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Daily Dose

Baby's First Foods

1:30 to read

Have you heard of “baby led weaning” (BLW)? Many of my patients who have infants that are ready to start “solid foods”, also called complementary foods, have questions about this method. Most babies begin eating foods along with breast milk or formula somewhere around 5 - 6 months of age.  So BLW is not really “weaning”,  as your infant will continue to have breast milk or formula in conjunction with foods…so this really should more aptly be named “baby self feeding”. 

In this method you never offer your baby “mush” or pureed foods, but rather offer them foods from the table.   While I am a huge advocate of self feeding (old term is finger feeding), I also think that early on offering a baby “mushy” food on a spoon is an important milestone. In fact, for most babies at 5 -6 months, it is difficult to pick up a small piece of food to self feed as the pincer grasp has not developed. So, a baby is trying to get food to their mouths by cupping it or hoping it sticks to their hand while pushing pieces around their tray. Some parents will put the food into their baby’s hand.  But, by 8-ish months most babies have developed their pincer grasp and the finger feeding should be preferred.  

Parents are also concerned about starting solid foods and the possibility of choking.  I am always discussing how to make sure that your child avoids choking hazards with foods. In other words, no whole grapes, or hot dogs, or popcorn or chunks of meat.   Other hazards are raw carrots, apples, celery and any “hard” food that your baby might be able to bite a chunk of and then choke. But, if you cook the carrots and then cut them in small bites they are easily handled by a baby who is self feeding.  It is really all about the consistency of the food as once your baby has lower teeth they can easily bite/pry off a big “chunk” of food that could lead to a choking hazard.

Interestingly, there was a recent study that looked at the incidence of choking in children who started with self feeding vs those fed traditionally with pureed foods from a spoon. In this study of about 200 children between 6 - 8 months of age the incidence of choking was similar, while there were more gagging events in the BLW group.  Fortunately, “the choking events resolved on their own”. Gagging is quite different than choking. Some children will gag on pureed foods just due to texture issues. 

I am an advocate of what I am going to call parent led feeding followed by early self feeding of appropriate foods. By the time a child is 9 months of age they should be able to finger feeding the majority of their meals. But there are some foods that are just not conducive to finger feeding at all….yogurt, apple sauce, puddings…and they will be spoon fed until your child is capable of using a spoon which is anywhere from 12 -18 months.   But as a reminder, whenever you offer your child a finger food you should remember two things, #1 is the piece small enough that my child cannot choke and #2 is the food cooked well enough to not pose a choking hazard.  

Several years ago there was a 1 year old in our practice who was given a piece of an apple to chew on… she bit off a chunk of the apple, aspirated and died. It was a terrible accident.  I will never forget that….and re-iterate to all of my patients…a pork chop, or chicken leg or any number of foods can become a choking hazard if your child bites off a chunk. Children really don’t chew until they are around 2 years, they just bite and try to swallow so I pay a great deal of attention to what foods they are offered.


Old school and new school…the combo seems to make sense to me. 

Daily Dose

The Importance of Family Mealtime

I have believed in the importance of family mealtime for a long time, I think since my boys were in elementary school. The time that was spent together, even if only for 10 to 15 minutes a night grew to be one of the favorite times of the day, especially as the kids grew older. It was one of the few times that we were all able to enjoy one another's company, discuss what everyone had done that day ("what was the best part of your day") and to also try to teach table manners to three boys.

An added benefit was that the boys became fairly good "eaters" as my husband (who by the way is a good cook) and I also subscribed to the "same meal" for the entire family theory. I mean, who has time to cook multiple meals? Mow, that is not to say that they all ate the dinners that were made, and there were plenty of complaints too, but over the years they began to explore more foods and they even learned that pork is not chicken, what a breakthrough. No one starved when they didn't like a meal; they always seemed to find something on the table that they would eat. We also let everyone have their say in meal planning one night a week, when you could pick your favorite meal. A study from the April issue of Journal of Nutrition Education and Behavior also found that eating together as a family "has long term nutritional benefits." This study assessed the eating habits of 677 youths during their early teen years and then again five years later. Those who ate regular family meals at both points in their life had "better diet quality, and consumed more vegetable, calcium rich foods, dietary fiber and essential nutrients." So start up those family meals, it is never too late and it will improve your child's overall nutrition. As an aside, they will learn that a napkin goes in their lap! That's your daily dose, we'll chat again tomorrow.

Daily Dose

Good News About Peanut Allergies

1:15 to read

There has been a lot of news recently about peanut allergies and good news on all fronts. For several years there had been recommendations that children should not be given any peanut products until at least two years of age due to concerns about children and peanut allergies. At the same time, some physicians even recommended that breastfeeding mothers not consume peanut products. This was a difficult scenario for both parents and children as what young child did not eat peanut butter?

