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Daily Dose

Food Textures

1:30 to read

If you have a baby between the ages of 8-9 months and have already been offering them pureed baby foods it may be time to start some textures as well.  Many parents are a bit “wary” of offering any food that hasn’t been totally pureed, but it is important that your baby starts to experiment with foods that have different consistencies. 

Of course this does not mean you hand your baby anything that they could choke on like a grape, or piece of meat etc. But instead of totally pureeing carrots, why not cook them well, chop them up a bit and put them on the high chair tray. It is fun to watch how they touch and feel the carrots, before they “smoosh and moosh” them and get them to their mouths.   

There are so many foods that are easily offered to a baby to get them used to feeling different textures.  This is the very beginning of experimenting with finger foods, and this doesn’t just mean puffs or cheerios either. I like to encourage babies to feel cold, gooey, warm, sticky, all sorts of different textures which will ultimately help them become better and more adventuresome eaters as they get older.  

Unfortunately, I see far too many little ones (and not so little ones too) continuing to eat totally pureed foods and then becoming adverse to textures as they did not get the experience at an early enough age. 

It is also fun to watch your child as they begin to pick up foods that have been chopped and diced into small soft pieces. In the early stages they have to scoop and lick the food from their fingers and hands, but very quickly their pincer grasp takes over and suddenly they can pick up that well cooked green bean or pea!!  Such a feat and worthy of a home video to send to the grandparents for sure. 

So, put out some mushy food and let them play - I know it is messy but that is what being a kid is often about!

Daily Dose

Breastfeeding & Bottle Feeding

1:30 to read

As you know, I am a huge advocate for breastfeeding your new baby. But, with that being said I also know that there are different circumstances for each mother and baby and that some new mothers either choose to breast feed for a short period of time or not at all. I always talk to the mothers about making their own choice, and to not feel they are being judged by anyone.

 

But many mothers are concerned about not breastfeeding and the long term implications for their baby.  They feel “guilty” if they choose not to breastfeed or if they in fact want to breast feed and are unable to for some reason.  I assure them that infant formulas continue to be improved upon and now contain DHA, ARA and oligosacharides that are found in breast milk.  Formula has safely been used for many years and that they themselves may have been a formula fed baby (you usually don’t even know!).

 

So… I am always interested in studies related to breastfeeding. There are good studies that continue to the show the many benefits to breastfeeding, including lower the risk of allergies, ear infections and SIDS. It is also known that breast feeding helps build a child’s immune system. Parents often ask “if I breast feed for X number of days or weeks is that enough?”.  I have not seen any data to quantitate a simple answer to that question.

 

Several years ago it was thought that babies who were breastfed had a higher IQ (by several points), and this was later found not to be the case. It seems that a child’s IQ is actually better explained by long term factors such as family background, genetics and education.

 

The impact of breast feeding on cognitive abilities continues to be studied and debated.  A new study just released in the April issue of Pediatrics  looked at 8,000 families and did not show a statistically significant difference in cognitive ability at ages 3 or 5 years between those babies that were breastfed for 6 months and formula fed babies.  They also looked at the relationship between breastfed and formula fed babies and parent rated hyperactivity scores. They found lower parent rated hyperactivity scores for 3 year olds only, but those benefits were not maintained in the long term. Again, much of this behavior may be based on genetics and environment.

 

Bottom line in my opinion…..adequate nutrition for your baby is the most important factor. Whether that is breast or bottle is up to each mother, and maternal well-being and feelings of happiness are so important in the first few months of an infant’s life.  

 

 

 

Your Baby

Fish Oil During Pregnancy May Reduce Baby’s Asthma Risk

2:00

A Danish study’s results suggests pregnant women that take a fish oil supplement during the final 3 months of pregnancy may reduce their baby’s risk of developing asthma or persistent wheezing.

The study involved 736 pregnant women, in their third trimester. Half the women took a placebo containing olive oil and the other group was given 2.4 grams of fish oil. The women took the supplements until one week after birth.

Among children whose mothers took fish-oil capsules, 16.9 percent had asthma by age 3, compared with 23.7 percent whose mothers were given placebos. The difference, nearly 7 percentage points, translates to a risk reduction of about 31 percent.

In the study, the researchers noted that they are not ready to recommend that pregnant women routinely take fish oil. Although the results of the study were positive, several experts have noted that more research needs to be done before higher doses of fish oil supplements are recommended over eating more fish.

Researchers found no adverse effects in the mothers or babies, the doses were high, 2.4 grams per day is 15 to 20 times what most Americans consume from foods.

