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Daily Dose

Baby's First Foods

1:30 to read

Have you heard of “baby led weaning” (BLW)? Many of my patients who have infants that are ready to start “solid foods”, also called complementary foods, have questions about this method. Most babies begin eating foods along with breast milk or formula somewhere around 5 - 6 months of age.  So BLW is not really “weaning”,  as your infant will continue to have breast milk or formula in conjunction with foods…so this really should more aptly be named “baby self feeding”. 

In this method you never offer your baby “mush” or pureed foods, but rather offer them foods from the table.   While I am a huge advocate of self feeding (old term is finger feeding), I also think that early on offering a baby “mushy” food on a spoon is an important milestone. In fact, for most babies at 5 -6 months, it is difficult to pick up a small piece of food to self feed as the pincer grasp has not developed. So, a baby is trying to get food to their mouths by cupping it or hoping it sticks to their hand while pushing pieces around their tray. Some parents will put the food into their baby’s hand.  But, by 8-ish months most babies have developed their pincer grasp and the finger feeding should be preferred.  

Parents are also concerned about starting solid foods and the possibility of choking.  I am always discussing how to make sure that your child avoids choking hazards with foods. In other words, no whole grapes, or hot dogs, or popcorn or chunks of meat.   Other hazards are raw carrots, apples, celery and any “hard” food that your baby might be able to bite a chunk of and then choke. But, if you cook the carrots and then cut them in small bites they are easily handled by a baby who is self feeding.  It is really all about the consistency of the food as once your baby has lower teeth they can easily bite/pry off a big “chunk” of food that could lead to a choking hazard.

Interestingly, there was a recent study that looked at the incidence of choking in children who started with self feeding vs those fed traditionally with pureed foods from a spoon. In this study of about 200 children between 6 - 8 months of age the incidence of choking was similar, while there were more gagging events in the BLW group.  Fortunately, “the choking events resolved on their own”. Gagging is quite different than choking. Some children will gag on pureed foods just due to texture issues. 

I am an advocate of what I am going to call parent led feeding followed by early self feeding of appropriate foods. By the time a child is 9 months of age they should be able to finger feeding the majority of their meals. But there are some foods that are just not conducive to finger feeding at all….yogurt, apple sauce, puddings…and they will be spoon fed until your child is capable of using a spoon which is anywhere from 12 -18 months.   But as a reminder, whenever you offer your child a finger food you should remember two things, #1 is the piece small enough that my child cannot choke and #2 is the food cooked well enough to not pose a choking hazard.  

Several years ago there was a 1 year old in our practice who was given a piece of an apple to chew on… she bit off a chunk of the apple, aspirated and died. It was a terrible accident.  I will never forget that….and re-iterate to all of my patients…a pork chop, or chicken leg or any number of foods can become a choking hazard if your child bites off a chunk. Children really don’t chew until they are around 2 years, they just bite and try to swallow so I pay a great deal of attention to what foods they are offered.

Old school and new school…the combo seems to make sense to me. 

Your Child

July 4th Food and Fireworks Safety Tips

2:00

This July 4th may be even more special than usual for a lot of families. Besides the excitement and patriotic fervor of celebrating our country’s official Independence Day, it may finally stop raining long enough for people to enjoy being outside.

However the day unfolds, you can bet there will be plenty of families and friends celebrating with good food!

Grilling is particularly popular on the Fourth as well as picnics. To make sure that the food you prepare is safe and stays safe for consumption, the USDA and the FDA offers these food preparation tips:

•       Clean: Make sure you clean all surfaces, utensils, and hands with soap and water.

•       Separate: When grilling, use separate plates and utensils for raw meat and cooked meat and ready-to-eat foods (like raw vegetables) to avoid cross-contamination.

•       Keep cold food cold. Place cold food in a cooler with ice or frozen gel packs. Cold food should be stored at 40°F or below to prevent bacterial growth. Meat, poultry, and seafood may be packed while still frozen so that they stay colder longer. 

