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Your Baby

1 Egg a Day Improves Growth in Babies

1:30

While not as common in the United States, an astounding number of children worldwide suffer from stunted growth; mainly due to malnutrition or disease. It is a serious problem that impacts about 162 million children under the age of 5.

A new study from the Brown School at Washington University in St Louis, suggests that just one egg daily may significantly increase growth and reduce stunting in children.

"Eggs have the potential to contribute to reduced growth stunting around the world. They are also a good source of nutrients for growth and development in young children," said Lora Iannotti, an author and researcher in the Washington University study.

Researchers gave eggs to 80 infants between six and nine months of age for one year. Another 84 weren’t given eggs and served as a control group. Compared to these controls, the egg-eating youngsters had a 47 percent lower prevalence of stunting, which is defined as being too short for one’s age. Their length-for-age measurement also shot up by a significant margin.

Why would a daily egg have such a dramatic effect? Eggs are often referred to as “the perfect food.” They contain all of the necessary amino acids, as well as choline, various growth factors and DHA, a polyunsaturated fatty acid important for the brain. All of these are necessary for proper growth and development, and the normal function of the body.

There has been some concern in the past, that eggs may raise an infant’s cholesterol level or induce an allergic reaction.  However, research has not shown these hypotheses not to be true. The food appears to be safe and healthy for infants, says Iannotti.

Eggs are easily available for parents and affordable as a food option. Lots of families are even experimenting with raising chickens for their eggs in communities across the country.

Iannotti believes this study shows that just one egg a day could have a dramatic impact, globally, on the number of children suffering from stunted growth.

The study was published in the June edition of the journal Pediatrics.

Story sources: Pawel Kopczynski / Reuters, http://www.newsweek.com/one-egg-day-boosts-growth-infants-621266

Neil Schoenherr, https://source.wustl.edu/2017/06/eggs-can-significantly-increase-growth-young-children/

Daily Dose

Is Fruit Juice Healthy?

1:30 to read

I remember when my children were small that it was “routine” to begin offering infants dilute juice around 6-9 months of age.  Over the years the AAP (American Academy of Pediatrics) continued to advise against offering fruit juice to children under the age of 6 months.  Now…decades later, the AAP has just issued new guidelines including the recommendation “not to offer juice to children under the age of 1 year”.

 

The new recommendations will be published in the June issue of Pediatrics in which they write, “while parents may perceive fruit juice as healthy, it is not a good substitute for fresh fruit and just packs in more sugar and calories.”  The article continues to state, “small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1 year.”

 

I always diluted juice for my children, even when they were older.  I would just add a few cans of water to concentrated juice and they never even knew it. It just seemed logical to me at the time. But while 100 percent fresh or reconstituted juice may be healthy, it should still be limited depending on a child’s age.  The concern over steadily increasing obesity rates as well as dental health and the risk of cavities makes even fresh fruit juice a culprit for added calories and sugar.

 

The recommendations include:  toddlers should never be given juice from a bottle or in a sippy cup that allows them to consume juice (even diluted) throughout the day. I continue to recommend that the bottle “goes bye-bye” at the 1 year birthday party and a child only drinks from a sippy cup at meals and snacks after that.  

 

The child should also not have a sippy cup to “wag around all day”.   Parents often tell me that “their child drinks water all day long” but again that may keep them from eating a healthy meal if they drink throughout the day. You know how many adult diets recommend “drink tons of water all day” so you won’t feel hungry…same may be said for a toddler who is already a picky eater.  

Small children get plenty of fluids at meals and snacks and are not hydrating for athletics like my older patients. There are no recommendations that young children drink a certain amount of water everyday….although parents swear their child needs 16 ounces a day?

 

In reality children of all ages should be encouraged to eat whole fruits and be educated about the difference between the fruit they choose and juice.  With “juicing” being so popular, they need to know that even “green juice” lacks dietary fiber and may contribute to excessive weight gain.  I agree that fruit juice is better than no fruit…but for toddler ages 1-3 years, no more than 4 ounces of juice a day, children age 4-6 only 4-6 ounces a day and for children 7-18 years only 8 ounces (1 cup) of juice. The recommendation is that a child should have 2-2.5 cups of whole fruit per day. 