One in five young children are affected by asthma and wheezing disorders. In recent decades, the rate has more than doubled in Western countries. Previous research has shown that those conditions are more prevalent among babies whose mothers have low levels of fish oil in their bodies. The new large-scale test, reported in The New England Journal of Medicine, is the first to see if supplements can actually lower the risk.

Before doctors can make any recommendations, the study should be replicated, and fish oil should be tested earlier in pregnancy and at different doses, Dr. Hans Bisgaard, the leading author of the study, said in an email to the New York Times. He is a professor of pediatrics at the University of Copenhagen and the head of research at the Copenhagen Prospective Studies on Asthma in Childhood, an independent research unit.

Dr. Bisgaard said it was not possible to tell from the study whether pregnant women could benefit from simply eating more fish. Pregnant women are generally advised to limit their consumption of certain types of fish like swordfish and tuna because they contain mercury. But many other types are considered safe, especially smaller fish like sardines that are not at the top of the food chain and therefore not likely to accumulate mercury and other contaminants from eating other fish.

“It is possible that a lower dose would have sufficed," the Bisgaard team said.

The supplements didn't seem to affect the odds of a baby or toddler developing the skin condition eczema, or an allergy such as a reaction to milk or egg products, or a severe asthma attack.

An editorial in the same journal by an expert who was not part of the study praised the research, saying it was well designed and carefully performed. The author of that editorial, Dr. Christopher E. Ramsden, from the National Institutes of Health, said the findings would help doctors develop a “precision medicine” approach in which fish-oil treatment could be tailored to women who are most likely to benefit.

If the findings are confirmed in other populations, doctors could test to see who would mostly likely benefit from fish oil supplements. "The health care system is currently not geared for such," Bisgaard said. "But clearly this would be the future."

If you are considering taking fish oil supplements during pregnancy, be sure and check with your OB/GYN for a recommended dose.

All fish oils are not the same. Some brands of fish oil are of higher quality than others. A reputable fish oil manufacturer should be able to provide documentation of third-party lab results that show the purity levels of their fish oil, down to the particles per trillion level. Also, if the supplements smell or taste fishy, they shouldn’t. High quality fish oil supplements don’t. Avoid fish oils that have really strong or artificial flavors added to them because they are most likely trying to hide the fishy flavor of rancid oil.

Story sources: Denise Grady, http://www.nytimes.com/2016/12/28/health/fish-oil-asthma-pregnancy.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl

Gene Emery, http://www.reuters.com/article/us-health-asthma-fish-oil-idUSKBN14H1T3

http://americanpregnancy.org/pregnancy-health/omega-3-fish-oil/

 

Daily Dose

Why Vitamin D is Important!

1:30 to read

As a follow up to the blog last week on children, calcium and vitamin D needs, a recent article in a Canadian Medical Journal reports that children who drink non-cow’s milk, such as soy, rice, almond and goat’s milk have lower serum vitamin D levels than those who are drinking vitamin D fortified cow’s milk.

This study looked at 2800 children between 1-6 year olds, and their consumption of either cow’s milk which is all vitamin D fortified and those who drank non-cow’s milk, in which case fortification is voluntary.  The researchers then looked at blood samples to measure vitamin D levels.

The researchers found that children who drank non-cow’s milk had nearly three times the risk for having low vitamin D levels.

So...bottom line...when I am discussing milk and dairy intake with families I am going to reiterate the need to drink cow’s milk, or children may need to continue vitamin D supplementation  and for most parents, including myself, it is hard to remember to give a vitamin or mineral supplement every day for a child’s entire life!).  A glass of vitamin D fortified milk at meals seems an easier choice in most cases.

Daily Dose

Your Teen's Eating Habits

1:30 to read

While seeing patients one evening, I saw a 15 year old boy who had come in complaining of feeling dizzy and tired. It was the end of school as well, so he was busy with studying and finals.  This is the kind of patient that is typically given a 15 minute appointment.....but needs a lot more than that to figure out what is going on.

He was with his father who said that his son had not had a fever, had not otherwise been ill with cough or cold symptoms. Upon further questioning the teen said he was just tired and thought he might faint....although he had not.  He had gone to school that day. He was not involved in athletics and had no history of previous syncope (fainting). There was not a history of sudden cardiac death in the family. He also had a fraternal twin who was healthy. He usually tried to get about 6-8 hours of sleep a night. He denied drug or alcohol use. He had not had weight loss. HIs exam was entirely normal with normal vital signs.

But, when questioned about his eating habits he informed me that he was a vegan.  His father sat there quietly while I discussed his son’s choices.  He said that he had decided to be a vegan about a year prior, and that he rarely ate with his family. When I asked him to give me an idea of a typical breakfast, lunch and dinner I was amazed at what I heard. He really only ate “junk food”. He ate sugary cereal for breakfast, he might eat a veggie burrito for lunch, and he would often eat another fast food burrito or taco for dinner. He did not eat fruit at all. His Dad said that everyone else in the family ate “normal” meals, and that they were offered to his son as well.

