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Your Toddler

What’s In Infants and Toddler’s Prepackaged Food?

2:00

As a parent, you may have assumed that pre-packaged food for infants and toddlers surely must be healthy; I mean really, what kind of a company would knowingly put these innocents at risk for long-term health issues? If that has indeed been your assumption, then you may be surprised to learn the results of a new study using a comprehensive analysis of foods sold for infants and toddlers by the Centers for Disease Control and Prevention (CDC).

However, if you’ve ever read the confusing Nutritional Facts list on such products, you may not be surprised at all.

The health culprits contained in children’s food products are sugar and sodium. A little is fine, too much is a health disaster waiting to happen in the form of diabetes, obesity and heart disease. The harsh reality is that some of these products have more sodium and sugar in them than adult food products.

We’re not talking about natural sugars and sodium contained in food, but added sugar and salt to make the foods “taste better”.

The CDC’s study showed that about one-third of prepared dinners made for toddlers contained at least one kind of added sugar as well as 97% of breakfast pastries and cereal bars. Researchers found that 88% juices and other drinks marketed for infants and toddlers contained added sugars.

On the sodium spectrum, 72% of toddler dinners were found to be way over the recommended limit, with an average of 2,295 milligrams of sodium per meal. The Institute of Medicine recommends that toddlers consume no more than 1,500 mg of sodium per day.

Some foods marketed to infants and toddlers had more sodium than comparable adult foods. Among 34 types of savory snacks for infants and toddlers – a category that includes crackers, some types of rice cakes and mini-hot dogs sold in jars – the average concentration of sodium was 486 mg per 100 grams of food. In comparison, salted potato chips intended for adults have about 450 mg of sodium per 100 grams, the researchers noted in their study, which was published by the journal Pediatrics.

When you take a hard look at what children are eating these days, and the lack of recommended physical activity, it’s no surprise that 23% of American kids between the ages of 2 and 5 (yes, that young) are either overweight or obese. With the added sodium in their diets, obese children are at an increased risk of high blood pressure, which can lead to heart disease (the No.1 cause of death in the U.S.), and other health problems. These health issues are starting to show up in teenagers, where once they didn’t develop till much later in life.

The CDC researchers set out to better understand the amount of sodium and sugar in prepared foods designed for infants and toddlers. They scoured a commercial database that includes nutrition information on more than 200,000 prepared foods. They also walked the aisles of Wal-Marts, Targets, Costcos and supermarkets in the Atlanta area to find additional products for their analysis. Altogether, they included 1,074 food items for infants and toddlers in their sample.

The good news is that not all of their findings negative. For instance, among 657 infant vegetables, fruits, dry cereals, dinners and ready-to-serve items that combined mixed grains with fruit, all but two were considered low in sodium. In addition, more than 80% of the 582 fruit, vegetable, soup and dinner items for infants had no added sugars.

However, food content began to change after kids turned 1 and moved on to toddler foods. Cereal bars, fruit and dry fruit snacks for this age group were still low in sodium, but most contained at least one type of added sugar. The most common additive listed was “fruit juice concentrate”, a somewhat creative name for squeezing out most of a fruit’s water and fiber so that only the fruit sugar is left.

The authors of the study expressed concern that starting children on high sodium and sugar foods when they are little could set them up for a lifetime of poor eating habits.

So what can you do as a parent? Become a label investigator before purchasing pre-packaged food for your child (or yourself for that matter).

When reading the Nutrition Facts label on a food, check for four things:

·      How many servings are contained in the product. Oftentimes a product – even a small one- contains more than one serving.

·      The sodium content per serving

·      The sugar content per serving

·      The list of ingredients.  Added sugars may have names such as high fructose syrup, corn syrup, fruit juice concentrate, maltose, dextrose, sucrose, honey and maple syrup. Added sodium may be listed as monosodium glutamate (MSG), sodium nitrite, and sodium bicarbonate (baking soda)

Look at where these items fall in the list of ingredients.  Ingredients are listed in order of the quantity they contribute to the overall food. When you see any ingredient listed first or at the top of the list, there’s a lot of it in the food.

For this study, the data on sodium and sugar came from the Nutrition Facts labels that appear on food packages. These aren’t necessarily accurate because the U.S. Food and Drug Administration allows the figures on the label to be off by as much as 20%, the researchers noted. 

