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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

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!

Your Teen

Sports Drinks May Damage Teeth

Those sports drinks that your young athlete sips on may be eroding their teeth a new study suggests.040509healthlines1 Those sports drinks that your young athlete loves to sip on may provide an energy boost, but they could also be eroding their teeth a new study suggests. Findings by New York University dental researchers show many popular energy drinks contain levels of acid that can cause tooth erosion, hypersensitivity and staining. The beverages can also cause excessive tooth wear and may damage underlying bone-like material, causing teeth to soften and weaken the researchers say. They also say the drinks may possibly trigger conditions leading to severe tooth damage and loss. "This is the first time that the citric acid in sports drinks has been linked to erosive tooth wear," says Mark Wolff, DDS, professor and chairman of the department of cardiology and comprehensive care at New York University College of Dentistry. He says people who use sports energy drinks for energy should brush their teeth immediately after drinking the beverages. Softened enamel, he says, is highly susceptible to the abrasive properties of toothpaste. The five sports drinks tested were Vitamin water, Life Water, Gatorade, Powerade and Propel Fit Water. The study involved cows' teeth that were cut in half. Half of the specimens were immersed in a sports drink, the other half in water. Cows' teeth were used because of their close resemblance to human teeth. All the teeth immersed in a sports drink softened, but Gatorade and Powerade caused "significant" staining, according to an abstract of the study. Craig Stevens, spokesman for the American Beverage Association, says such studies are unfair and do not present "an accurate or actual picture of the way sports drinks are consumed." "The testing procedures they used are outside the realm of what happens in real life," he says. "Beverages pass right through the mouth, and these beverages have a purpose, and are proven to enhance physical performance. To use them like this is simply providing unhelpful information to consumers." He adds: "To suggest that sports drinks are a unique cause of dental caries or tooth erosion is overly simplistic. Oral health is determined by a variety of factors, including types of food consumed and the length of time foods are kept in the mouth."

Daily Dose

Get Your Toddlers Walking!

With childhood obesity numbers rising, get your toddlers out of a stroller and walking!I walked into our office waiting room recently and was shocked at how crowded it was!! It really wasn’t that there were that many patients waiting, but it was the fact that there were about 6 “triple wide” strollers holding children of various ages who were being wheeled in and parked in the waiting room.

Not one toddler was walking or even standing!! I had a huge epiphany, children don’t walk anymore!! So, after looking out at the parking lot in our waiting room, I watched as these strollers maneuvered around hallways and doors as mothers brought their children to an exam room. Now, I must tell you, these children were not infants, or even new walkers. They were not twins or triplets either. These strollers were often holding a 5 year old, 3 year old and 1 year old, all being pushed toward their destination. In many cases, the older children were playing with a Nintendo DSL or their mother’s iPhone oblivious to the fact that their mother was struggling to push the “wide load” down the hallway.  It was reminiscent of a Cleopatra movie, while she was being carried eating grapes! I know I'm showing my age, but what happened to the day that the baby was in a stroller while the parent held the older children’s hands as they walked into our office, or a store or a restaurant. You may have even tried to maneuver around one of these mega strollers while shopping alone.  They take up entire aisles and should have to have a “wide load” sign with flashing lights. Not only are they a “road hazard” I think that they promote inactivity. Knowing that we have a terrible problem with childhood obesity, it seems that these” strollers on steroids”, only help promote inactivity. Not only are these toddlers and young children not walking on their own, they are missing out on many learning opportunities.  How many times do you remember saying or hearing,  “hold my hand” before you started walking through grocery store the parking lot?  How about “we have to stop and look both ways” as you came up to an curb or intersection.  If there were more than 1 or 2 children it was not uncommon to hear “hold your brother’s hand and he will hold my hand and we will all walk together”. These are important skills/lessons for a child to learn as they begin to establish some independence and autonomy.  You have to learn to ”run before you walk” and you have to learn how to navigate on your own by following simple “rules of the road” for safety, all of which needs to be achieved under a parent’s watchful eye during those early childhood years. These skills cannot be mastered when you are being “wheeled” around town without the need to pay attention to what is happening around you. At the same time that a child is inactive in the stroller, they are often eating cookies, goldfish, cheerios or granola bars and drinking from the sippy cup which is conveniently strapped to the side of their seat.  The combination of inactivity and snacking cannot be a positive way to promote a healthy lifestyle. I challenge mothers and fathers to get their children back on terra firma, and to hold hands and walk with their children rather than push those heavy children around. (can’t be good for the parent’s backs either).  Talk about where you are going, what you see along the way, and practice your child’s listening skills and following directions.  Return the mega stroller to the store and get those toddlers and pre-schoolers some good walking shoes! What do you think?  Send me your comments! That's your daily dose for today. We'll chat again tomorrow. Send your comment or question to Dr. Sue!