•       Organize cooler contents. Consider packing beverages in one cooler and perishable foods in another. That way, as picnickers open and reopen the beverage cooler to replenish their drinks, the perishable foods won’t be exposed to warm outdoor air temperatures.

•       Clean your produce. Rinse fresh fruits and vegetables under running tap water before packing them in the cooler - including those with skins and rinds that are not eaten. Rub firm-skinned fruits and vegetables under running tap water or scrub with a clean vegetable brush while rinsing with running tap water. Dry fruits and vegetables with a clean cloth towel or paper towel. Packaged fruits and vegetables that are labeled "ready-to-eat," "washed," or "triple washed" need not be washed.

•       Cook: Cook foods to the right temperature by using a food thermometer. That’s the only way to know it’s a safe temperature.

•       Remember: Ground beef and egg dishes should be cooked to 160°F. Steaks, roasts, pork and fish should be cooked to 145 degrees F, and Chicken breast and whole poultry should be cooked to 165 degrees F. Shrimp, lobster, and crabs  cook until pearly and opaque. Clams, oysters, and mussels cook until the shells are open

•       Chill: Chill raw and prepared foods promptly if not consuming after cooking. You shouldn’t leave food at room temperature for longer than two hours (or 1 hour if outdoor temperatures are above 90° F), so if you’re away from home, make sure you bring a cooler to store those leftovers.

Warm weather events present opportunities for foodborne bacteria to thrive. As food heats up in summer temperatures, bacteria multiply rapidly. Safe food handling and cooking when eating outdoors is critical for your family’s health.

Most cities have banned fireworks within the city limits except for controlled displays. However, rural and unincorporated areas still allow the sale and use of fireworks by citizens.

Fireworks are now much more sophisticated and larger than mere firecrackers and sparklers; injuries associated with fireworks can be devestating. 

In 2013, U.S. hospital emergency rooms treated an estimated 11,400 people for fireworks related injuries; 55% of 2014 emergency room fireworks-related injuries were to the extremities and 38% were to the head. The risk of fireworks injury was highest for young people ages 0-4, followed by children 10-14.

On Independence Day in a typical year, far more U.S. fires are reported than on any other day, and fireworks account for two out of five of those fires, more than any other cause of fires.

The Consumer Product Safety Commission recommends these fireworks handling safety tips:

•       Never allow young children to play with or ignite fireworks.

•       Avoid buying fireworks that are packaged in brown paper because this is often a sign that the fireworks were made for professional displays and that they could pose a danger to consumers.

•       Always have an adult supervise fireworks activities. Parents don't realize that young children suffer injuries from sparklers. Sparklers burn at temperatures of about 2,000 degrees - hot enough to melt some metals.

•       Never place any part of your body directly over a fireworks device when lighting the fuse. Back up to a safe distance immediately after lighting fireworks.

•       Never try to re-light or pick up fireworks that have not ignited fully.

•       Never point or throw fireworks at another person.

•       Keep a bucket of water or a garden hose handy in case of fire or other mishap.

•       Light fireworks one at a time, then move back quickly.

•       Never carry fireworks in a pocket or shoot them off in metal or glass containers.

•       After fireworks complete their burning, douse the spent device with plenty of water from a bucket or hose before discarding it to prevent a trash fire.

•       Make sure fireworks are legal in your area before buying or using them.

The Fourth of July is definitely one of the most treasured holidays for Americans, make sure your family has a safe one!

Sources: http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm109899.htm

http://www.cpsc.gov/en/Safety-Education/Safety-Education-Centers/Fireworks/

 http://www.nfpa.org/safety-information/for-consumers/holidays/fireworks

 

 

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 Toddler

Uncut Grapes Can Choke Young Children

1:30

While good nutrition involves plenty of fresh fruits and vegetables, there’s one fruit that should not be given to children 5 and under; grapes.

Uncut grapes are dangerous for young children because their size and smooth texture can cause choking and even death.

