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Daily Dose

Lead Found in Baby Food

1:30 to read

I know many of the parents of the children I care for are concerned about the latest news from the Environmental Defense Fund which showed that about 20% of baby food samples tested over a 10 year period had detectable levels of lead.

 

This non profit group looked at data that the FDA had collected from 2003-2013 which included 2,164 baby food samples. While none of the baby food samples seemed to exceed the FDA’s “allowable” levels of lead, it is still quite concerning. At the same time the FDA is in the process of reviewing their standards to reflect the latest science surrounding the potential risks to young children who are exposed to lead.  

 

While lead testing is routinely performed in young children (1 and 2 yrs), the CDC currently  considers a blood lead level greater than 5 micrograms/deciliter as elevated, but no lead level is “safe”. 

 

Lead exposure has been shown to have neurocognitive effects - which means IQ, the ability to pay attention and academic achievement…and the effects cannot be corrected.

 

The study did not name baby foods by brand.  Root vegetables (carrots are one) had the highest rate of lead detection (65% of samples), followed by crackers and cookies (47%) and the then fruits and juices (29%). Only 4% of the cereal samples contained lead.

 

This report will cause a lot of parental anxiety, but really doesn’t tell us much about what to do?  Lead based paint is still the number one source of lead exposure, followed by water, which may also have contributed to lead in food…. but there is still lots of be determined.

 

In the meantime, the take home message is “feed your babies and toddlers a wide variety of baby foods” and when possible eat fresh foods. One hypothesis is that baby foods are more processed which may contribute to the higher lead content.  It is easy to cook and “mush” up your own food to feed your baby and it really does not require a fancy food processor.  If you can mush it your baby can eat it!!! The only concern about the introduction of food is basically it has to be soft enough not to be a choking hazard. So no whole nuts, chunks of meat, uncooked hard veggies…you get the idea.

 

Just because your baby doesn’t seem to like certain foods, don’t get stuck feeding them just a few foods…but continue to offer a variety of healthy foods..some of which they may eat more of than others. Every day will be different.

 

So…don’t go throw away all of your baby foods but think if you might be able to substitute fresh foods, don’t offer fruit juices to your babies and toddlers and most importantly eat healthy foods. That’s the best thing for you and your child.  

Daily Dose

Surviving Picky Eating

It's been a busy day in the office and a lot of parents have had questions about picky eaters.It was a busy week in my pediatric office (always is!) and one of the hot topics surrounded picky eating.  The issue of picky eating seems to be on every parent's list from one to 18 years. Actually, picky eating is not as much of a subject in the older kids, seems that there are bigger issues and also hopefully the picky eating resolved when the child was younger.

I think that food is important for nutrition, nurturing, time spent together over a meal, etc....but it is not a big issue if you are relaxed about feeding your child. If you begin preparing your child healthy meals from the age of one year, provide them with many opportunities to experience different foods, and realize that most toddlers are picky regardless of what you feed them, they will eventually become good eaters. Parents worry that "they will starve" if I don't fix their favorite food every night. Children are SMART and they are smarter than we are, they self regulate and eat when they are actually hungry. If you provide a well-balanced meal three times a day, most younger kids will eat one fairly well and may pick at two. That does not mean that they need a different meal when they pick or refuse to eat, it just means they are not hungry at that time and should nicely be reminded that they might be hungry later, but not forced to eat. Along those same lines, when it is snack time later in the day, they should be given something healthy (even that sandwich or fruit that they refused at lunch) and not crackers and goldfish. Again, let them decide whether to eat it. IF you take the high road on this issue, hang in there for a LONG time, you will be pleasantly surprised that they become "good eaters", eat a wide variety of foods and know that you are not the short order cook at home. Those picky toddlers continue to gain weight, learn their colors and alphabet and grow into children that enjoy mealtime together. That's your daily dose, we'll chat tomorrow.

Your Child

Healthier Choices for Students in School Lunch Lines

1:30

School lunches have changed over the years and in many school cafeterias, food options are healthier than ever before, according to a new study.

Elementary school cafeterias are offering more vegetables, fresh fruit, salad bars, whole grains and more healthy pizzas, while the availability of high-fat milks, fried potatoes and regular pizza has decreased, researchers report.

"School food service programs have worked hard to improve the nutritional quality of school lunches, and largely have been very successful," said lead researcher Lindsey Turner, director of the Initiative for Healthy Schools at Boise State University, in Idaho.

Although in some schools food choices are improving, that’s not the case everywhere. Turner noted that more work needs to be done to make sure every student has the same healthy choices in the lunch line.

In the study of more than 4,600 elementary schools that are part of the U.S. National School Lunch Program, researchers found that school lunches improved significantly between 2006-2007 and 2013-2014.

Despite improvements in food choices, disparities were still found. For example, schools in the West were more likely to offer salad bars than schools in the Northeast, Midwest or South, the researchers found.

Schools with a majority of black or Hispanic children were less likely to offer fresh fruit than schools with a preponderance of white students.

Also, schools in poor areas were less likely to offer salads regularly.

Over the course of the study, Midwestern schools slightly reduced offering pre-made salads in favor of salad bars, but Southern schools were more likely to offer pre-made salads and less likely to have salad bars, the researchers found.

