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Daily Dose

Don't Let Your Child Become an Obesity Statistic

Healthy eating begins with the first foods that you feed your infant.An alarming statistic was released today which shows that one in five 4-year-old children are obese and these numbers are even higher in minority children. This study was just published in The Archives of Pediatric and Adolescent Medicine, and followed over 8,000 children looking at height and weight. The findings were quite concerning, showing a trend toward obesity at an age younger than predicted, and numerous long term health problems associated with obesity, such as heart disease, diabetes, high blood pressure and bone and joint problems.

This is a national health issue and a call to action for all families to teach and model healthy eating. One of the problems is that many of the government sponsored food programs provide foods high in carbohydrates, and low in fresh fruits and vegetables, and this promotes obesity. School lunches have also been found to be high in fat and carbohydrate and continue to promote poor food choices. With the bad economy and recession, families have cut back on groceries and may be eating more fast foods, breads and pastas, again providing more carbohydrate than protein. Healthy eating begins with the first foods that you feed your infant. A well balanced diet with grains, fruits, vegetables and meats begins in the high chair and should continue at the family dinner table. The meals may be simple and healthy. Being a short order cook, or providing your child's favorite pizza and fried food on a daily basis, even in a young toddler will have deleterious effects for the rest of their life. Don't let your child become a statistic heading toward lifelong health issues secondary to childhood obesity. Change your own eating habits, improve your children's and remain committed to family meals. We, as parents, cannot afford to raise a generation where obesity is the norm: the change must begin now. That's your daily dose, we'll chat again tomorrow. More Information: 1 in 5 Preschoolers Obese

Daily Dose

Introducing Finger Foods

We had a recent question: how to introduce finger foods?The Kid's Doctor iPhone App is great and we are getting a lot of good questions that I will continue to answer! One mother (Samantha) wrote in asking about beginning finger foods for her 11 month old.  She wasn’t sure what she could offer her daughter.

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Finger feeding is a very important developmental milestone for babies and usually begins around 8–10 months of age, depending on your baby and their interest. You often realize that while you are trying to spoon feed a baby of that age, that they are reaching out to grab the spoon or grabbing at your fork as you put something into your own mouth.  This naturally occurs as you baby explores the environment around them, and they are always putting things into their mouths, so it would seem logical to start finger foods. The easiest way to start finger feeding with your baby is by giving them small pieces of “mushy” food that you are already feeding them, but rather than putting it on a spoon to feed them, put the food on their high chair tray and watch them as they “scoop” it into their hand and then it goes straight to their mouths. Every child is different too. So, some immediately love putting foods with texture into their mouths and will happily feed themselves almost anything. Then there is another group that doesn’t like the “texture” or feeling of having non pureed food in their mouths. This group happily picks up the food, but once it hits their lips, out is comes as if it was some sort of “poison”. As with so many things, every child is different, so don’t push it, but at the same time continue to offer bite sized pieces of mushy table food.  Let your child explore the textures of different foods as this is integral to becoming familiar with different textures.  It is easy to let a child’s natural hunger help drive them to taste things too, so while you are preparing their meal, put a few things on their tray and see how they do with finger feeding. There are really no “rules” as to what you can give to your child for finger foods, as long as the food is well cooked, soft, and is in small bite sized portions. Children (similar to old folks “without their teeth”) don’t chew their food, but gum it, so you need to be aware of offering foods that might pose a choking hazard.  So any fresh vegetable that is well cooked, like carrots, green beans, peas and corn are easy for a baby to pick up and eat. Same thing for fresh fruits, with blueberries and pieces of ripe pineapple, or kiwi, or banana.  It is easy to offer a baby the “over ripe” fruits that you previously threw away as being too mushy. Babies love it all and truly need to experiment with the different textures of foods.  Other good things to try are pieces of pancake, pasta, scrambled eggs and beans and rice.  Do NOT offer peanuts, popcorn, hard candies,  chips, or chunks of meats, as these may cause choking and aspiration risks. By the time your child is around 1, they will really be mostly finger feeding and you will only be spoon  feeding the yogurt, applesauce, cereals that cannot be easily finger fed. By that time too your child will no longer be “scooping” the foods, but they will be using their pincer grasp and are quite agile at getting everything in their mouths.  The next milestone will be as your child begins spoon feeding themselves!! That's your daily dose.  We'll chat again tomorrow! Send your question or comment to Dr. Sue!

Daily Dose

Introducing New Foods To Your Child

When to introduce new foods to your child's diet.There are so many questions (including Megan's via our iPhone App) about “when” you can feed a child different foods.  More and more information is being published on this subject and the “older” recommendations around withholding certain foods from children have recently changed.  Actually, they have changed about 360 degrees!

