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Your Child

Healthier Choices for Students in School Lunch Lines


School lunches have changed over the years and in many school cafeterias, food options are healthier than ever before, according to a new study.

Elementary school cafeterias are offering more vegetables, fresh fruit, salad bars, whole grains and more healthy pizzas, while the availability of high-fat milks, fried potatoes and regular pizza has decreased, researchers report.

"School food service programs have worked hard to improve the nutritional quality of school lunches, and largely have been very successful," said lead researcher Lindsey Turner, director of the Initiative for Healthy Schools at Boise State University, in Idaho.

Although in some schools food choices are improving, that’s not the case everywhere. Turner noted that more work needs to be done to make sure every student has the same healthy choices in the lunch line.

In the study of more than 4,600 elementary schools that are part of the U.S. National School Lunch Program, researchers found that school lunches improved significantly between 2006-2007 and 2013-2014.

Despite improvements in food choices, disparities were still found. For example, schools in the West were more likely to offer salad bars than schools in the Northeast, Midwest or South, the researchers found.

Schools with a majority of black or Hispanic children were less likely to offer fresh fruit than schools with a preponderance of white students.

Also, schools in poor areas were less likely to offer salads regularly.

Over the course of the study, Midwestern schools slightly reduced offering pre-made salads in favor of salad bars, but Southern schools were more likely to offer pre-made salads and less likely to have salad bars, the researchers found.

On the other side of offering healthier foods is choosing to eat those foods. Just because there are better food options available, doesn’t mean that kids will eat them. One expert noted that it takes time and effort for kids to change their eating habits. It not only has to look good, it has to taste good.

"It is not only important to improve the quality of school lunches but to make these foods attractive, tasty, easily seen and accessible," said Samantha Heller, a senior clinical nutritionist at New York University Medical Center, in New York City.

Studies have found that putting fresh fruit in a nice bowl, in a conveniently located, well-lit area in the school cafeteria increased sales of fruit by 102 percent, she noted.

"A brightly lit, hot-and-cold salad bar filled with colorful fresh fruits, vegetables, beans and nuts, mushroom and spinach pizza, and veggie tacos center-stage in the lunchroom would be very attractive to students and staff alike," Heller said.

This approach works well at home, too, she added.

"Kids are more likely to grab healthy foods like cut-up melon, carrots, peppers, edamame and hummus when they are upfront and easy to grab in the fridge," Heller said.

The study was published in the journal Preventing Chronic Disease.

Story source: Steven Reinberg,

Your Child

The Benefits of Being Bilingual

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Do children who speak more than one language score higher on cognitive tests? Yes, according to a new Canadian study. Researchers say that bilingual students develop a deeper understanding of the structure of language, an important skill in learning to read and write.

Cognitive tests study the mental processes that allow us to perform daily functions such as paying attention, solving problems, producing and understanding language appropriately and making decisions.

Does being bilingual make a child smarter? Not necessarily, but previous studies have shown that children who learn two languages from birth are able to concentrate on the meaning of words better than monolingual children and have an advantage in developing multi-tasking skills.

In the Canadian study, researchers compared 104 six-year olds to measure their cognitive development. Some children were English speaking only. Others were Chinese-English bilinguals, French-English bilinguals, and Spanish-English bilinguals.

The experiments investigated the effects of language similarity, cultural background and educational experience on verbal and non-verbal abilities.

The children did a battery of tests that measured verbal development and one non-verbal task that measured executive control, in this case, the ability to focus attention where necessary without being distracted and then shift attention when required. The bilingual children demonstrated a superior ability to switch tasks.

"The results endorse the conclusion that bilingualism itself is responsible for the increased levels of executive control previously reported," the study's authors wrote.

To acquire language, bilingualism where the languages are similar in origin may have slight advantages, the researchers found. For example, Spanish-English bilinguals outperformed Chinese-English bilinguals and monolinguals on a test of awareness of the sound structure of spoken English.