There have already been three choking cases in Scotland, out of which two turned out to be fatal, involving boys who were 5 or younger.

A report published in the journal Archives of Disease in Childhood notes that food is responsible for more than half of the choking incidents, which end in deaths when it comes to children under the age of 5.

"There is general awareness of the need to supervise young children when they are eating ... but knowledge of the dangers posed by grapes and other similar foods is not widespread," noted Dr. Jamie Cooper, co-author of the report, from the emergency department at Royal Aberdeen Children's Hospital.

According to the same report, there is no awareness concerning the specific risks that soft fruits raise, and the relatively small numbers of cases per hospital, which occur every year, don't fully reflect the extent to which this issue can affect young children.

Kids that have choked on grapes don’t often make the news, but according to research conducted in the United States and Canada, grapes occupy third place when it comes to deaths caused by food-related incidents, after hotdogs and sweets.

There are two reasons why grapes are so dangerous, especially in very young children: first, because the airways of the children are small and their swallow reflex is not fully developed, and second due to the smooth texture of the fruit.

Other foods with similar texture can pose a choking hazard, such as tomatoes.  Health experts suggest that grapes and tomatoes be cut in half twice. Anytime a child (or an adult for that matter) is eating uncut grapes or small tomatoes they should pay attention to their eating and not mechanically pop them into their mouths – like when watching TV or playing video games.

Grapes and tomatoes are good sources of fiber and healthy nutrients, just make sure that your little one has his or hers’ cut up so they are not easily choked when eating them.

Story source: Livia Rusu, http://www.techtimes.com/articles/189851/20161224/grapes-as-a-choking-hazard-doctors-say-lack-of-awareness-puts-young-children-at-risk.htm

 

 

Daily Dose

No Tech at the Table

1.15 to read

I am a huge proponent of family meals and Chef Dad Tom Fleming is always supplying The Kid’s Doctor with new family friendly recipes. I think many families are now trying to “make the time” to eat together at least several nights a week.  Kudos to those families! 

The problem that I am now seeing is that while families are trying to make a point to eat together, the meal is suddenly being invaded by technology! What I mean by this is that everyone is coming to the table with their smartphone, tablet, iPod, Nintendo DS or any other gadget or gizmo which allows one to be “disengaged” during mealtime. 

I certainly remember many a family dinner where I could barely get three words out of any of the boys (they would tell me that they had already used up their 700 words that day), despite the numerous “open ended” questions that I peppered them with.  We would even try to play those games like, “best thing that happened today” or “worst thing that happened”, I think the Obamas call this “thorns and roses” as they too enjoy families meals. 

With 3 sons and a husband I sometimes felt like it might be possible that those 4 males would eat together and never even say a word. (they tell me that when I was gone this was often the case and they did not view that as a problem!) 

At any rate, part of the value of the family meal is conversation and that means with those who are gathered at the table. Emailing, texting, game playing etc. during dinner needs to be not only discouraged but forbidden. That goes for both the adults (me included) and the children. 

I realize that there are many important world events happening during meal time…one might miss some one’s post on facebook, or a tweet or a text for a few minutes. But the need for continuous information from a gadget, or constant communication via texting does not have a place at the family meal. 

It used to be that we talked about no TV during meals. I remember that rule was rarely broken during my childhood except for events like the Kennedy assassination or the men landing on the Moon.  For our family we tried to continue the same rule and it was broken for events like Super Bowl, early space shuttle launches and landings and for terrible tragedies like 9/11. But we tried to keep the TV out of the dining area.  

I now I find that I have to remind my children and myself to “check all electronics” at the door before coming into dinner. If I don’t, I sometimes look down the family table and see heads bent looking at a sports score, or replying to a text about a party later that night or reading an email about work (me included). But if we all just leave the gadgets turned off/silenced and away from the table the conversation gets going. 