Like so many things in medicine and life in general, “nothing stays the same”.  When I was beginning foods with my own young children we always started with them eating rice cereal and added vegetables, fruits and then meats.  The recommendations ( I don’t know if they were actually via the doctor or my friends) were to try a new food every 2 – 3 days.  We were not very “sophisticated” then either and there were only about 7 vegetables in the Gerber section and about the same number of fruits. I don’t think “organic” was even a word.

Over the years, as food allergies seemed to become more common,  there were newer guidelines which recommended restricting certain foods from a child’s diet.  In  theory it was thought that by delaying a child’s exposure to a food group,  they would have a more mature GI tract and immune system and therefore might not develop food allergies. There were even some doctors recommending that pregnant and breast feeding women avoid certain foods too.   At the time, this seemed very restrictive to me, and by now my own children were living on peanut butter and fish sticks (both newly forbidden foods).  I don’t think many of the children born in the late 90’s ever saw a jar of Skippy. In the past 2 years the theories regarding delayed introduction of foods have been “de-bunked” and we the pediatricians are returning to a more relaxed approach to feeding infants.  It seems that keeping children away from peanut butter and fish and eggs really did nothing to slow down the development of food allergies.  What it seemed to do was to make new parents quite uneasy about introducing new foods and many children were eating “less healthy” foods by avoiding some food groups. Currently, I recommend that parents begin feeding their infants solid foods at about 5 – 6 months of age. It seems logical to me to start cereal, as a baby is usually happy in the morning at breakfast time, and that is a good time to begin spoon feeding. In reality it does not have to be cereal. There is some data that we should start protein first (meat, hmmm….breakfast sausage for babies?). I then begin vegetables, simply because of taste, again with the thoughts that a baby will not eat carrots when given sweet pears first, but I really don’t think there is any study to substantiate that belief.  Then we just “plow” ahead with almost any food that can be pureed or mushed to spoon feed a baby.  So many mothers are making their own baby food, and that is really quite easy for certain foods.  There are now many more selections in the baby food aisle and babies are happily eating avocado, mango, beets, lentils and so on. There is not a “FORBIDDEN” food, except for CHOKING issues.  So, peanut butter, cashew butter and almond butter are great sources of protein.  So too are bits of flaky fish such as salmon and tilapia.  By the time a baby is 8 -9 months old they are ready to explore some mushy finger foods too, and this does not have to be limited to cheerios, goldfish and puffs.  Pieces of overripe fruits (any kind) cut into small bits are great.  So too are noodles and sauce (tomato is fine) as well as eggs. Unless you have another child with definite food allergies I would try everything.  The more foods your baby is exposed to the broader range of tastes and textures they will have tried.  Just remember to cut everything into tiny pieces and offer a little bit at a time.  The risk of choking seems to be greater than the risk of food allergies. That's your daily dose.  We'll chat again tomorrow.

Your Child

Can Eating Fish Make Kids Smarter?

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As the New Year approaches and after all the turkey, dressing, mashed potatoes and gravy, cookies and cakes– you might be thinking of starting off 2018 a little healthier!

How about starting a family love affair with fish? Myth has it that fish is actually good food for the brain-- but it just might be more than myth, a new study suggests.

Kids who ate fish at least once a week had intelligence quotients, or IQs, that were nearly 5 points higher than the IQs for kids who ate less fish or none at all, the study found. Fish eaters also slept better. How’s that for encouragement?

The study was small and conducted with Chinese children, but American kids are just as likely to benefit from fish, according to lead researcher Jianghong Liu, an associate professor of nursing at the University of Pennsylvania School of Nursing in Philadelphia.

"If parents want their children to be healthy and higher-performing, they should put fish on the table once a week," Liu said.

Although the study cannot prove that eating fish accounted for the higher IQs and better sleep, they do seem to be associated, she said.

According to the researchers, the benefit in IQ can be pinned to the better sleep afforded by omega-3 fatty acids found in many types of fish.

To find out if fish was linked to benefits in children's health, Liu and her colleagues studied the eating habits of more than 500 boys and girls in China, 9 to 11 years old. The children completed a questionnaire about how often they'd eaten fish in the past month, with options that ranged from never to at least once a week. 

The kids also took the Chinese version of an IQ test that rates verbal and nonverbal skills, called the Wechsler Intelligence Scale for Children-Revised.

In addition, the children's parents answered questions about their child's sleep quality. The information collected included how long kids slept, how often they woke during the night and whether they were sleepy during the day.

Liu's team also took into account other factors that could influence the findings, such as the parents' education, occupation and marital status and the number of children in the home. 