Dr. Ellen Bialystok, one of the world's foremost experts on bilingualism among children, led the group of researchers from York University in analyzing the effects of bilingualism. Summarizing the results, Dr. Bialystok commented, "Our research has shown that reading progress amongst all bilingual children is improved" over monolingual children. In a separate statement, she said, "I think there's a lot of worry out there about other languages conflicting with a child's ability to learn to read in English, but that's absolutely not the case. Parents should not hesitate to share their native tongue with their children—it's a gift."

Because bilingualism is often tied to other factors such as culture, socioeconomic status, immigration history and language, the researchers partly took those into account by enrolling participants who all attended public schools and came from similar socio-economic backgrounds.

During the study, the children learned to read in both languages at the same time. Dr. Bialystok and her team thought that the additional time spent learning two languages might give the children an advantage. But, results showed that the advantages garnered by the children were independent of the instruction time in the other language.

Researchers noted in the online issue of the journal Child Development that "People always ask if the languages themselves matter and now we can definitively say no," study co-author, Dr. Bialystok, said in a release.

Learning a second language teaches children more about their first language. They understand the intricacies of grammar and acquire an additional awareness of how language is used to express thoughts.

The Canadian study was published in the February 8th, online issue of the journal Child DevelopmentThe study was funded by the U.S. National Institutes of Health.


Your Child

Doctors May Unknowingly Discourage HPV Vaccine for Preteens


The majority of physicians say that the HPV vaccine given to preteens, before they become sexually active, can help prevent infections with viruses that can cause cervical, penile and anal cancers as well as genital warts.

However, about 27 percent of doctors may inadvertently discourage parents from having their preteens vaccinated against human papillomavirus (HPV), according to a new study, because they don’t recommend the vaccine strongly enough.

Pediatricians and family physicians deliver the bulk of HPV vaccines. Some of these physicians do not offer the vaccines as strongly as they do when urging parents to vaccinate against meningococcal disease or to get tetanus, diphtheria, and pertussis booster shots, the study reported.

The study, which is based on a national online survey of 776 doctors, found a quarter did not strongly endorse the need for HPV vaccination with the parents of the 11- and 12-year-olds under their care.

Nearly 60 percent were more likely to recommend the vaccine for adolescents they thought were at higher risk of becoming infected — perhaps because the doctors knew or suspected they were sexually active — than for all 11- and 12-year-olds.

“You kind of get the sense that some [health care] providers see this as a somewhat uncomfortable situation,” said lead author Melissa Gilkey, a behavioral scientist in the department of population medicine at Harvard Medical School.

Many parents don’t like to think about the possibility of their child having sex, particularly when they are only 11 or 12 years old. The vaccine is actually meant to provide protection for when they are older. That’s why it is recommended before a child typically begins engaging in sexual activity. Studies have also shown preteens get the best immune response to the vaccines.

Evidence generated by one of Gilkey’s earlier studies suggests it’s not necessarily parents that are squeamish about the vaccination, but physicians that overestimate a parent’s response when the vaccination is urged. 

 “It’s not necessarily that physicians always are negative about it. But it’s kind of that HPV vaccine may get damned with faint praise, if you will,” Gilkey said. “Compared to the way that they recommend these other vaccines, parents may suspect that there’s something wrong with it.”

The aim of the research is to help figure out why HPV vaccination rates remain disappointingly low. The CDC reported that in 2014, 40 percent of adolescent girls and 22 percent of adolescent boys had received the recommended three doses of HPV vaccine. The agency says girls and boys should have all three doses by their 13th birthday.

According to the study, how the information is presented has an impact on how well it is received. Doctors who started conversations about the HPV vaccination by telling parents the vaccines protect against cancers and genital warts gave stronger recommendations than those who opened saying HPV viruses are sexually transmitted.

The study was published Thursday in Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

Although Gilkey declared no conflicts of interest, the senior author of the study, Noel Brewer of the University of North Carolina, has received research funding and speaker fees from companies that sell HPV vaccines.