 

I still recommend that my young patients only consume milk (low fat is fine) and water on an everyday basis and add juice later on…when their friends happen to tell them about juice boxes etc. If I am going to buy juice at all I recommend 100% fresh fruit juice and if you can, get juices with added calcium (a little extra never hurts!).

Lastly, juice is not appropriate for re-hydration or for the treatment of diarrhea. For those instances it is necessary to use an “oral re-hydration solution”.

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

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.

Your Child

Unhealthy TV Snack Ads Work on Preschoolers

1:30

Kids love snacks and advertisers count on that to sell products.  That’s why so many commercials on children’s TV shows promote snacks packed with sugar and salt. According to a new study, preschoolers who are exposed to these types of ads will eat more of those foods, even if they are not hungry.

The study, led by Jennifer Emond, an assistant professor of pediatrics at Dartmouth College, in Hanover, New Hampshire, involved a small study of 60 children, 2 to 5 years old. Emond’s team monitored the kids as they watched a 14-minute segment of “Sesame Street.”

The preschoolers got a filling snack before the show, so they were not hungry, and then had unlimited access to snacks during it.

Some of the children watched the "Sesame Street" segment without food commercials, while others watched the show with commercials for a popular salty snack. The ads depicted kids happily playing and eating the snack.

While viewing the segment, the children were provided with two snacks: corn snacks and graham snacks. The same corn snacks provided were featured in the food advertisements shown to some of the children.

The researchers found that the preschoolers who watched the segment embedded with food ads consumed more calories in snacks on average than those who watched the department store ads.

Additionally, the children who watched the food ads ended up eating more of the advertised corn snack than the graham snack -- even if they had never eaten the corn snack before and, therefore, were not familiar with it.

"That was surprising because it demonstrated the powerful effect food advertising can have on priming potentially unhealthy eating behaviors at a young age," Emond said.

The results of this small study replicate the findings of other studies with older children.

About 40% of all food and beverage ads that children and teens see on television are for unhealthy snacks, according to a 2015 report by the University of Connecticut's Rudd Center for Food Policy and Obesity (PDF).

"Parents should not shrug off food marketing. These ads really do influence children," said Marlene Schwartz, director for the center and a professor of human development and family studies at the University of Connecticut, who was not involved in the new study.

"If the ads were for healthy foods, that would be an asset to parents, but when the ads are for unhealthy foods, they make parents' job harder," she said.

Story sources: Jacqueline Howard, http://www.cnn.com/2016/11/21/health/food-ads-kids-preschool/

https://consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/tv-snack-food-ads-get-preschoolers-snacking-more-study-shows-716956.html

Your Baby

Starting Baby on Solid Foods

Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.Starting baby on solid foods can be an exciting and perplexing time for parents. What foods should I start with? How much? How often?