Many children's parents would not even let peanut butter in the house and were consumed with reading labels looking for peanut products. Remember, this was not in a peanut allergic child, or even in a family with a history of peanut allergies. I would have failed as a mother during this time as my kids ate peanut butter sandwiches almost daily.

I can remember a patient coming over to my house for one of those "house calls" I frequently do and at the end of the visit I offered her child (about 22 months) a peanut butter cookie that I had just baked. As she took the cookie from me, ready to take a big bite, the mother screamed, "She has never had peanut butter, don't let her have that!" Before you could even grab the cookie she took a big bite, a grin spread over her face and lo and behold, she ate the rest. (I am a good cookie baker, if I do say so myself.) No reaction, happy child and now the mother was convinced her child would not die if she ate peanut butter before two. Well, the recommendations have changed and children may have peanut butter, or peanut products before they are even one and seem to actually have a lower chance of developing peanut allergies. They should not eat a whole peanut, for risk of choking, but other products are fine.

I had never been convinced that withholding peanuts seemed to make a difference, and peanut butter is a childhood staple, full of good protein. Now, news from Duke University is also showing that very peanut allergic children may be de-sensitized to peanuts by giving them miniscule amounts of peanut protein on a daily basis. After 8 to 10 months of gradually increasing doses of peanut powder several of the children were able to tolerate peanuts in their regular diet and several more were able to tolerate up to 15 peanuts at a time without serious reactions. This is significant data for those children suffering from peanut allergies, and who have the risk of developing anaphylaxis and even death if exposed to peanuts. It seems that scientists are making inroads into developing oral immunotherapy to de-sensitize children with food allergies, and further studies are underway.

That's your daily dose, we'll chat again tomorrow. More Information: Experimental Treatment Gives Hope to Children with Peanut Allergies

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!

Daily Dose

Kids And Choking Dangers

There are so many foods that can cause choking in your children. Dr. Sue tells you which ones.It has been a difficult week for my group practice as we have had a small child sustain a terrible accident after choking on an apple.  As a pediatrician, I talk about choking with parents beginning at the first visit, and encourage all new parents to take a CPR course.

When you discuss this with young parents you never dream that they will actually ever have to perform CPR. Choking hazards in young children are very real. A toddler’s airway is about the size of their “pinky” finger and there are many ominous objects just waiting for an active toddler to put into their mouths. Children like to explore with their mouths, so nothing is off limits!  With that being said, child proofing the house from choking hazards such as small toys, and objects is imperative. It is also important that when beginning to offer a toddler table foods that parents and caregivers think about choking hazards.  Parents worry about a child choking if they are beginning table food and don’t have teeth. It is not commonly known that teeth really have nothing to do with a toddler eating table foods, as even toddlers with a full mouth of teeth do not know to chew.  They just take big bites and swallow. So, think about foods being mushy and well cooked, in order that chewing is not necessary. It is like older folks, who often do not have a lot of teeth to chew with, so their food is all well cooked and cut into small pieces, which does not necessitate chewing. Every food that is offered to a toddler needs to be well cooked and think about being able to mush it up with a fork or between your fingers. The concerns about food allergies and the risks of giving a child a food “too soon” are no longer thought to be valid. The biggest concern about new foods for toddlers and children is really more about choking risks. With that being said, think about some of these foods.  Peanut butter is fine, but never a peanut or other nut that could easily cause airway obstruction. Melons that are mushy and given in small pieces would be fine too, but never a melon ball. Chips, popcorn, hard candies and hot dogs are a no-no too. So are uncooked carrots, celery sticks, apple slices, and chunks of meat like steak or pork.  Remember, can you mush it between your fingers? Well cooked peas, carrots, squash, eggplant, this list goes on and on and well cooked food are usually okay. So too are ground meats, shredded lunch meats and flaky fish.  It is important for toddlers to have a well balanced diet, while at the same time being aware of the risks of choking. Grapes should be cut into pieces, strawberries too.  Don’t let a toddler take a “bite” out of a hard fruit, rather cut it all up and give them small mushy pieces, several at a time. Lastly, remember to have your child sitting at a table for meals and snacks and do not allow them to walk around the house carrying food that might cause choking. It may be something that takes a little thought and reminding in the beginning, but your child will quickly learn that they eat at a table, rather than while “cruising”. It’s a really a good rule for all of us! So if you have a young child, and do not know CPR, call and sign up now!  At the same time be aware of choking hazards and the rare but deadly accidents that may occur. That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Throwing the Bottle Away

1:30 to read

When a child reaches their first birthday, they have already reached many milestones. But when a child turns one, mom and dad need help their child do one more thing says pediatrician Dr. Sue Hubbard. “They need to throw the bottle away, she says.” “Developmentally, a your baby does not need to suck for nutrition at age one.”