The team found that children who ate fish at least once a week scored 4.8 points higher on the IQ tests than those who seldom or never ate fish. Kids whose meals sometimes included fish scored slightly more than 3 points higher. 

Moreover, eating more fish was linked with better sleep.

Not everyone is so excited about the study’s results. One U.S. nutritionist says that advice to eat fish should be taken with a grain of salt. 

"It's not that eating fish is unhealthy per se, but there are issues that need to be considered before parents go overboard feeding fish to their kids to make them smarter and sleep better," said Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City. She was not involved with the study.

Fish is a good source of lean protein and is high in omega-3 essential fatty acids, she said. These acids are highly concentrated in the brain and play important roles in neurological function. They are essential for brain, eye and neurological development in fetuses. They are also necessary for eye, heart and brain health in adults and may reduce systemic inflammation, Heller said.

One concern many people have is the amount of mercury found in some fish. The advice many nutritionists offer is that families should concentrate on eating fish that are low in mercury such as shrimp, canned light tuna, salmon, pollock and catfish, according to the FDA.

The U.S. Food and Drug Administration (FDA) recommends only one to two 2-ounce servings of low-mercury fish a week for children ages 4 to 7; 3 ounces for children 8 to 10; and 4 ounces for children 11 and older, Heller said.

"A healthy, balanced diet, plenty of exercise and limited computer and screen time can all help kids sleep better and do better in school," Heller noted.

The study was published online Dec. 21,2017, in the journal Scientific Reports.

Story source: Steven Reinberg, https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/can-eating-fish-make-kids-smarter-729613.html

Daily Dose

Breakfast: Fuel for the Day

What did your child have for breakfast this morning?

What did your child have for breakfast this morning? Study after study reiterates the importance of breakfast to provide your child’s body and brain the fuel they need to face their day. A healthy breakfast does not necessarily have to be difficult to make or even conventional. Some kids would prefer a peanut butter sandwich or left over hamburger over eggs. But all of these provide protein to stay with your child for the day. Try to provide fruit and dairy also, and that may be easily done with a fruit smoothie that may be made with either fresh or frozen fruit, and you can even drink this on the go.

Be clever with new breakfast ideas to keep your child healthy. It has also been shown that kids who eat breakfast are less likely to be obese. So this morning I am taking my own advice and have started eating breakfast, which is still not MY favorite meal, but may be the most necessary. That’s your daily dose, we’ll chat tomorrow!

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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

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

Food Myths & Your Baby

1.15 to read

I really enjoy talking to my young parents about feeding their baby and toddler new foods. But what about food allergies they say?   I believe that healthy nutrition and good eating habits begin early on, actually just as a child starts to eat solid foods. The more foods a child is exposed to initially, the better chance a parent has of having a child who eats a variety of foods when they are older.  This means no making yucky faces if you (parent) don’t like spinach - fake it! 

But, with that being said, so many new parents are still under the impression that there is a “list” of forbidden foods. As I talk to them about finger foods and letting their baby explore new foods and textures they are amazed when I say things like, “let them try scrambled eggs” or “what about trying almond butter or peanut butter?”, “try ripping up pancake pieces”. 

I also like to let a 9-15 month old try all sorts of different fruit, veggies and proteins. In fact, “there are really no forbidden fruits” as long as the food you offer is mushy (we adults might say a bit over cooked at times) and broken/or cut into very small pieces. I am most concerned about the size and texture of the piece and protecting the airway than I am about the food itself.  

Over the last 5-10 years studies have shown that restricting foods and delaying introduction of certain food groups did not prevent the development of food allergies.  So, the idea that delaying the introduction of peanut butter until after a child is 2 yrs old, or waiting to give a child fish until they are older, or not letting your 9 month old child taste scrambled eggs, did not prevent food allergies. Some researchers would say it may actually be the converse, earlier introduction may be preventative.  

But the funniest thing to me, it is like old wives’ tales....these ideas have somehow been perpetuated.  The new group of parents that I am now seeing were often still in college and dancing at parties when it was the recommendation to wait to introduce some foods (egg, peanut , fish etc).  How do they hear these old ideas?  Maybe grandparents or friends with older children. Who knows? 

So, for the record, the rates for most common food allergies are still low at 2.5% for milk, 1.3% for eggs and 1% for peanut and less than that for tree nuts.  Don’t limit what you give your child unless you have seen them have a reaction when a food is initially introduced, and if you are concerned, talk to your doctor.  Most people who report having food allergy actually turn out not to have true food allergies after a good history and further testing. 

More about true food allergies to come.  Stay tuned! 

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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. 

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