The American Academy of Pediatrics currently recommends gradually introducing solid foods when a baby is about 6 months old. Your pediatrician, however, may recommend starting as early as 4 months depending on your baby's readiness and nutritional needs. Be sure to check with your pediatrician before starting any solid foods. Is your baby ready? Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support — essential skills for eating solid foods. If you're not sure whether your baby is ready, ask yourself these questions: •       Can your baby hold his or her head in a steady, upright position? •       Can your baby sit with support? •       Is your baby interested in what you're eating? If you answer yes to these questions and you have the OK from your baby's doctor or dietitian, you can begin supplementing your baby's liquid diet. What Foods to Start With. Continue feeding your baby breast milk or formula as usual. Then: •       Start with baby cereal. Mix 1 tablespoon (15 milliliters) of a single-grain, iron-fortified baby cereal with 4 to 5 tablespoons (60 to 75 milliliters) of breast milk or formula. Many parents start with rice cereal. Even if the cereal barely thickens the liquid, resist the temptation to serve it from a bottle. Instead, help your baby sit upright and offer the cereal with a small spoon once or twice a day. Once your baby gets the hang of swallowing runny cereal, mix it with less liquid. For variety, you might offer single-grain oatmeal or barley cereals. Your baby may take a little while to "learn" how to eat solids. During these months you'll still be providing the usual feedings of breast milk or formula, so don't be concerned if your baby refuses certain foods at first or doesn't seem interested. It may just take some time. Do not add cereal to your baby's bottle unless your doctor instructs you to do so, as this can cause babies to become overweight and doesn't help the baby learn how to eat solid foods •       Add pureed meat, vegetables and fruits. Once your baby masters cereal, gradually introduce pureed meat, vegetables and fruits. Offer single-ingredient foods at first, and wait three to five days between each new food. If your baby has a reaction to a particular food — such as diarrhea, a rash or vomiting — you'll know the culprit. •       Offer finely chopped finger foods. By ages 8 months to 10 months, most babies can handle small portions of finely chopped finger foods, such as soft fruits, well-cooked pasta, cheese, graham crackers and ground meat. As your baby approaches his or her first birthday, mashed or chopped versions of whatever the rest of the family is eating will become your baby's main fare. Continue to offer breast milk or formula with and between meals. Foods to Avoid for Now. Some foods are generally withheld until later. Do not give eggs, cow's milk, citrus fruits and juices, and honey until after a baby's first birthday. Eggs (especially the whites) may cause an allergic reaction, especially if given too early. Citrus is highly acidic and can cause painful diaper rashes for a baby. Honey may contain certain spores that, while harmless to adults, can cause botulism in babies. Regular cow's milk does not have the nutrition that infants need. Fish and seafood, peanuts and peanut butter, and tree nuts are also considered allergenic for infants, and shouldn't be given until after the child is 2 or 3 years old, depending on whether the child is at higher risk for developing food allergies. A child is at higher risk for food allergies if one or more close family members have allergies or allergy-related conditions, like food allergies, eczema, or asthma. Introducing Juice. Juice can be given after 6 months of age, which is also a good age to introduce your baby to a cup. Buy one with large handles and a lid (a "sippy cup"), and teach your baby how to maneuver and drink from it. You might need to try a few different cups to find one that works for your child. Use water at first to avoid messy clean-ups. Serve only 100% fruit juice, not juice drinks or powdered drink mixes. Do not give juice in a bottle and remember to limit the amount of juice your baby drinks to less than 4 total ounces (120 ml) a day. Too much juice adds extra calories without the nutrition of breast milk or formula. Drinking too much juice can contribute to obesity can cause diarrhea. Infants usually like fruits and sweeter vegetables, such as carrots and sweet potatoes, but don't neglect other vegetables. Your goal over the next few months is to introduce a wide variety of foods. If your baby doesn't seem to like a particular food, reintroduce it at later meals. It can take quite a few tries before kids warm up to certain foods.

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.  

Parenting

Vegetarian Diet Is Good For the Whole Family

1:456

Has your teen or little one brought up the idea of going vegetarian? In the current age of online videos and social media groups, a lot of kids are seeing and learning about animal product processing and are experimenting with the idea of changing what they eat. While it may seem like a silly idea at first, you might want to give it further consideration.

For years, some people have thought that vegetarian and vegan diets may not be healthy enough for children.

A new study published by the Journal of the Academy of Nutrition and Dietetics (AND), says not to worry, vegetarian and vegan diets can be safe and healthy for people of any age.

In fact, several studies show that vegetarians generally have lower risks of obesity and chronic diseases such as type 2 diabetes, heart disease and certain cancers, according to the AND. That includes vegans -- who avoid not only meat and fish, but also all animal products, including dairy.

"No one should doubt that vegetarian diets are safe at all life stages, including infancy, childhood and adolescence," says Susan Levin, one of the report authors and director of nutrition education at the nonprofit Physicians Committee for Responsible Medicine in Washington, D.C.

Levin also noted that studies show children on vegetarian diets eat more fruits and vegetables, and fewer sweets and salty snack foods. They're also less likely to be overweight or obese.

The academy also noted that vegetarian and vegan diets can be safe during pregnancy and lactation. These diets can also be fine for athletes and the elderly, the report said.