Source: Karen Kaplan,  http://www.latimes.com/science/la-sci-sn-infant-toddler-foods-salt-sugar-20150202-story.html

Daily Dose

Food Textures

1.30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

Daily Dose

Infant Food Recommendations May Be On The Way

A new year has begun and with that there often come changes, one of which may be in how infants are introduced to solid foods.

The American Academy of Pediatrics (AAP) has recommended that infants be fed breast milk or formula exclusively before beginning solid foods between four and six months of age it is typically recommended that infants begin spoon feedings with an iron fortified cereal, such as rice cereal. After a baby has “learned” how to eat cereal from a spoon, other foods are started typically beginning with vegetables, followed by fruits and then meats. For many years I was taught that women who exclusively breast fed their infants for the first six months of life might be able to prevent allergic disease in their children. This was especially recommended for mothers who had a strong family history of allergies. Many pregnant and nursing mothers also restricted their dietary intake of peanuts, shellfish and other foods in hope that this too might help reduce allergies in their offspring. For many years it was recommended that children also be restricted from eating peanuts in hopes of preventing peanut allergies that were suddenly on the rise. What we did find is that we reduced the incidence of choking episodes from peanut aspiration, but peanut allergies continued to rise and I have no idea what children were eating for lunch seeing that my own children were raised on peanut butter and jelly sandwiches (cut in triangles I might add). Those recommendations changed several years ago, although many mothers still balk when I recommend peanut butter for their toddlers. Now, a study out of Finland, published in the December issue of Pediatrics Online, showed that the late introduction of solid foods is associated with an increased risk for allergic sensitization to foods and inhalant allergies in children at five years of age. Scientific evidence for delaying food introduction now seems to be pointing in the opposite direction. This study actually showed that by delaying the introduction of eggs, milk and cereal children were at increased risk for developing atopic dermatitis (eczema). The late introduction of fish and potatoes (go figure that one) led to more inhalant allergies. This was determined by drawing IgE levels in children at 5 years of age. So, there will be a lot of new studies being done to try and reproduce the Finnish data. New recommendations about infant feeding are already forthcoming from the AAP and should be published in February. In the meantime, I would not worry about introducing foods to your baby after five to six months of age as long as they are pureed and easy to swallow. You can still wait several days between starting new foods, but no need to be as limiting. There are many foods that we eat including numerous fruits and vegetables that may be pureed in a Cuisinart or blender or even mashed with a fork that are not offered in typical baby food jars. Why not feed your baby black eyed peas (remember we all need good luck), or avocado or mashed potatoes when you are fixing these foods for yourself. The broader the palate as an infant may encourage less picky eating later on. Stay tuned for more on this subject. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Do You Have a Happy Spitter?

1.15 to read

New parents often come in concerned about their baby spitting up.  They typically  ask, “does my baby have gastroesophageal reflux (GER)?”.  I reassure them that “spit happens” and it occurs in more than 2/3 of perfectly healthy infants.  Whether you want to call it GER or spit up, it is regurgitation and in most cases it goes away with time. 

GER is defined as “the physiologic passage of gastric contents into the esophagus”, while GERD is “reflux associated with troublesome symptoms or complications”.  GER in infants is typically painless and does not affect growth. We call these babies “happy spitters”.  

For a “happy spitter” parents need to know that spitting gets worse before it gets better and typically lasts for 5-6 months, with the worst spitting occurring around 3-4 months of age.  

The best treatment for benign GER is lifestyle management.  Small things like thickening feedings with either rice or oatmeal cereal will often decrease the volume of spit up ( parents get sick of wearing towels over their shoulders). Thickening feedings does increase the calories a baby receives. There are also formulas available that contain thickening agents if parents prefer trying them that have the same amount of calories as other formulas.  Thickening feeds has been shown to decrease crying time in some irritable infants with GER and also increases sleep time for fussy babies.  It is always worth trying.

While many parents try putting their baby in a car seat to help with reflux and spitting, car seats may actually make the problem worse. Infants have less reflux when in the prone (tummy) position, but remember your baby must NEVER sleep on their TUMMY!

Babies who are spitters may also benefit from smaller more frequent feedings. When a baby is fussy, parents may try to keep feeding their baby and overfeeding may actually make the spitting worse. Just because a baby is crying, does not always mean they are hungry, especially if they have just been fed.  Sucking in and of itself may help reflux, so a pacifier may be the trick and provide non nutritive sucking.

