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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

Surviving Picky Eating

2.00 to read

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.

Daily Dose

Do You Have a Happy Spitter?

1.15 to read

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

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

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

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

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

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

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

Your Child

Should Schools Ban Peanut Butter?

As a result of the increasing number of peanut allergies, some parents are petitioning schools to ban peanut butter from lunch menus and snacks.Peanut Ban

Nearly 400,000 children are allergic to peanuts and many parents do everything they can to make sure their child is not exposed. As a result of the increasing number of peanut allergies, some parents are petitioning schools to ban peanut butter from lunch menus and snacks.

“Over the past few years because of the increased incidences of peanut allergies, more and more schools have been banning peanut butter and 18% of schools have bans in place and that number seems to be growing. But there is a lot of controversy around this on both sides of the equation,” says pediatrician Dr. Sue Hubbard. Dr. Hubbard says it is very hard to ban an entire student body from taking anything with peanuts as it requires a large amount of label reading education by children and parents. She says it is important to have a dialogue with your child’s teacher, school and school nurse to alert them to a food allergy. “The Food Allergy and Anaphylaxis Network does not believe the peanut butter should be banned in schools. They are of the belief that you should have something called a “PAL” plan to protect a life from food allergies

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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