After that first birthday, children should be drinking whole milk out of a sippy cup. The fat in whole milk is essential for the child’s developing brain. Dr. Hubbard says to do the transition from bottle to sippy cup cold turkey. “At 9 months, buy a sippy cup, one without a nipple, and give it to your child to play with. This will help teach him how to hold it. Then start with whole milk, never juice or water.” 

Dr. Hubbard says that studies have shown that prolonged bottle feeding leads to increased dental cavities, iron deficiency, anemia and obesity. “I’ve heard parents say ‘My child won’t drink out of a sippy cup.’ I say yes they will if they are thirsty. They won’t starve or get dehydrated.” If you wait until a child is 15 to 18 months old to remove the bottle, it becomes more of an issue she warns. Once your child has transitioned to a sippy cup, Dr. Hubbard reminds parents to only offer the sippy cup to the child at meal and snack times. “A child should never carry a sippy cup around the house,” she says.

Your Child

July 4th Food and Fireworks Safety Tips


This July 4th may be even more special than usual for a lot of families. Besides the excitement and patriotic fervor of celebrating our country’s official Independence Day, it may finally stop raining long enough for people to enjoy being outside.

However the day unfolds, you can bet there will be plenty of families and friends celebrating with good food!

Grilling is particularly popular on the Fourth as well as picnics. To make sure that the food you prepare is safe and stays safe for consumption, the USDA and the FDA offers these food preparation tips:

•       Clean: Make sure you clean all surfaces, utensils, and hands with soap and water.

•       Separate: When grilling, use separate plates and utensils for raw meat and cooked meat and ready-to-eat foods (like raw vegetables) to avoid cross-contamination.

•       Keep cold food cold. Place cold food in a cooler with ice or frozen gel packs. Cold food should be stored at 40°F or below to prevent bacterial growth. Meat, poultry, and seafood may be packed while still frozen so that they stay colder longer. 

•       Organize cooler contents. Consider packing beverages in one cooler and perishable foods in another. That way, as picnickers open and reopen the beverage cooler to replenish their drinks, the perishable foods won’t be exposed to warm outdoor air temperatures.

•       Clean your produce. Rinse fresh fruits and vegetables under running tap water before packing them in the cooler - including those with skins and rinds that are not eaten. Rub firm-skinned fruits and vegetables under running tap water or scrub with a clean vegetable brush while rinsing with running tap water. Dry fruits and vegetables with a clean cloth towel or paper towel. Packaged fruits and vegetables that are labeled "ready-to-eat," "washed," or "triple washed" need not be washed.

•       Cook: Cook foods to the right temperature by using a food thermometer. That’s the only way to know it’s a safe temperature.

•       Remember: Ground beef and egg dishes should be cooked to 160°F. Steaks, roasts, pork and fish should be cooked to 145 degrees F, and Chicken breast and whole poultry should be cooked to 165 degrees F. Shrimp, lobster, and crabs  cook until pearly and opaque. Clams, oysters, and mussels cook until the shells are open

•       Chill: Chill raw and prepared foods promptly if not consuming after cooking. You shouldn’t leave food at room temperature for longer than two hours (or 1 hour if outdoor temperatures are above 90° F), so if you’re away from home, make sure you bring a cooler to store those leftovers.

Warm weather events present opportunities for foodborne bacteria to thrive. As food heats up in summer temperatures, bacteria multiply rapidly. Safe food handling and cooking when eating outdoors is critical for your family’s health.

Most cities have banned fireworks within the city limits except for controlled displays. However, rural and unincorporated areas still allow the sale and use of fireworks by citizens.

Fireworks are now much more sophisticated and larger than mere firecrackers and sparklers; injuries associated with fireworks can be devestating. 

In 2013, U.S. hospital emergency rooms treated an estimated 11,400 people for fireworks related injuries; 55% of 2014 emergency room fireworks-related injuries were to the extremities and 38% were to the head. The risk of fireworks injury was highest for young people ages 0-4, followed by children 10-14.

On Independence Day in a typical year, far more U.S. fires are reported than on any other day, and fireworks account for two out of five of those fires, more than any other cause of fires.

The Consumer Product Safety Commission recommends these fireworks handling safety tips:

•       Never allow young children to play with or ignite fireworks.

•       Avoid buying fireworks that are packaged in brown paper because this is often a sign that the fireworks were made for professional displays and that they could pose a danger to consumers.

•       Always have an adult supervise fireworks activities. Parents don't realize that young children suffer injuries from sparklers. Sparklers burn at temperatures of about 2,000 degrees - hot enough to melt some metals.

•       Never place any part of your body directly over a fireworks device when lighting the fuse. Back up to a safe distance immediately after lighting fireworks.

•       Never try to re-light or pick up fireworks that have not ignited fully.

•       Never point or throw fireworks at another person.