I am writing this to illustrate one of the problems I see with teens who decide to become vegetarians or vegans etc, but really are just what his Dad so correctly stated are “junk food vegans or vegetarians”.

After a lengthy discussion and some lab work,  he was sent home with instructions to research ways to improve his diet even as a vegan, which in turn would probably help his fatigue. He was also stressed about the end of school.... which was another discussion as well!

Both eating issues and stress cause teens to have a lot of complaints of fatigue and feeling blah...I see them all day long. This adolescent agreed to   come back in a month with his diary of meals and he is going to see our nutritionist over the summer.

He was a delightful young man....and I was only an hour behind...but at least we got to the bottom of the problem.

Daily Dose

Sports Drinks or Water?

Does your child need a sports drink or water to hydrate? A new study reveals the best practices for your kids. The AAP Committee on Nutrition and the Council on Sports Medicine and Fitness just released a report outlining the use and misuse of sports drinks and energy drinks among children and adolescents.

While pediatricians have been effective in discouraging families from drinking full calorie carbonated beverages, and schools have phased out full-calorie soft drinks in cafeterias and vending machines, there has been huge growth in the sports and energy drinks market. It seems that these sports drinks are now the third fastest growing beverage category in the US, after energy drinks and bottled water. Many of these beverages are being marketed towards children and teens for a big variety of inappropriate uses. To begin with, sports drinks and energy drinks are really very different products. Sports drinks are flavored beverages that contain carbohydrates, along with minerals, electrolytes, and they should be used specifically for hydration in athletes. Advertisements would suggest that these products may optimize athletic performance and replace fluid and electrolytes lost in sweat during exercise. For the average child who is engaged in routine physical activity, the use of sports drink is really unnecessary, good old water will do the trick. It is important to teach children to hydrate with plenty of water before, during and after regular exercise. If doctors and parents are encouraging exercise as a means of improving overall health and wellness, providing sugary sports drinks seems counter intuitive. Some kids may not even burn as many calories with their exercise as they may receive from one bottle of a sports drink. In other words a child’s overall daily caloric intake may increase without any real nutritional value provided by a sports drink. Back to reading labels! For athletes who are participating in vigorous exercise, or in conditions of prolonged physical activity, blood glucose is an important energy source and may need to be replenished; in which case sports drink providing additional carbohydrate may be appropriate. But, different sports drinks contain differing amounts of carbs, anywhere from 2-19 grams of carbohydrate per 8 oz serving. The caloric content of sports drinks is 10 – 70 calories per serving.  You must look at the labels and judge the intensity and duration of exercise to decide which drink to use. With summer approaching, it is good to know that sports drinks really are not indicated for use during meals or snacks, and are not a replacement for low fat milk or water. Turn on the faucet and cut down on calories and cavities! That’s your daily dose for today.  We’ll chat again tomorrow. How do your kids stay hydrated? Let me know!

Daily Dose

Picky Eaters

1:15 to read

There is an interesting article in Pediatrics which looks at children who were identified by their parents as picky eaters. It seems that being a picky eater (now also called selective eating), may not just be a phase for some children. Selective eating and a child’s  food preferences may be an indicator of other psychological problems.

Picky eating affects about 20% of children. In this study from Duke University, 917 children ages 2-6 who were identified as picky eaters by their parents were followed over 3 years.  The author found that those children with “moderate picky eating habits” were more likely to have symptoms of anxiety, depression and ADHD.  Children who had severe selective eating ( those children who had intense aversions that made it difficult to eat outside of their home) were even more likely to have social anxiety and depression.

I found this study to be fascinating as it does not show that picky eating causes psychological issues or even vice versa…..but it does show that there is a correlation between the two. I think this only substantiates what I have seen in my own practice and I often ask parents is this a “nature or nurture issue”, or both?

While many children go through phases when they only want peanut butter and jelly for lunch or could live on chicken nuggets and pizza, some children seem to develop more intense feelings related to food choices.  Many parents that I see say , “we just try to ignore it” and their child seems to “move on”. But over the years other parents have said that “their child would starve to death if they did not capitulate to their picky eating”, and that the struggles it caused were “just not worth the anxiety”.  Even before this study, it seemed that some children “are just wired” differently.

These children also seemed to have heightened issues with textures and tastes, that you sometimes even notice in a child as they begin to eat soft table foods between 9-12 months of age. Are these the children that go on to become extremely picky eaters? Could it be that these children are just born with heightened sensitivity to taste, texture and smell?