Source: Helen Branswell,






Your Child

Skin Cancer Risk Higher for Redheaded and Fair Skin Children


Too much exposure to sunlight can damage the skin, particularly for children who have pale skin, red or fair hair, freckles or the type of skin that sunburns easily. 

Researchers found that having the genes that give you red hair, pale skin and freckles increases your risk of developing skin cancer as much as an extra 21 years of sun exposure.

Their study found gene variants that produce red hair and freckly, fair skin were linked to a higher number of mutations that lead to skin cancers. The researchers said even people with one copy of the crucial MC1R gene - who may be fair-skinned but not have red hair - have a higher risk.

"It has been known for a while that a person with red hair has an increased likelihood of developing skin cancer, but this is the first time that the gene has been proven to be associated with skin cancers with more mutations," said David Adams, who co-led the study at Britain's Wellcome Trust Sanger Institute.

"Unexpectedly, we also showed that people with only a single copy of the gene variant still have a much higher number of tumor mutations than the rest of the population."

Redheads have two copies of a variant of the MC1R gene which affects the type of melanin pigment they produce, leading to red hair, freckles, pale skin and a strong tendency to burn in the sun.

Exposure to ultraviolet light from either the sun or sunbeds causes damage to DNA and scientists think the type of skin pigment linked to redheads may allow more UV to reach the DNA.

In this latest study, the researchers found that while this may be one factor in the damage, there are also others linked to the crucial MC1R gene.

Although skin cancer is rare in children, the amount of sun exposure during childhood is thought to increase the risk of developing skin cancer in adult life. Children who have had episodes of sunburn are more likely to develop skin cancers in later life.

The skin of children is more delicate and more prone to damage. Therefore, take extra care with children, and keep babies out of the sun completely.

Because infants’ skin is so sensitive, it’s better in the first six months to shield them from the sun rather than use sunscreen. It’s especially important to avoid direct sun exposure and seek the shade during the sun’s hours of greatest intensity, between 10 AM and 4 PM. Keep to the shady side of the street on walks, and use the sun shield on your stroller

Once your baby reaches 6 months of age, it’s time to introduce sunscreens. Choose a broad-spectrum, water-resistant sunscreen that offers a minimum sun protection factor (SPF) of 15. Look at the active ingredients; zinc oxide and titanium dioxide are good choices, because these physical filters don’t rely on absorption of chemicals and are less apt to cause a skin reaction. Test your baby’s sensitivity to the sunscreen first, by applying a small amount on the inside of baby’s wrist.

Toddlers should also be kept in the shade between 10 AM-4 PM. Protect young children with sunscreen, hats, sunglasses and lightweight clothing that covers the skin.

The study was published in the journal Nature Communications.

Most kids get much of their lifetime sun exposure before age 18, so it's important for parents to teach them how to enjoy fun in the sun safely. Taking the right precautions can greatly reduce your child's chance of developing skin cancer.

Story sources:



Your Child

Concussion Symptoms Continue Long After Injury

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Symptoms such as headache, dizziness and blurry vision typically show up right after a child suffers a concussion. In a study from the emergency medicine division at Boston Children’s Hospital, researchers have found that emotional and mental symptoms, such as irritability and frustration may show up much later and hang around longer.

 "Patients and their families should expect the physical symptoms that they experience after a head injury to get better over the next few weeks, but that emotional symptoms may come on later, even as the physical symptoms subside," said lead researcher Dr. Matthew Eisenberg.

"Only by knowing what symptoms can be expected after a concussion can we help reassure patients and families that what they experience is normal, know when to seek additional help, and make sure that children are taking appropriate precautions in regard to school and sports to achieve a full recovery," Eisenberg added.

For the study, 235 children and young adults, ages 11 to 22, who were treated for concussion at a pediatric ER, answered questionnaires about their injury and were followed for three months after their visit. Patients were monitored until all their symptoms were gone. During that time they were asked about symptoms, sports activity and school and athletic performance.