For babies with GERD who are extremely irritable, may refuse feedings and even lose weight further work up and management with pharmacotherapy may be necessary.  Talk to your doctor about options if lifestyle management does not seem to help. 

Your Child

What Food is Best for Your Child's Breakfast?

1:30

What’s the best choice for your child’s breakfast? According to a new study, eggs. Researchers found that children who eat eggs for breakfast tend to consume fewer calories at lunch and benefited from the protein and vitamins they provide.

The study looked at 40 eight to ten year olds who ate a 350 calorie breakfast-of eggs, porridge or cereal. Between breakfast and lunch they played physically active games.

The children were asked throughout the morning how hungry they were and parents kept a food journal of what else the children ate.

The research, led by Tanja Kral of the university’s Department of Biobehavioural Health Science, found children who ate the eggs for breakfast reduced their calorie intake by about four percent (70 calories) at lunch.

The scientists noted that children who regularly eat more than their daily calorie limit could gain weight, leading to obesity. Eggs contain about 6 grams of high quality protein and are a good source of vitamins and amino acids.

 "I'm not surprised that the egg breakfast was the most satiating breakfast," said Kral. He was however, surprised that the children said that the egg breakfast didn’t actually make them feel fuller than cereal or oatmeal even though they ate less at lunchtime.

”It's really important that we identify certain types of food that can help children feel full and also moderate caloric intake, especially in children who are prone to excess weight gain.“

The study was published in the International journal, Eating Behaviours.

Source: Emma Henderson, http://www.independent.co.uk/life-style/health-and-families/health-news/best-breakfast-for-children-eggs-what-is-scientists-research-a6850501.html

 

 

Daily Dose

Plate Size & Childhood Obesity

1.15 to read

While I have been trying to change up my eating habits a bit and talking to patients about trying some new foods, I came upon an interesting study in the journal Pediatrics.  

The hypothesis for the study, which was done among school children in Philadelphia, was “can smaller plates promote age-appropriate portion sizes in children?”.

There have been previous studies in the adult literature that have shown that dish ware size influences self-serve portion sizes and caloric intake. Whether the same conclusions with children were true had yet to be examined, but it does make sense that it might.

So, the hypothesis was correct and when children were given larger bowls, plates and cups, they served themselves larger portions and in turn more calories. In the study, 80% of the children served themselves more calories at lunch when using adult-size plates and bowls.

This is really great news, in that by changing the size of the plate we might be able to affect a child’s portion size without them even really being aware!

I remember that our kids all had children’s bowls, plates and cups that they loved to use and eventually they either broke, got lost, or we just decided to have everyone eat off of the same plates. But, maybe it would make more sense to continue to have our children use child sized plates until they reach puberty?  Certainly seems that it wouldn’t hurt and if schools did the same thing we might be able to impact some of the obesity problem by just changing one behavior.  It is definitely worth trying!

Daily Dose

The Importance of Vitamin D

As I start a new week and head to the office on a Monday morning there is some new news that will affect my daily practice. I have always been a big proponent in the need for children of all ages to drink milk to ensure healthy bones. We have talked about the concept of "banking your calcium" so that your calcium stores are growing while you are young and are "fully funded" by your 20s to ensure enough calcium for withdrawal later in life. The worry about this calcium issue is that many children do not drink milk or get enough dairy and that they may end up being adults with osteopenia and osteoporosis. Milk is also vitamin D fortified.

Now there is new data to show that children also need more vitamin D than previously thought as vitamin D may not only be involved in keeping bones healthy, but may also be beneficial in reducing risks of cancer, diabetes, and heart disease. It was previously recommended that children and adults to age 50 years needed 200 units of vitamin D daily. The new recommendations will be 400 units per day. So, exclusively breast fed babies will begin taking a vitamin supplement, and all of those children who are not drinking milk will also need calcium plus vitamin D supplement. The problem with this is getting mothers and children to remember to take a vitamin supplement. I have always recommended calcium for my patients who are not milk drinkers, but I have found that they rarely continue to take them more than several weeks to months and then they sit on the counter. This is especially true for tweens and teens who have rapidly growing bones too. Here is more information to support the need for vitamin D, so drink that milk, get some sunshine everyday and make sure you get 400 units of vitamin D a day. That's your daily dose, we'll chat tomorrow!

