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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

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

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.

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. 

Daily Dose

Transitioning to Whole Milk or Toddler Formula

Is it best to transition to whole milk or use toddler formula instead?I received a question from our iPhone App regarding the use of a toddler formula, such as Enfagrow. The mother wondered if this was preferred over switching to cow’s milk when a child reaches 12 months of age.

While there have been several products that have been brought to market in the last few years, so called toddler’s formulas, there is really no evidence to show that these are preferable to using cow’s milk you’re your child reaches 1 year of age. The toddler’s formula does contain more calcium and phosphorous than infant formulas, but beyond that there is really no advantage to using a toddler formula over milk.  It really seems to be an expensive marketing ploy directed to parents who are concerned about calories and vitamins. The American Academy of Pediatrics recommends that 1 year old children either continue breast feeding or make the transition to whole milk.  It is also recommended that child transitions from bottle to a cup (sippy cup is fine). At that time a toddler should reduce their milk intake to approximately 16 ounces a day, as they are getting the majority of their nutrition from eating a wide variety of solid foods, with less calories coming from breast milk or whole milk.  If a parent is offering their toddler a variety of healthy foods, you will be amazed at what they will and will not eat, but they do manage to gain weight and grow, which often surprises their parents. The most interesting thing about a toddler, is that they self-regulate, and unlike adults, they eat when they are hungry, rather than out of boredom or due to stress.  So, if you offer your toddler healthy meals and snacks accompanied by whole milk from a cup, they will meet their nutritional requirements and also get enough calcium and vitamin D. On the other hand, for parents that have a difficult time dealing with a child’s whims for eating, and will indulge their child’s  food preferences,while also allowing them to have juice instead of milk, the idea of a toddler formula seems to be just the ticket! Just let them drink their nutrition (somewhat like an adult who might need a nutritional supplement like Ensure while they are sick), but this may not be the answer as this really just reinforces poor eating habits. Like many things in parenting, the “perceived” easy solution, may not always be the best. So, at the end of the day there is little need for “follow up  formulas” for the otherwise healthy toddler.  Save the money, buy whole cow’s milk unless otherwise directed by your pediatrician.  Make sure that your child is getting about 16–18 ounces of milk a day and several other servings of dairy products.  If you are really concerned about calcium and vitamin D as well as other vitamins, then offer them an over the counter vitamin supplement. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue.

Daily Dose

Infant Food Recommendations May Be On The Way

A new year has begun and with that there often come changes, one of which may be in how infants are introduced to solid foods.

The American Academy of Pediatrics (AAP) has recommended that infants be fed breast milk or formula exclusively before beginning solid foods between four and six months of age it is typically recommended that infants begin spoon feedings with an iron fortified cereal, such as rice cereal. After a baby has “learned” how to eat cereal from a spoon, other foods are started typically beginning with vegetables, followed by fruits and then meats. For many years I was taught that women who exclusively breast fed their infants for the first six months of life might be able to prevent allergic disease in their children. This was especially recommended for mothers who had a strong family history of allergies. Many pregnant and nursing mothers also restricted their dietary intake of peanuts, shellfish and other foods in hope that this too might help reduce allergies in their offspring. For many years it was recommended that children also be restricted from eating peanuts in hopes of preventing peanut allergies that were suddenly on the rise. What we did find is that we reduced the incidence of choking episodes from peanut aspiration, but peanut allergies continued to rise and I have no idea what children were eating for lunch seeing that my own children were raised on peanut butter and jelly sandwiches (cut in triangles I might add). Those recommendations changed several years ago, although many mothers still balk when I recommend peanut butter for their toddlers. Now, a study out of Finland, published in the December issue of Pediatrics Online, showed that the late introduction of solid foods is associated with an increased risk for allergic sensitization to foods and inhalant allergies in children at five years of age. Scientific evidence for delaying food introduction now seems to be pointing in the opposite direction. This study actually showed that by delaying the introduction of eggs, milk and cereal children were at increased risk for developing atopic dermatitis (eczema). The late introduction of fish and potatoes (go figure that one) led to more inhalant allergies. This was determined by drawing IgE levels in children at 5 years of age. So, there will be a lot of new studies being done to try and reproduce the Finnish data. New recommendations about infant feeding are already forthcoming from the AAP and should be published in February. In the meantime, I would not worry about introducing foods to your baby after five to six months of age as long as they are pureed and easy to swallow. You can still wait several days between starting new foods, but no need to be as limiting. There are many foods that we eat including numerous fruits and vegetables that may be pureed in a Cuisinart or blender or even mashed with a fork that are not offered in typical baby food jars. Why not feed your baby black eyed peas (remember we all need good luck), or avocado or mashed potatoes when you are fixing these foods for yourself. The broader the palate as an infant may encourage less picky eating later on. Stay tuned for more on this subject. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

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.

Daily Dose

Diagnosing Food Allergies

1.15 to read

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

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

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

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

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

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

Daily Dose

E. coli Outbreak Continues

E. coli bateria is spreading across Europe with more deaths reported. What you need to know about this deadly bacteria.I was on the treadmill this morning simultaneously watching a plethora of channels on the flat screens TV’s at the gym. One of the headlines at the bottom of the MSNBC screen caught my eye as it read, “deadly virus spreading across Europe”, while the next headline read, “e. coli continues to spread in Europe.”

Unfortunately, there does continue to be concern over the deadly BACTERIA that has been spreading across Germany and has caused illness in at least 10 other European countries as well as several cases in the United States. But the concern is not due to a virus, but a bacterial infection!  Viruses and bacteria essentially have nothing to do with one another except that they can both cause illness. The bacteria, a new strain of Escherichia coli (E.coli), have caused an outbreak of diarrheal disease with over 2,900 people being infected. Of these, over 500 have suffered life-threatening complications, and there have been 30 deaths reported. The sickest patients have developed hemolytic uremic syndrome, a kidney disease which may result in renal failure. It seems that this “new” bacteria has caused the most serious illness among previously healthy women, including those that are pregnant. This is unusual as it is typically thought that children and elderly have more serious complications from hemorrhagic E.coli strains. Several of the cases of this specific type of E.coli have been reported in the U.S., with all persons except one having had recent travel to Germany. E. coli is a bacteria that had long been known to cause food borne gastroenteritis (vomiting and diarrhea). The bacteria may be found in fecal material and then may be spread via food that has been contaminated.  It was just announced that the most likely source of this E.coli infection is not cucumbers as was previously suspected, but rather by contaminated bean sprouts. The initial source of infection looks to be from a farm worker who has tested positive for E.coli and is thought to have spread the bacteria while working. The mainstay for preventing any food-borne illness is HANDWASHING!!  It is also important to thoroughly wash fruits and vegetables, especially those that are eaten without being cooked.  Peeling the produce is also a way of helping to prevent disease. The WHO and also the CDC have put U.S. doctors on alert for this disease. If you or your children develop bloody diarrhea it is important that you seek medical care, and if possible have a stool specimen available for your doctor. In the meantime, have your children practice good hand washing, especially after using the bathroom!  Remember, this is a bacterial rather than a viral infection. There is a difference. That’s your daily dose for today. We’ll chat again tomorrow.

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