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Keeping Kids Heart Healthy

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”.

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

Anemia

1:30 to read

Adolescent females are at greater risk for anemia than adolescent boys. This may due to several reasons including the fact that adolescent girls lose blood each month during their menstrual cycles and many teenage girls eat less red meat than adolescent boys.  

 

While some adolescents with anemia (low hemoglobin and hematocrit) complain of headaches, irritability or fatigue (which are very common teenage complaints), others are completely asymptomatic.  It is recommended that teens have a screening complete blood count around the age of 13 and then every 5 years or so thereafter. At the same time, the AAP recommends more frequent blood counts in those with risk factors for anemia, including diets low in iron rich foods (meat, eggs, fortified cereals) teens who have significant physical activity (especially female adolescent athletes) those with vegetarian or vegan diets and for any adolescent girl with excessive menstrual bleeding. Obese teens also have a higher incidence of anemia and should be screened. This list includes many of my patients.

 

Interestingly, you can have low iron stores without yet being anemic.  I have now started looking at the serum ferritin levels in teens with risk factors for anemia, as I am finding that some of my athletic patients have low ferritin levels, with a normal blood count. Some recent studies have shown that low ferritin may impact athletic performance including fatiguability. While fatigue during exercise is a subjective symptom,  maintaining iron stores is important for overall health.

 

Lastly, iron deficiency may impact cognitive function in adolescents. There have been several studies showing that girls who had higher serum ferritin levels had statistically significant improvement on cognitive tests of verbal learning and memory…so it may be worth looking at levels in a teen who is suddenly having difficulty in school, without previous issues. One blood test!

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!

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

Who's in Control of Family Meals?

1.30 to read

At each well-check visit, I try to talk to all of my patients and families about media use and the need for a healthy media diet, and I also try to incorporate questions about eating habits into my well child visits. Even though most pediatricians are busy, a few minutes spent discussing healthy eating can go a long way.  I have started asking a few new questions which I think are really helpful about assessing a families eating habits.

It is impressive how much information you can get out of asking a few key questions even to children as young as 4 or 5 years of age.  This is especially true if they are talkative!  You know the saying, “out of the mouth of babes”, it is so true.....kids often have no filters.  

If I just ask, “do you think your family eats healthy meals?” the answer is usually yes. But that doesn’t really tell me much about what the child (or their parents) deem “healthy”.   So, I start off asking  “who fixes breakfast?”. This question not only lets me know if a child is eating breakfast but also if a parent is involved in getting a child’s breakfast ready.  Not every child is fortunate enough to have a parent around in the morning to fix breakfast...and some of their food choices are related to that issue.  Then I ask them what is their favorite cereal......rarely do I hear “steel cut oats”.

Next, I ask if they take their lunch to school or if they buy their lunch. If they buy lunch, I ask what they like to buy at school, and often it is pizza, chicken, hamburgers, tacos.  Almost any age child can name their favorite food, but then I ask them their favorite fruit or vegetable... sometimes a child cannot name one, which makes me think they are not eating them.

Most kids come home from school and have a snack as well.....so once again I ask “what do you do after school for a snack?” . Some kids are in after school programs and seem to have healthier snack options, while others tell me they stop at “fast food” restaurants almost every day. Some come home and eat cereal for the second time that day.

Lastly, I ask....”who fixes dinner?” “Do you set the table?”  This also is a great way of seeing if a family eats together. As you know I am a big believer in family meals for all sorts of reasons.

I hope your pediatrician is asking you and your children about mealtimes as well.....very important to promote healthy eating habits.

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

Preschool Nutrition Can Be Challenging

1:30 to read

Does your child eat three meals a day with healthy snacks along the way? I often find myself talking to parents about establishing healthy eating habits especially when you have a preschooler. 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 website sponsored by the U.S. Department of Agriculture. This website 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 website 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 website 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.

 

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