Parenting

Is Your Child Becoming an Emotional Eater?

2:00

You may be tempted to appease your child with food after a fall or tears for short-term relief, but this could actually set your child up for long-term unhealthy eating patterns.

What happens is that children begin to identify eating with self-comforting or relieving boredom instead of nutrition or eating when they’re actually hungry.

Almost all children, teens, and adults may engage in emotional eating at one time or another.

Hunger associated with emotional eating comes on quickly and feels urgent. It's often triggered by a specific event or mood. It's not like typical physical hunger, which gradually builds and is a result of an empty stomach. Physical hunger can be satisfied by a number of different foods, but cravings usually involve particular foods. Examples might be ice cream or candy after a fight with a friend or a tough day at school.

Why is emotional eating unhealthy? Emotional eating isn’t really about hunger or nutrition; it’s about filling an emotional need. It can lead to overeating and over time, lead to extra weight gain or obesity. It also sets up a pattern of handling uncomfortable situations by eating instead of by learning how to solve social and psychological problems.

There are lots of reasons kids may seek out food for comfort such as:

  • Anger
  • Boredom
  • Change
  • Confusion
  • Depression
  • Frustration
  • Loneliness
  • Loss
  • Resentment
  • Stress

Even positive emotions such as excitement and happiness can result in emotional eating once it becomes a go-to as a reward. 

If you notice signs of emotional eating in your child, talk to him or her about your concerns. Be gentle. Stay positive. Helping your child might be as simple as having a warm and loving conversation.

Help your child develop a healthy response to his or her problems, such as focusing on solutions. Encourage your child to talk about the emotions that trigger his or her emotional eating. Brainstorm other ways to deal with those emotions. For example, your child could exercise or become involved in sports when he or she feels stressed out, or call a friend when he or she is bored.

Emotional eating can be learned, so your influence as a parent or primary caregiver is one key to prevention. Be sure to model healthy eating habits for your child. Also, avoid using food to celebrate occasions or to reward your child for good behavior. Instead, use verbal praise and give other types of rewards (for example, stickers for a young child or a fun activity with an older child).

There are signs you can look for in children to let you know if your child is an emotional eater. They are:

  • Eating in response to emotions or situations, not to satisfy hunger
  • Feeling an urgent need to eat
  • Craving a specific food or type of food
  • Eating a larger amount of food than usual
  • Eating at unusual times of day (for example, late at night)
  • Gaining excess weight
  • Feeling embarrassed or guilty about eating
  • "Sneaking" food during high-stress times
  • Hiding empty containers of food

A recent study from Norway found that kids offered food for comfort at ages 4 and 6 displayed more emotional eating at ages 8 and 10.

Also, the researchers found signs that kids who felt more easily comforted by food were fed more by parents for that purpose.

Emotional eating typically starts early in life but can really begin at any age; it seems like an easy fix for anxiety at the time, but can lead to health problems if not brought under control.

Story source: https://familydoctor.org/emotional-eating-in-children-and-teens/

Daily Dose

Don't Give In To Picky Eating

2.00 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.

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. 

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

Preschool Nutrition Can Be Challenging

With all of the back-to-school discussions surrounding getting back to healthy breakfasts, nutritious lunches and family dinners, I thought it was a good time to discuss preschooler nutrition too. 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 Web site sponsored by the U.S. Department of Agriculture. This Web site 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 Web site 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 Web site 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.

More Information: MyPyramid for Preschoolers

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DR SUE'S DAILY DOSE

Do antacids work for babies?

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