There is not such a rush to “go to the next event” and the work issues are put aside for 15 - 20 minutes. We can enjoy the rare occasion that all 6 of us get to be together and actually converse in real time. The time a family can spend together talking over breakfast, lunch or dinner is too important and precious to be shared with others not present until the meal is over. 

So, start the rule, No Tech at the Table, and enjoy family mealtime.   

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

Diagnosing Food Allergies

1.15 to read

Food allergies continue to be a problem in the pediatric population and I often get calls or see a patient for an office visit with a parent who has a concern that their child “may have” reacted to something they ate. Their question is, are they allergic?  

There is a great resource for physicians entitled “The Guidelines for the Diagnosis and Management of Food Allergy in the United States”.  Not all adverse reactions to foods are allergic and it sometimes takes a bit of “detective work”, which is a good history and physical exam, to begin to determine if a child has a food allergy.   

So, when a parent tells me that their child gets a rash on their chin or cheek after eating “xyz” food the questions begin.  Was it the first time they had ever been exposed to that food? Describe the rash and how the child was acting?  Did they have other symptoms with the rash? Was the rash just on a cheek or was it all over? Was it hives? This list of questions go on and on.   

The most common food allergens are egg, milk, peanut, tree nuts, wheat, shellfish and soy. I also ask if this was a one time occurrence, and  If they have tried the food again did it happen every time? Many times hard to tease out what a child has had to eat when they have a mish-mash of food on their plate and nothing is new!  

Is there a family history of allergy or asthma?  Does your child have eczema as well?  If so there is a greater chance of developing a food allergy.  

After a detailed history, and if I do think that the child has a good history for a food allergy, there are tests (skin prick and blood) that may help determine if an allergy may exist.  BUT, with that being said, there are several caveats.  Number one, your doctor should not test for “every” food allergen, only for the suspected food or foods, as there are many false positive tests when you just check all of the boxes for testing IGE levels for an allergy.  For example, if your child eats eggs and has had no problem but the IGE level comes back a bit high for egg allergy, what does that really mean?  In other words, I just test for the suspected culprit. So, I do not test for tree nuts if the parents only had concerns with a peanut product.   More to come on this topic. 

Daily Dose

Changes Are Coming In Infant and Baby Feeding Recommendations

In early 2010, The American Academy of Pediatrics is going to be announcing revisions to long-standing infant feeding recommendations. From what I have been reading there will be lots of changes ahead in how foods are going to be introduced to babies.

A new study to be published in Pediatrics in January 2010 finds that delaying introduction of certain foods may actually contribute to the future development of food allergies. Studies have continued to show a rise in food allergies despite previous recommendations to limit intake of certain foods in younger children in hopes of reducing the incidence of food allergies. This study was performed in Finland, and researchers there found that children introduced to certain foods later in infancy were more likely to become sensitized to that food, and therefore had an increased risk of developing a full blown allergy. For as long as I have practiced it has been recommended that infants receive breast milk or formula exclusively for the first six months of life. After the first six months, it is recommended that an infant begin rice cereal after which vegetables are typically introduced. Foods are typically introduced one at a time for several days before adding the next new food. Most infants receive vegetables, followed by fruits and then meats. In this study over 900 children were followed from infancy. By the age of five, 17 percent had food allergies. 12 percent were sensitized to cow’s milk, 9 percent to eggs, 5 percent to wheat and 1 percent to fish. Later introduction of some foods actually increased the likelihood that a child would be sensitized to that food by the time they were five-years-old, whether their parents had allergies or not. This was fascinating as it was in exact opposition to previous thoughts that later introduction of foods might decrease food allergies. The later introduction of food and subsequent allergy development was greatest for eggs if introduced after 10.5 months of age, for oats after 5 months and wheat if introduced after 6 months. So, bottom line, this study suggests that for children who are at risk for developing allergies, earlier introduction of food may actually prevent sensitization from occurring. There will be more studies to come with randomization of children in a double blind manner to see if these results will be duplicated. This subject is going to be big in 2010, so watch for more! That’s your daily dose, we’ll chat again soon.

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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