•       Keep a bucket of water or a garden hose handy in case of fire or other mishap.

•       Light fireworks one at a time, then move back quickly.

•       Never carry fireworks in a pocket or shoot them off in metal or glass containers.

•       After fireworks complete their burning, douse the spent device with plenty of water from a bucket or hose before discarding it to prevent a trash fire.

•       Make sure fireworks are legal in your area before buying or using them.

The Fourth of July is definitely one of the most treasured holidays for Americans, make sure your family has a safe one!




Daily Dose

Rice Cereal & Childhood Obesity

Does white rice cereal cause childhood obesity? One pediatrician thinks so.I recently saw Dr. Alan Greene on TV discussing infant feeding practices and how that may relate to the problem of childhood obesity. Dr. Greene, like most pediatricians, has long been a proponent of healthy eating. He recently launched his “White Out” campaign to change how babies are introduced to solid foods.

His argument is that an infant’s first food has long been rice cereal.   Rice cereal is typically introduced to a baby between 5 – 6 months of age when they are just beginning to sit up in a high chair, and may be fed with a spoon. Rice cereal  typically comes in a box and breast milk or formula is added to the dried flakes in order to make it the consistency where the  baby may be  offered a few bites from a spoon. Although rice is a “white grain” there are also other infant cereal products available, and there are no “directives” that say that a brown rice or mixed grain cereal may not  be used. As I understand it, the whole idea is really just to get the baby used to spoon feeding and then I begin introducing my infant patients to vegetables and fruits. So, the idea that the baby rice cereal is somehow linked to the entire problem of childhood obesity seems somewhat shortsighted to me. An infant is only fed rice cereal one or two times a day while still receiving either breast milk or a formula. Remember that breast milk and formulas contain carbohydrates too. Infant cereal whether it be brown or white rice should not be the only food a baby is introduced too, nor should they eat cereal all day long. While Dr. Greene is concerned that babies will “get hooked on the taste of highly processed foods”, I'm more concerned that parents will quickly forgo rice and whole grain cereals, fruits, veggies and meats and begin feeding their children frosted or honey nut cheerios (a favorite early finger food),  as wells as goldfish and puffs, pasta and other white foods.  These are the foods I  am most likely to see in my office, not a bowl fruits and vegetables. Babies really get the  majority of their calories from breast milk or formula until about 9 – 12 months of age. Parents should be encouraged to feed their babies a wide array of healthy foods including cereals, vegetables, fruits and meats.  Dr. Greene is right,  a baby doesn’t tell you he won’t eat brown rice, or oatmeal or spinach or prunes. For the most part an infant happily opens their mouths and will take what is fed to them. The problem occurs a little later as babies start to show a preference for foods , whether that is by making a face, or pushing food away, they definitely show preferences. This is when the idea of getting “hooked on foods” really begins. It is not uncommon for me to hear a parent of a one year old say, “my baby doesn’t like…… squash, or cereal, or peaches.”  Soon thereafter you hear, “my toddler will only eat…..fill in the blank”. Those are the words that send shivers down my spine. Trying to get those parents to buy into the fix the meal and they will eat it if they are hungry is quite a difficult concept at times. The issue is not only beginning a baby on rice cereal, the problem is more complex. It is getting parents to understand that our children will always have food preferences, that does not mean that we need to acknowledge them or submit to them. It means that we need to make good healthy meals for our families, white rice or brown rice is only the beginning of the story. That's your daily dose for today. What do you think? Leave your comments below!

Your Child

What Food is Best for Your Child's Breakfast?


What’s the best choice for your child’s breakfast? According to a new study, eggs. Researchers found that children who eat eggs for breakfast tend to consume fewer calories at lunch and benefited from the protein and vitamins they provide.

The study looked at 40 eight to ten year olds who ate a 350 calorie breakfast-of eggs, porridge or cereal. Between breakfast and lunch they played physically active games.

The children were asked throughout the morning how hungry they were and parents kept a food journal of what else the children ate.

The research, led by Tanja Kral of the university’s Department of Biobehavioural Health Science, found children who ate the eggs for breakfast reduced their calorie intake by about four percent (70 calories) at lunch.

The scientists noted that children who regularly eat more than their daily calorie limit could gain weight, leading to obesity. Eggs contain about 6 grams of high quality protein and are a good source of vitamins and amino acids.

 "I'm not surprised that the egg breakfast was the most satiating breakfast," said Kral. He was however, surprised that the children said that the egg breakfast didn’t actually make them feel fuller than cereal or oatmeal even though they ate less at lunchtime.

”It's really important that we identify certain types of food that can help children feel full and also moderate caloric intake, especially in children who are prone to excess weight gain.“

The study was published in the International journal, Eating Behaviours.

Source: Emma Henderson,




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Keeping it fun for kids with food allergies during Halloween.

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