The most common physical symptoms were headache, dizziness and fatigue, which tended to start right after the injury and got better over time. Researchers found that most of the children also had mental symptoms, such as difficulty concentrating and taking longer to think.

Eisenberg’s team noted that a majority of the children recovered within two weeks, however, 25 percent still had headaches a month after their injury. More than 20 percent said they were fatigued and 20 percent reported taking longer to think.

For many, emotional symptoms -- such as frustration and irritability -- were not as common right after the injury, but developed later, the study authors noted.

Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, said, "It takes longer than people think to fully recover from a concussion. My experience is that kids who still have symptoms two weeks after a concussion are going to have a very hard time, and it's going to be a struggle to get them to the point where they have no symptoms."

Kuluz recommends that parents make sure concussion symptoms are not ignored and their kids receive prompt and continued treatment. He suggests physical therapy to work on balance and helping with any vision problems.

He also recommends keeping children out of school for a couple of days after the injury and then gradually letting them get back to normal activities.

Kuluz tries to get kids back to school for half a day or as much as they can tolerate until they get better. Children should not start sports again until all symptoms have disappeared and then only gradually, he added.

This study was published online and in print in the journal Pediatrics.

Another recent study looked at the effects of concussion and years of repeated hits to the brains of college football players.

Researchers found that players who had been diagnosed with concussions and those who had been playing football for years had smaller hippocampuses – a part of the brain that is critical to memory. A smaller hippocampus has been linked to depression, schizophrenia and chronic traumatic encephalopathy (CTE).

The symptoms of CTE, which tend to set in years after the last traumas, often include memory loss, aggression and dementia.

“Boys hear about the long-term effect on guys when they’re retired from football, but this shows that 20-year-olds might be having some kind of effect,” said Patrick Bellgowan, the study’s senior author from the Laureate Institute for Brain Research in Tulsa, Oklahoma.

Concussion studies seem to be popping up everywhere, and for good reason. For too many years, a concussion injury wasn’t given much attention. The common train of thought was that if you play rough sports and you get hit - you shake it off and get back in the game. That philosophy applied whether you were 10 or 30 years old.

Then professional players began to exhibit early onset dementia and depression. Teens began to complain of constant headaches and feeling out of sorts. College players had difficulty concentrating and vision problems.

Parents demanded answers and researchers began looking at concussion and its long-term impact on the brain. The new studies shed a bright light on why these symptoms were troubling.

Most young athletes will not become professional players in their chosen sport or even play on college teams. Eventually, the helmets and pads will be passed on to the next group of excited young athletes and children will choose other activities or graduate into   the “real world”.

What these types of studies tell us is that long after the games are over, children who suffer concussions may experience serious long-term effects.

The symptoms can be so similar to typical teen behavior that they get overlooked. Kids get headaches, they get tired, they forget things and they have emotional outbursts. But if your child has suffered a concussion or even a very hard hit and you notice these symptoms don’t go away, take him or her to see a concussion specialist. They may or not be related to a more serious brain injury, but a missed opportunity for treatment may change your child’s future in ways that no one ever expected.

Sources: Steven Reinberg,

Andrew M. Seaman,




Your Child

Antibiotics Often Prescribed When Not Needed

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By now, most parents understand that antibiotics are not effective for viral infections, only for illnesses caused by bacteria.

However, that hasn’t deterred many physicians from over-prescribing antibiotics for children with ear and throat infections.

More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but also supports the dangerous evolution of bacteria toward antibiotic resistance.

"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.

"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."

 Doctors have limited resources when it comes to differentiating between bacterial or viral infections. Physicians can use the rapid step test to determine if the streptococcus bacteria is the cause of a child’s sore throat, but that is about it for immediate diagnostic tools.

Most colds are virus related and one of the first symptoms will be a sore or scratchy throat. It will typically go away after the first day or so and other cold symptoms will continue. Strep throat is often more severe and persistent.

A virus often causes ear infection as well. Many doctors treat ear infections as though they are bacterial to be on the safe side and avoid serious middle ear infections.

