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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

Family Dinners Help Fight Obesity

1.15 to read

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

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

Daily Dose

The Obesity Epidemic Continues

The obesity epidemic continues with no end in sight. It is one of our major public health problems and the ongoing health care concerns of patients with obesity are well known. There have been many different studies looking for a biologic basis for obesity. There is a new study just released from the International Journal of Obesity that suggests that there is behavioral link for obesity.

In the study 226 families, both children and their parents were followed over three years with serial height and weight measurements. The results showed that obese mothers were 10 times more likely to have obese daughters, while obese fathers had a six-fold chance of having an obese son. In both cases, children of the opposite sex were not affected. Researchers therefore believe that the link for obesity may be behavioral rather than genetic. It would be very unusual to have genetics influence children only along gender lines. Rather, it seems that there may some form of “behavioral sympathy” related to becoming overweight. It seems that daughters copy lifestyles of their mothers, and sons their fathers. Looking further, researchers noted that eight in 10 obese adults were not severely overweight or obese when they themselves were children. In other words, the parents are passing their eating habits and behaviors on to their children, which brings us back to “modeling behavior”. I bring up the discussion of eating habits and nutrition when children are beginning their first table foods. Parents want to feed their children healthy foods, but they also worry if their child will not eat what the parent has prepared. Starting from the first foods the “notion” of eating healthy needs to be positively re-enforced. One way to do this is by preparing meals together which can teach cooking skills along with making healthy food choices. The idea that our children are going to like everything that we make, or clean their plates is obsolete. I think that our job as parents is to provide good food choices, a happy family mealtime and to be models of healthy eating. With this should come daily exercise. This study seems to confirm that it may be nurture, not nature that is contributing to the worldwide obesity problem. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Danger in BPA Bottles

2.00 to read

I have been getting plenty of question about BPA in baby bottles.I recently received an email from a parent who’s 4 year old son is a patient of mine, and she is pregnant and due with a baby girl in the next month. On top of all of that she is also a pediatrician. At any rate, her question was regarding BPA (bisphenol A) in bottles, and whether I thought she should throw out bottles that she had used with her son in favor of newer bottles.

I will tell you that her son is a perfectly delightful, bright, inquisitive and developmentally normal little boy and he received breast milk and formula from BPA containing bottles. With that information, and knowing that I am thrifty, I thought long and hard and decided that in my opinion I would toss the old bottles in favor of the newer BPA free bottles. The top manufacturers of baby bottles voluntarily stopped using BPA in their bottles at the end of 2008. These bottles include, Dr. Brown, Avent, Playtex, Evenflo and numerous others. It is easy to find BPA free bottles that are well marked and most large chain stores are no longer selling your-baby bottles containing BPA. The cost involved to replace old bottles seems minimal, and the data regarding the safety of BPA to infants and children continues to be released with more ongoing studies underway. There will be more data available in the coming months and years. The Endocrine Society who held their annual meeting last week presented “worrying” evidence about the effects of BPA , including the statement that “endocrine disruptors (which includes BPA) do have effects on male and female development, prostate cancer, thyroid disease, and cardiovascular disease”. There are concerns that infants and children may be particularly susceptible to BPA and possible long term effects on brain development and behavior. So, with these recent studies and more concern regarding the levels of BPA found in baby bottles as well as comparison data of exposure to BPA between breast and bottle fed infants, it seems prudent to me to purchase newer bottles that are BPA free. Cross this issue off of the mother worry list. The cost of new bottles is minimal as compared to future concerns about BPA. That's your daily dose for today. We'll chat tomorrow!

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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

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.

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