Daily Dose

Childhood Obesity

1.30 to read

Everyone knows that obesity is on the rise and it is often beginning in childhood.  During well-child visits (and often during a visit for colds or flu) parents often bring up a child’s weight.  By using growth charts it is fairly easy for the doctor to show a parent and child where they fall on the growth curve and BMI (body mass index) curve as well. When discussing weight issues it is sometimes difficult to decide what terms are appropriate to use.

A study just published on line in Pediatrics surveyed 445 parents of children 2–18 years of age to assess what are perceived to be the most appropriate terms to be used when discussing weight issues in a child. The study, done at Yale University, was interesting in that more than 60% of parents said that referring to a child as “extremely fat” or “obese” would be “most stigmatizing and the least motivating terms to encourage weight loss.”

In this study, American parents preferred that terms such as “unhealthy weight”, “weight problem” or “being overweight” be used to discuss weight issues and that these terms would also be more motivating for weight loss.

In the same study about 36% of parents said that they would “put their children on a strict diet” in response to weight stigma from a doctor. This is concerning as well as since research has shown that severe dieting and restriction of calories in young children may backfire and may at times lead to other issues including eating disorders.

Whether we call it an unhealthy weight or being overweight or even using the term fat probably depends on each family and their own preferences. But whatever we call it, the topic should be addressed at each well child visit. The basic tenets of a healthy body weight still depend on eating a well balanced diet and getting daily exercise. Why does that sound so simple?

The easiest way to start to control weight gain is to begin with good habits when your children are young. If children are raised from their toddler years with a wide variety of healthy foods presented to them at meal and snack time, they will learn to enjoy these foods. “Grazing” should be discouraged and discussions should not be about “what you will or won’t eat” but rather about gathering for family meals and enjoying the time together. Parents needn’t be “short order” cooks, a child will eat if they are hungry and given the opportunity. But by offering a limited variety of foods and preparing just a few items that a child “likes” the stage is already being set for poor eating habits down the road.

Our job as parents is to provide healthy meals (and snacks) to our children, while the children will have to decide whether or not to eat it. There will be days that they are getting their favorite foods and others that they may not, but in the long run they will be a better and healthier eater. It would be nice not to have to figure out the correct term to use for being overweight or even obese.  Maybe we can cure it in the next generation and the terminology will become obsolete!

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Diagnosing Diabetes

1.15 to read

I often see parents who come in worried that their child might have diabetes. I thought this would be a great opportunity to discuss the symptoms of type 1 diabetes, which was previously known as juvenile onset diabetes. 

While there is much in the news about type 2 diabetes, which is typically related to childhood obesity, the mystery of type 1 diabetes has not yet been totally elucidated. Type 1 diabetes affects about 1 in 400 children and adolescents. There does seem to be a genetic predisposition (certain genes are being identified) to the disease and then “something” seems to trigger the development of diabetes. Researchers continue to look at viral triggers, or environmental triggers (such as cold weather as diabetes is more common in colder climates). Early diet may play a role as well, as there is a lower incidence of diabetes in children who were breast fed and who started solid foods after 6 months of age.   

In type 1 diabetes the pancreas does not produce enough ( or any) insulin. Insulin is needed to help sugars (glucose) in the diet to enter cells to produce energy.  Without insulin the body cannot make enough energy and the glucose levels in the blood stream become elevated which leads to numerous problems. Children with type 1 diabetes are often fairly sick by the time they are diagnosed.  

The most common symptoms of type 1 diabetes are extreme thirst (while all kids drink a lot this is over the top thirst) frequent urination ( sometimes seen as new onset bedwetting with excessive daytime urination as well), excessive hunger,  and despite eating all of the time, weight loss and fatigue.  

Any time a child complains of being thirsty or seems to have to go the bathroom a lot, a parent (including me) worries about diabetes. But, this is not just being thirsty or having a few extra bathroom breaks or wetting the bed one night. The symptoms worsen and persist and you soon realize that your child is also losing weight and not feeling well. 

Although diabetes is currently not curable, great strides have been made in caring for diabetics and improving their daily life. I now have children who are using insulin pumps and one mother has had an islet cell transplant. The research being done is incredible, and hopefully there will one day be a cure. 

In the meantime, try not to  worry every time your child tells you they are thirsty or tired, as all kids will complain about these symptoms from time to time.  But do watch for ongoing symptoms.  

Lastly, eating sugar DOES NOT cause type 1 diabetes. Now it may lead to weight gain which can lead to type 2 diabetes....but that is another story. 

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