To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.

Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.

But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.

Kronan hopes that the study’s results will encourage the development of more diagnostic tools and will spur doctors to think more critically about prescribing antibiotics unless clearly needed.

Previous research has shown that parents often pressure their doctor to prescribe an antibiotic to treat their child’s ear or sore throat symptoms. However, when parents are given other suggestions on how to alleviate the symptoms they have been much more receptive than when their doctor just flat out says he won’t prescribe antibiotics.

Many physicians and researchers are concerned that the amount of antibiotics being prescribed these days is setting us all up for future problems when dealing with bacterial infections. Bacteria are adaptable and mutate over time becoming less responsive to antibiotics. When possible, it’s much healthier in the long run to treat your child’s symptoms with simpler therapies. Ask your physican ways you can make your little one more comfortable until the symptoms pass. 

The study was published online in the journal Pediatrics.

Source: Maureen Salamon,

Daily Dose

No Screen Time for a Week!

Kids are spending over 7 hours a day in front a screen: TV, watching video, playing games event texting. How much is too much?So, how much screen time does your child have?  You know what I mean, TV time, computer time, playing video games, using a cell phone (including texting). The list goes on and on!

The average American child spends 7 hours a day involved with some type of media, which is more than any other activity besides SLEEP! With that being said, this is National Turn Off Week!  My colleagues at the American Academy of Pediatrics are supporting an effort to encourage parents to implement a “screen free week” in their home. If the average child spends over 1000 hours a year involved in some type of media but only 900 hours a year in school it seems obvious that we are doing something wrong. The solution is to start limiting screen time beginning at the earliest ages. With so many parents believing that Baby Einstein videos will make their infant smarter (there is no proof), and parents who are teaching their children to use a computer or I-phone or I-pad by the age of two, early guidelines regarding time spend “on screen” are exceedingly important. The AAP endorses a “no TV for children under the age of two” rule and limiting TV/media time to 2 hours per day for children and teens.  Unfortunately, many parents may know that their children are home, but are not clear about what they are doing while at home, which often involves screen time in the “privacy” of their own rooms. I ask every patient and or parent about media time and if there is a TV or computer in the child’s room. I am continually amazed at how often the answer is yes, even for the elementary school set. Parents often view putting a TV in their child’s room as a “right of passage” despite the fact that there are really good studies to show that having a TV in a child’s room contributes to poor sleep habits which may impact children in many negative ways. I must say, there isn’t a teenager that I take care of that is “happy” that we are discussing media time, but just like other subjects that need to be addressed during a pediatric visit, this one may be more important than previously thought. For all of this interactive screen time may actually be becoming new “peer group” for a child, rather than having face to face time with their peers. So by turning off the “screens” and spending some time enjoying one another, a new normal could be started.  Families cooking together after the homework is finished, or going outside for a family walk or quick game, or reading together, or even playing board games, the list seems endless.  What a treat to get back 2, 3 or even 4 hours a day with your child.  Think about the  benefits that come from decreasing screen time, which include better academics, better sleep, less depression and anxiety and even an impact on obesity. I know it is challenging for all of us, but this is a “do-able” task for a week. While all of the screen are in the “OFF” mode, talk about new guidelines for when the screens go back on.  In this case the adage “less is more” seems appropriate. That's your daily dsoe for today.  We'll chat again tomorrow. Send your question or comment to  Dr. Sue!

Your Child

Kid’s Head Injury Linked to Long Term Attention Problems


Even mild brain injuries may cause children to have momentary gaps in attention long after an accident occurs, according to a new study.

The study of 6- to 13-year-olds found these attention lapses led to lower behavior and intelligence ratings by their parents and teachers.

"Parents, teachers and doctors should be aware that attention impairment after traumatic brain injury can manifest as very short lapses in focus, causing children to be slower," said study researcher Marsh Konigs, a doctoral candidate at VU University Amsterdam in the Netherlands.