All in all this is an interesting study which actually raises more questions about how to handle a picky eater. Is there one right answer….like most things the answer is NO. But having family meal time is still important and I always start with the statement, “a parents job is to provide their children with a healthy well balanced meal, and their child will decide if they want to eat it” . Sounds easy enough…..but for some it may not be.

So, if you find that your child is getting more selective, food choices are more intense and this is causing anxiety for both parent and child, make sure you discuss this with your pediatrician.  

Your Baby

Eating Chocolate While Pregnant May Improve Mom and Baby’s Health!

1:45

 Put another check in the win column for a reason to eat chocolate - as though anyone really needs one!

 A new study suggests that moms-to-be that eat a small piece of chocolate every day may improve their baby’s cardiovascular health and reduce the risk for preeclampsia.

 Researchers found that their findings held up regardless of whether the chocolate consumed contained high or low amounts of flavonoids, a group of phytochemicals that have antioxidant abilities. Various studies have also suggested that flavonoids may offer heart health benefits.

 As with most studies, the research did not prove that eating chocolate during pregnancy caused better circulatory health in pregnant women and their babies, only that there was an association.

 "Our observations suggest that a regular small consumption of dark chocolate -- whether or not the level of flavanol is high -- from the first trimester of pregnancy, could lead to an improvement of placental function," said study author Dr. Emmanuel Bujold. He is a professor of obstetrics and gynecology at Universite Laval in Quebec City, Canada.

 Bujold's team decided to see whether differences in flavanol content had any effect on the pregnancies of nearly 130 women.

 All of the women in the study were at the 11- to 14-week mark of their pregnancy, and carrying one child.

 All were instructed to consume 30 grams of chocolate (a little more than one ounce) each day over a 12-week period. That's equivalent to about one small square of chocolate per day, Bujold said.

 Half of the women consumed high-flavanol chocolate, while the other half was given low-flavanol chocolate. All were then tracked until their delivery date.

 Regardless of which type of chocolate was consumed, the women faced the same risk for both preeclampsia and routine high blood pressure. Placental weight and birth weight was also the same in both groups, the investigators found.

 Similarly, fetal and placental blood circulation levels, as well as in-utero blood velocity, did not appear to be affected by shifting flavanol levels.

 However, simply consuming a small amount of chocolate -- no matter what the flavanol content -- was associated with notable improvements in all blood circulation and velocity measures compared to the general population, the researchers said.

 Bujold said this suggests that there's something about chocolate, apart from flavanol levels, that may exert a positive influence on the course of pregnancy. Finding out exactly what that is "could lead to improvement of women's and children's health, along with a significant reduction of treatment cost," he said.

 While that’s good news for chocolate lovers, Bujold cautions that pregnant women keep the portion small and calorie intake low.

 So, a bit of chocolate daily while pregnant is not going to hurt you, in fact it just may give you and your baby’s health a little boost.

 The findings were scheduled for presentation at the Society for Maternal-Fetal Medicine's annual meeting, in Atlanta. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

 Source:  Alan Mozes, http://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/small-square-of-chocolate-each-day-during-pregnancy-may-help-mom-and-baby-707736.html

Daily Dose

Do Your Kids Drink Milk?

1:30 to read

I have noticed over my years in practice that fewer and fewer patients  drink milk every day. You may wonder why I ask the question, “does your child drink milk?”.  Calcium is an important nutrient which in necessary for healthy bones. But you have to put that calcium into your bones when you are a child and adolescent which means milk at meals. By age 18 years about 90% of your peak bone mass has been laid down.

Most children that I see are not drinking many soft drinks...in fact, many tell me they don’t like “fizzy drinks” at all...even on special occasions they would prefer “fancy waters”.  But, when I ask them what they drink at dinner they often say, “water”. I then ask their parents if they even pour milk for their children and they too say their child prefers water.

I am not sure how water became the preferred drink among many of my patients. When and how did parents and children decide that children need to drink a certain amount of water a day. I have never found any recommendations about water consumption in healthy children.  But there are recommendations regarding calcium and Vitamin D intake.

Children between 1-3 years of age need 700 mg/day of calcium, while 4-8 year olds need 1,000mg/day and 9-18 year olds need 1,300mg/day.  It is also recommended that all children between ages 1-18 years receive 600IU of vitamin D a day.  The best way to meet calcium and vitamin D needs is through food sources, including milk.  

With statistics showing that less than 15% of adolescent girls in the United States meet the recommended dietary allowance for calcium, many young girls may be setting themselves up for osteopenia and osteoporosis in their adult years. 

Exercise is equally important for maintaining bone health...which means more time outside or in the gym, rather than in front of a screen!

Change your habits and start pouring milk with your child’s meals and then go outside and get some vitamin D and exercise.

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