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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

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

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.

Daily Dose

Picky Eating: Magic Words Offer Food for Thought

1:15 to read

I am trying to clean up my desk and I have been looking through stacks of pediatric articles that I felt were really interesting. An article by Dr. Barbara Howard entitled “Three Magic Words Offer Food for Thought” made a wonderful point regarding family meals and eating habits.

She states that one of the best questions to ask a child during a “well-child” visit only requires three words, but offers so much insight into a family’s interactions. What are the magic words? “How are your meals?” I know you know how much I believe in, and promote, families eating together.

There has been a lot of data substantiating the many positive side effects that stem from family meals.  Not only does eating together as a family help improve food choices which may help prevent obesity, it also leads to children who have improved vocabulary and language skills, social skills and manners. Family meals have also been shown to lessen the chance of risk taking behaviors in adolescents. There has also been an association with fewer eating disorders among adolescents who have regular family meals. So, when I ask children about their meals, I also get parental feedback. The biggest complaint is that their children are “picky eaters”. Many children and parents will say that they don’t eat together as a family as everyone eats something different. I don’t think being a “short order cook” is a job requirement of any parent.

Social worker Ally Slater, delineates parent’s responsibilities with regard to food as “what, when and where” while leaving children, “how much and whether”. I love that!! Parents control the grocery cart, meal and snack choices and food offerings on the plate. It is nice to always offer at least one food that most family members like. Once that food is offered and we are gathered together to eat, parents need to back off. Is that easier said than done? Maybe in the beginning, but over time it actually simplifies family life. I think it is really fairly easy if you “buy into” the idea of family meals and know that children will make better and wider food choices if given that opportunity. It may take up to 100 times, and many months for your child to try different foods, but eventually you will be pleased that you have a child who is a healthy eater, and who also enjoys a wide variety of foods. Trust me, your children when raised this way, really turn out to be great eaters as adolescents and young adults.  I think my boys are less “picky” than I am! (No sushi for me).

Make family meal time a priority. Your children will respect the rules, learn table manners, and enjoy dinnertime conversation, while eventually developing a more mature palate. It just takes time. That’s your daily dose, we’ll chat again tomorrow.

Your Child

Are Kid’s Sack Lunches Healthier?

2:00

For some kids who bring their lunch to school, a new study suggests that as far as nutrition goes, they’d be better off buying their meal at the school cafeteria.

Researchers found that student’s bag lunches typically contained foods that were higher in sodium and sugar with fewer vegetables and whole grains compared with standards set for school cafeterias.

The findings are not necessarily surprising, said the study's senior researcher, Karen Cullen, a professor at Baylor College of Medicine in Houston.

"Parents often pack lunches based on their children's preferences," she noted. Plus, she added, some other recent studies have found a similar pattern.

The study involved 12 elementary and middle schools in one Houston-area school district. Over two months, the researchers observed more than 300 students who brought their lunch from home -- noting what they ate and what they threw away.

On average, bag lunches were low on fruits and whole grains, and especially vegetables and milk.

School guidelines say kids should have three-quarters of a cup of vegetables (which really isn’t much) with every lunch. The average elementary school bag lunch had about one-tenth of that amount, according to the study.

Lunches brought from home also contained way too much sodium. The average bag lunch averaged 1,000 to 1,110 mg, versus a limit of 640 mg in elementary school lunches.

About 90 percent of the home lunches contained a dessert, sugary drink or snack chip. Guess what? Kids ate those items whereas between 20 and 30 percent of vegetables ended up in the garbage, according to the study.

Packing milk and palatable vegetables is tricky, noted Dr. Virginia Stallings, a pediatrician at Children's Hospital of Philadelphia who specializes in nutrition.

Giving your kids money to buy it at school can help solve the milk dilemma, said Stallings, who wrote an editorial published with the study. With vegetables, though, it can be challenging to go beyond carrot sticks, she added.

"I think that's one of the advantages of the school lunch," Stallings said. "Kids can have a hot meal, with cooked vegetables." She added that schools are working on making meals that are tasty without relying on salt, and expanding to include culturally diverse choices.

I don’t really think that kid’s attitudes have changed much about school lunches in the last few decades. As long as I can remember, kids eat what they want, trade foods with others and throw out the rest. They often gripe about their lunch food whether it comes from home or the school cafeteria.. That’s just what kids do.

So, if they are going to complain anyway you might as well fix them a lunch that will help them develop strong bones and hearts. The school systems have finally started paying attention to nutrition after all these years. They’re working on creative recipes that just might temp kids to eat better.

You already know that there are way too many American children that are eating poorly, not exercising and developing diabetes at a young age. It’s important what our children eat. Sometimes a school lunch is best and sometimes a lunch brought from home is best. Many times parents split the difference and do both.

Source: Amy Norton, http://consumer.healthday.com/kids-health-information-23/education-news-745/kids-bag-lunches-not-meeting-nutrition-guidelines-694048.html

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! 

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

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. 

Daily Dose

No More Food Battles

1.30 to read

Seems that I spend several times a day discussing “food battles” with my patients and their families.  I guess the longer I practice the more I don’t think we should even have to discuss how often parents “battle” with their kids about eating.  

From the early days of parenting when a baby is first offered either breast or formula, they are not asked “do you like this?”.  It is taken for granted that an infant will eat and grow and  there you have it.  The easiest days of parenting, correct? (except for a few months of sleep deprivation).  But once that baby begins to eat the discussions start about “he makes a face when he eats spinach”, or “she will only eat chicken tenders from Chik-fil-a”, or “he only likes pasta and won’t eat meat”, or even “I make 3 diferent meals for my 3 kids”.  If you have a child older than 9 months you understand what I am talking about. 

Food is necessary to nutrition, growth and health. But, with that being said, parents have to trust that a child WILL EAT when they are hungry.  Really, hunger drives us all to eat, eventually.  That bowl or cereal, or the steamed vegetables or even the dreaded chicken breast will get eaten if your child gets hungry enough. I remember reading somewhere that , “ a parent’s job is to provide food for their children at appropriate meal times, and child’s job is to decide if they will eat it.”  In other words, make the meal whether for your toddler or teen and “forget about it”.  Meal time needn’t be a battle but more a gathering to enjoy being together eating is just a bonus.  

As an adult, when you go to a dinner party, you don’t ask what they are serving before you accept, nor do you tell the host/hostess, I hate lamb!!  (my example).  You just smile and find something to eat and there is not a battle.  We all need to approach family meals as a dinner party. Our children are our guests, and sometimes they like what we fix and other times they push some food around their plate and choose not to eat.  The good news for most children is that there is another meal to follow. 

So, think about it and don’t let certain food likes and dislikes dictate mealtime. The more foods young children are exposed to the better chance they have of EVENTUALLY becoming a well rounded eater.  Children’s taste buds change with time as well, so you will find some foods that a 3 year old loved is no longer the favorite at 13 years of age.   

Well balanced, nutritious, colorful meals are the family goal and “food battles” can be left out of the vocabulary.   

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