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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

When Tests Should Be Ordered

1:30 to read

The American Academy of Pediatrics has been involved in a series of articles entitled “Choosing Wisely”, as it relates to when and why some tests should be ordered. The latest is related to endocrinology and the myriad of laboratory tests that are often ordered unnecessarily and are overused.

 

The AAP states that it is important to, “avoid ordering Vitamin D concentrations routinely in otherwise healthy children, which includes children who are overweight or obese”.  While a Vitamin D level is the correct screening lab to monitor for Vitamin D deficiency, it should only be ordered in patients with disorders associated with low bone mass (like rickets), some children with liver disease, or in those children who have recurrent low-trauma fractures (not one broken arm).

 

I have seen many patients who have had lab work done by another physician in which they “have a low Vitamin D level” and they are concerned that this is the reason their child is “fatigued”, “depressed”, “not doing well in school”….just to name a few of the statements. Vitamin D levels have not been correlated with any of the above. 

 

Due to the variability of tests available, and unclear cutoffs for deficiency, many children could be misclassified as having Vitamin D deficiency.  The uncertainty around “ normal levels” may lead to over diagnosis, with no clear benefit and may cause undue anxiety. 

 

More important than a Vitamin D level is the assurance that parents are routinely offering their children milk and dairy products high in Vitamin D. Vitamin D is necessary to help the body use calcium, which is the building block for strong bones and teeth.  As many parents have stopped giving their children milk, but are offering more water, the daily recommended intake of Vitamin D and calcium may be difficult to reach.

 

Other foods high in Vitamin D include canned tuna, salmon and some fortified cereals.

 

If you have questions about Vitamin D intake talk to your pediatrician.  

 

 

Daily Dose

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.

I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!

 

Your Baby

Eating During Labor May Speed Up Delivery

1:45

In many hospitals, when a woman is in labor, all she is allowed to eat are a few ice chips. That rule may need updating, according to a new study that finds women who were allowed to eat before delivery had a slightly shorter labor than those who were restricted to ice chips or sips of water - although the study can't prove that eating caused deliveries to happen sooner.

The practice of limiting food during labor goes back a study in the 1940s in which women who delivered under general anesthesia were at risk of inhaling their stomach contents and choking in it, writes senior author, Dr. Vincenzo Berghella, of Thomas Jefferson University in Philadelphia, and his colleagues in Obstetrics and Gynecology.

“We really don’t know how much if anything people can eat or drink in labor," said Berghella,.

Whether women can have more than water or ice chips as they labor to give birth is a common discussion among healthcare providers, he told Reuters Health.

General anesthesia is not commonly used during delivery these days, but the old guidelines are still in use.

For the new study, the researchers compiled data from randomized controlled trials that compared the labor outcomes of women who were allowed to eat only ice chips or water and those who were allowed to eat or drink a bit more.

For example, one study allowed women to drink a mixture of honey and date syrup. Another study allowed all types of food and drinks. A few others allowed women to drink liquids with carbohydrates.

Overall, the researchers analyzed 10 trials that included 3,982 women in labor. All were only delivering one child - not twins or triplets - and were not at risk for cesarean delivery.

The women with the less restrictive diets were not at increased risk for other complications, including vomiting or choking, during the use of general anesthesia.

And women who were allowed to eat and drink more than the traditional ice chips and water had labors that were shorter, by an average of 16 minutes, compared to women with the more restrictive diets.

Speaking from experience, 16 minutes less of labor pains is a real bonus. How does adding more liquid or food during delivery help reduce the time before delivery? The researchers presented some ideas.

"If we’re well hydrated and have adequate carbohydrate in our body, our muscles work better," said Berghella. A woman's uterus is largely made of muscle.

Another of his studies, which found women who received more fluid than normal delivered faster than other women, reinforces the finding.

Berghella said it's still common practice for women with uncomplicated births to be restricted to water or ice chips during labor.

"The evidence from well-done studies is they can have more than that," he said.

Do women really want to eat much during labor? Probably not, there’s a lot going on in the body as labor progresses.  But more liquids and some light carbohydrates during the early part of labor may be welcomed – especially if they shorten the time between labor and when baby enters the world.

Story source: Andrew M. Seaman, http://www.reuters.com/article/us-health-pregnancy-labor-food-idUSKBN15O2ZR

 

Daily Dose

Preschool Nutrition Can Be Challenging

With all of the back-to-school discussions surrounding getting back to healthy breakfasts, nutritious lunches and family dinners, I thought it was a good time to discuss preschooler nutrition too. Preschool children, specifically the two- to five-year-old set are notoriously picky eaters, and parents need to recognize that this is developmentally appropriate, although frustrating for parents.

