to begin in early elementary school. Sit down with your child and the school lunch menu and look over the choices. It might make sense to “make a deal” that they may buy their lunch two days a week and you will pack them a lunch on the other three days. They can put stars or check marks on the days that they want to buy. When packing a lunch let your child be involved, while at the same time guiding their choices. The prepackaged pizza and lunchables are not good choices. Choose whole grain breads for the sandwich. Use lean sandwich meats. Add some cheese for some added calcium. Peanut, almond or cashew butter provides protein too. Cut up veggies in clever ways to make them more appealing. Chips may be baked and put them in your own sandwich bag. There are many great ways to pack and delicious and healthy lunch, and it is probably cheaper too! That’s your daily dose, 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

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

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

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

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

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

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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DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

DR SUE'S DAILY DOSE

New report says not enough babies are getting much needed tummy time!

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