On the other side of offering healthier foods is choosing to eat those foods. Just because there are better food options available, doesn’t mean that kids will eat them. One expert noted that it takes time and effort for kids to change their eating habits. It not only has to look good, it has to taste good.

"It is not only important to improve the quality of school lunches but to make these foods attractive, tasty, easily seen and accessible," said Samantha Heller, a senior clinical nutritionist at New York University Medical Center, in New York City.

Studies have found that putting fresh fruit in a nice bowl, in a conveniently located, well-lit area in the school cafeteria increased sales of fruit by 102 percent, she noted.

"A brightly lit, hot-and-cold salad bar filled with colorful fresh fruits, vegetables, beans and nuts, mushroom and spinach pizza, and veggie tacos center-stage in the lunchroom would be very attractive to students and staff alike," Heller said.

This approach works well at home, too, she added.

"Kids are more likely to grab healthy foods like cut-up melon, carrots, peppers, edamame and hummus when they are upfront and easy to grab in the fridge," Heller said.

The study was published in the journal Preventing Chronic Disease.

Story source: Steven Reinberg, http://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/america-s-school-lunches-getting-healthier-study-709097.html

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. 

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

Hot Dogs: A Choking Hazard

The AAP recommends the food industry change the shape of a hot dog as it causes choking in children. Dr. Sue says other foods are just as hazardous. Did you read the latest AAP (American Academy of Pediatrics) position statement which addressed the issue of choking among children?   Choking is unfortunately a common problem in the pediatric population and prevention of choking is a topic I discuss with all parents as their children begin eating table food.

Children under the age of 3 have the greatest frequency of choking and hot dogs are a major concern for causing choking.  Due to this, the AAP has recommended that food manufacturers “design new food and redesign existing food to minimize choking risk”. They also state that foods that pose a high choking risk (peanuts, hard candy, grapes, apples, popcorn and chewing gum) should also get warning labels. But this may sound crazy, while knowing that choking is a problem in the pediatric population, I cannot understand a recommendation to change the shape of a hot dog.  A hot dog is a hot dog and if flattened it will then be called bologna. Hot dogs are not the issue, as grapes and peanuts cause choking and we cannot advocate changing their shapes.  Rather, it seems to me to be an issue with educating parents and making parents responsible for cutting up their children’s food. Parents need to be parents and take responsibility for protecting their children but not by changing the shape of a hot dog.  Think of all of the different objects that can cause choking, coins, toys, buttons, weird small objects that toddlers find on the floor. We cannot protect our children from all small objects and at the same time, things that we have control over, such as a hot dog or a grape, should be cut into small pieces before giving them to a child.  Lollipops also cause choking and some pediatricians still give lollipops after an office visit.  Hotdogs and lollipops are just what they are, they cannot be changed. We educate parents about using sunscreen (but we did not change the sun) and we are concerned about drowning and advocate fences and pool safety, but we don’t stop going outside or playing in a pool in the summer. Keep talking to parents about the risk of choking, advocate that all parents take infant and child CPR, cut up a child’s food until they are old enough to tell you that they know how to use a knife, but don’t outlaw hot dogs.  I will eat a hotdog at the ballpark or state fair, but not bologna. That's your daily dose for today.  We'll chat again soon.

Your Teen

Energy Drinks

Just about every store you go into these days has a shelf of energy drinks, many of them marketed towards our teenage children. “Many are marketed as energy drinks but should be called stimulant drinks” says pediatrician Dr. Sue Hubbard. Many of these drinks contain large amounts of caffeine.”

Dr. Hubbard warns that too much caffeine in a teenager’s system can cause anxiety, rapid heartbeat, insomnia, nervousness and upset stomachs. “It can also mess up a child’s sleep cycle, which is not good” she says. Dr. Hubbard recommends that parents read the labels of the drinks their children are consuming. She also recommends that if you need to hydrate your child during sports or other physical activity, give them water or a true sports drink, like Gatorade, and not energy drinks.

Daily Dose

Why Family Meals Are Important

It seems so easy to have meal time together, but it needs to begin when your child are younger, so that you will continue to have family dinner time once your children are older and busier.On our last radio show I was fortunate to have the opportunity to interview Dr. Dan Kindlon the author of Too Much of a Good Thing, where he discusses the problems with overindulged children. One of the many interesting points in his book is that he reiterates the importance of family mealtimes.

During Dr. Kindlon's research he looked at common attributes among the teens that he felt were "well adjusted" and successful at both school and outside the home. One of his findings was that these students had regular family meals. It seems so easy to have meal time together, but it needs to begin when your child are younger, so that you will continue to have family dinner time once your children are older and busier. Too many families find too little time to gather for a family meal. The excuses for all of us are many: after school and evening activities, parents work schedule, homework, etc. But there are really very few reasons to skip weeknight and or weekend family meals. It may be more convenient to have meals as a family three school nights and one weekend or all school nights or some combination. But, the bottom line is, the more often families gather for meals and spend time together engagedin dinner table conversation, the better adjusted, more successful and happier the children and teens seem to be. The other great thing about family meals is that they tend to be healthier and cheaper! If youneed recipe ideas, check out What's Cooking with Chef Dad on our Web site. A family dinner is just a click away!

That's your daily dose, we'll chat again tomorrow.

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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.   

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