This loss of focus was apparent even when brain scans showed no obvious damage, the researchers said.

The study’s results are being released as schools gear up for a new academic year combined with some sports programs that can put children at risk for head injuries.

Traumatic brain injury can occur from a blow to the head caused by a fall, traffic accident, and assault or sports injury.

Concussion is one type of traumatic brain injury. In 2009, more than 248,000 teens and children were treated in U.S. emergency rooms for sports- and recreation-related traumatic brain injuries or concussions, according to the U.S. Centers for Disease Control and Prevention.

Here’s how the study was conducted.  Researchers compared 113 children who had been hospitalized with a traumatic brain injury with 53 children who had a trauma injury not involving the head. The injuries, which ranged from mild to severe, occurred more than 18 months earlier on average.

The researchers tested mental functioning and evaluated questionnaires completed by parents and teachers at least two months after the injuries.

The head-injured group had slower processing speed, the researchers found. And their attention lapses were longer than those noted in the other children. But unlike other research, no differences were reported in other types of attention, such as executive attention -- the ability to resolve conflict between competing responses.

As is typical with most studies, the results do not prove a cause and effect relationship, but an association.

The take-home message from this study is that even mild head injury can lead to problems, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park, N.Y. He was not involved with the research.

"This study provides further evidence of the importance of trying to minimize brain trauma, since even when there is no visible damage on CAT scans or MRIs, there can still be a significant adverse effect on attention span and behavior," Adesman said.

This research underscores the need to protect children from head injuries through proper supervision, consistent use of child car seats and seat belts, as well as headgear when bike riding and playing contact sports, he added.

The study was published in the journal Pediatrics.

More information on brain injury in children can be found at the Brain Injury Association of America’s website,

Source: Kathleen Doheny,

Your Child

Exercise Boosts Kids’ Grades!

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We all know that exercise is good for the heart, lungs, weight-control and now a new study suggests that it’s good for increasing academic performance as well.

The Dutch researchers reviewed several prior studies conducted in the United States, one from Canada and another out of South Africa. What they discovered was that all the studies showed that the more physically active students are, the better they do in the classroom.

"We found strong evidence of a significant positive relationship between physical activity and academic performance," the researchers, led by Amika Singh of the Vrije Universiteit University Medical Center at the EMGO Institute for Health and Care Research in Amsterdam, the Netherlands, said in a journal news release.

"The findings of one high-quality intervention study and one high-quality observational study suggest that being more physically active is positively related to improved academic performance in children," the authors noted.

A total of 14 studies were reviewed. They involved students between the ages of 6 and 18. Some studies were smaller, working with 50 students, while another study had as many as 12,000 students. 

Researchers noted that students who exercised had increased blood flow and oxygen to the brain. These school-age children did better in the schoolroom. The analysis suggests that exercise also increases the levels of hormones responsible for curtailing stress and boosting mood, while at the same time establishing new nerve cells and synapse flexibility.

In recent years, there has been increasing evidence that has shown that many functions of the brain are highly dynamic, or “plastic”, meaning that the brain is able to continually change in response to stimulus and experience. This flexibility is thought to be a key property in allowing the nervous system to support short-term and sustained changes in output, associated with learning and memory.

Other studies have shown that people with early dementia benefit from exercise. Again, the increased blood flow and oxygen to the brain helps improve memory and learning function.

So, getting the kids off the couch and onto the playground (no matter whether it’s a public playground or the backyard) can help children stay physically fit and mentally alert.

The Dutch researchers would like to see more high quality studies conducted in this area of investigation.

"Relatively few studies of high methodological quality have explored the relationship between physical activity and academic performance," they acknowledged. "More high-quality studies are needed on the dose-response relationship between physical activity and academic performance and on the explanatory mechanisms, using reliable and valid measurement instruments to assess this relationship accurately."

It’s a pretty safe bet though, that the more a family exercises together, the healthier everyone will be.

The findings are published in the January issue of the Archives of Pediatrics & Adolescent Medicine.

Sources: /


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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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