This is an appropriate time to begin teaching children the importance of healthy eating habits to encourage a lifetime of good health and prevent obesity. A good place to start to get information is “MyPyramid for Preschoolers”, a Web site sponsored by the U.S. Department of Agriculture. This Web site not only covers what your children should be eating, but also is full of good advice on handling picky eaters, how to monitor your child’s growth and ideas to encourage physical activity. The Web site encourages parents to lead by example and let your children see you eating a wide array of foods including fruits, vegetables, and whole grains throughout the day. There are ideas for healthy snacks that can be eaten on the run, as you get back into carpools and after school activities. Even the toddler set is busy after school! Remember: do not let food choices become a battle or an issue. Do not make negative food comments around your children, and keep trying new things. It may take up to 20 attempts or more before your child will try something new, but if you don’t keep trying you will never know if they might really like broccoli. Also, no “yucky faces” for the adults and older children while at the table and eating their meal. That will only discourage your toddler from trying unfamiliar foods. Put on that happy face, even if it is not your favorite food, it might be your child’s. The most important message is to make mealtime and snack time pleasant and healthy. Even a toddler can help with planning and preparing a meal. This Web site is really quite good and interactive as you can enter your child’s first name, age, gender and typical amount of activity and the site will generate a plan just for your child! Can’t be easier than that. That’s your daily dose, we’ll chat again tomorrow.

More Information: MyPyramid for Preschoolers
Daily Dose

Milk vs. Non Cow's Milk

1:00 to read

Once your child turns one, the AAP recommends that they transition from formula to milk…cow’s milk that is. But, more and more of my patients state that they prefer to drink almond milk, soy milk, rice milk, coconut milk, hemp milk and even goat’s milk. I am constantly having to look up the calcium, protein or fat content of all of these “cow’s milk alternatives”.  In the majority of the cases there is not a medical issue driving the choice of milk, but rather parental preference for non dairy, lactose free etc. etc.  

 

Interestingly, I just read an article from the American Journal of Clinical Nutrition that found that children that drink non-cow’s milk may be “slightly shorter” than those children of the same age who drink cow’s milk. There is an ongoing research project which studied about 5,000 children between the ages of 2 and 6, and looked for height differences between those children “who consumed about 8 ounces of non-cow’s milk per day compared to those who drank the same amount of cow’s milk”. 

 

The children who drank non-cow’s milk were about 0.15 inches shorter than average for their age. Although this is just one study,  it will be important to continue to evaluate this data to see if the height differences continue into adolescence. This is a good study to keep following.

 

While I am always concerned about the calcium intake in children and their long term bone health, here is yet another concern.

 

It may be time to re-think your family’s milk choice and unless there is a medical reason to avoid dairy…..try good old cow’s milk…it may actually make you a bit taller?  

Daily Dose

No More Food Battles

1.30 to read

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

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

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

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

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

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

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

Healthier School Lunches

1.00 to read

With everyone back in school after a nice summer break, what better time to discuss school lunches, especially as they relate to healthy choices.  The USDA (Department of Agriculture) has just issued new national guidelines for school lunches which will begin this school year.  The new guidelines include calorie and sodium limits for foods served on the school lunch line and are age dependent.   

The new guidelines also include the recommendation for more whole grains, and dark green, orange or red vegetables (color on the plate). Students buying school lunches must choose at least one fruit or vegetable at every meal.  Portion sizes may also be smaller as well. 

These changes are all geared at helping students understand the importance of healthy eating and making good nutritious food choices.  It is hoped that as students get “used” to seeing and eating healthier school lunches, the choices that they make at home may become better as well.  

Students will also be able to choose from fat-free, low-fat and lactose-free milk and will be required to have 1 serving a day.  Flavored milk will be required to be fat free. 

Lastly, half of the grains served in a school lunch must be whole grain and by 2014 school year all grains must be whole grain rich. 

So, if you are planning on packing your child’s lunch this year, remember these guidelines as well. I think that a combo of packing healthy lunches on some days, while letting your child buy a school lunch on other days seems to be the perfect balance.  Let your children help pick out healthy food choices to put in their packed lunch and they might even pick up a few ideas from the new school lunches this year too. 

You can find the new guidelines at http://1.usa.gov/Qzd5Z7

 

 

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DR SUE'S DAILY DOSE

Why texture is important when introducing new food to your baby.

DR SUE'S DAILY DOSE

Why texture is important when introducing new food to your baby.

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