Twitter Facebook RSS Feed Print
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

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

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

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

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.

Tags: 
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.

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

What is baby led weaning when it comes to first foods?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.