While all this information sounds promising, what you include in your vegetarian diet is the key to staying healthy. If you subsist on white rice, Levin pointed out, that might be technically vegetarian, but not nutritious.

So it's important to eat a variety of foods, including a range of whole grains, beans, fruits and vegetables, and nuts and seeds.

Vegetarians and vegan diets do lack one important nutrient found in animal products– vitamin B-12.

According to the AND report, vegans should take supplemental vitamin B12. Vegetarians usually need supplements or B12-fortified foods, too, the group said -- since their dairy intake may not supply enough of the nutrient.

But, Levin said, B12 is the only supplement vegans need. They can get all of their other nutrient needs from food.

Getting enough protein, calcium and iron has been another concern about vegetarian diets and particularly vegan diets. That shouldn’t be a problem, Levin says, as long as you make wise food choices.

The report noted, it's imperative to make wise food choices: Calcium from vegetables like kale, turnip greens and bok-choy is much better absorbed than calcium from high-oxalate vegetables such as spinach and Swiss chard, for example.

As for the potential health benefits, studies have found that vegetarians and vegans tend to weigh less and have lower cholesterol levels than omnivores do. They also tend to have lower risks of high blood pressure, heart disease, type 2 diabetes and certain cancers, such as cancers of the prostate and gastrointestinal tract.

"If there were a pill that did all of that," Levin said, "everyone would be taking it."

Lots of families aren’t necessarily willing to give up all animal products, but would like to cut down on their meat consumption. Vegetarian and vegan recipes can help fill the void on meatless lunch and dinners while offering a nutritious substitute.

The AND report also notes that vegetarian diets are kinder to the environment.

It takes far fewer resources -- land, water, fuel and fertilizer -- to produce a pound of kidney beans than a pound of beef, for example.

"Vegetarian diets leave a lighter carbon footprint," said Levin.

The ADA suggests that families interested in going completely vegetarian or vegan should seek assistance from a registered dietician to help them learn about the various sources of protein and other vital nutrients. Vegetarian cookbooks and classes are also available for families thinking of making a dietary switch. There are also very good informational resources online.

Story source: Amy Norton, https://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/vegetarian-diets-benefit-people-and-the-planet-717307.html

Daily Dose

Does Your Baby Need Water?

2.00 to read

Since most of the country is sweltering with summer heat and temperatures well into the upper 90’s and even over 100 degrees, I guess I can understand parents’ concerns about giving their babies water. It seemed like a strange question to me when I first started hearing, “Dr. Sue, how much water does my baby need to drink every day?”  I know I am continuing to talk about staying hydrated during the heat wave, but we are really talking about those children and adults who are spending time outdoors, especially when involved in physical activity.

I have actually been telling parents with newborns that there is really no reason to take that sweet new baby outside for any length of time. I think it is too hot to enjoy being outside, and an infant doesn’t miss going to the playground like a 2 or 3 year old would.

But, when you have young children you have to get out (or go crazy inside everyday), so everyone just suffers through the heat. Remember to take your sunscreen and fluids and head out for an hour or two, in the morning or later afternoon if at all possible. These children need lots of water breaks, as do their parents and caregivers.

So, back to the water and baby question. Infants in the first 6 months are getting fed breast milk or formula which is made up of free water, so therefore a baby is staying hydrated by eating every  2 -3 hours. A baby doesn’t “need” water every day for any particular reason.

With that being said, it does not mean that your baby cannot have a bottle of water. This is especially true for a breast fed infant whose mother may have run out for an hour but is coming back to breast feed.  But what if the baby awakens or gets hungry 30 min or so prior to mother getting home.  This might be a good time to “stall” by giving the baby a bottle of water, rather than formula. In this case it is fine to use tap water (yes bottled water is not necessary, unless you have a well or something) in a bottle and see if the baby will even take it. Most babies don’t just gulp down 8 ounces of water!

If you are out in the heat with an infant, just remember to feed them every 2 – 3 hours and make sure they have nice drool in their mouths and wet diapers. If you are concerned about hydration take along a bottle of water for both you and your baby. You will probably need it more than your baby!

That’s your daily dose for today.  We’ll chat again tomorrow.

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