LittleStomaks » Ask The Expert

Ask the Expert – Building a Healthy Immune System

TwinToddlersDad — Tue, 15 Mar 2011 10:00:59 +0000

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week Registered dietitian Jill Weisenberger offers ideas for foods that can help your child build a stronger immune system.

Jill Weisenberger, MS, RD, CDE

Education: M.S. Food Science & Human Nutrition, University of Florida
Degree in Communications, University of Florida
Nutrition consultant, writer, speaker, educator
Expertise in diabetes nutrition
Writer for Eating Well, Diabetic Living, Her Sports and Fitness magazines
Twitter: @nutritionjill
Website: All That’s Nutrition
LinkedIn Profile
Contact via email: jill@allthatsnutrition.com

Question: What kinds of foods will keep my child’s immune system as healthy as possible?

Answer:

Winter colds and flu are making the rounds. In some households, it seems that just as one family member is well, another gets sick. A well-running immune system can mount a powerful attack against viruses and other invaders, so paying attention to diet is especially important now. An apple a day is a good start to keeping the doctor away, but it’s the total diet – not any individual food or supplement – that stokes the immune system and keeps it humming.

The types of foods your child needs to fend off colds and illnesses are the same ones you need. Don’t fall for the hype of immune-boosting supplements and fortified foods. Simply eat a balanced diet. For most, that means a stronger emphasis on fruits, vegetables and whole grains. Try to eat a whole grain and at least one fruit or vegetable at every meal. Here are a few to try, but again a balanced diet is required – not any specific food.

Beans: Baked beans, kidney beans and others are a powerhouse of nutrients including zinc which may reduce some upper respiratory infections. Smash up some white beans to thicken soups and stews. No one will ever know they’re there. Add red or black beans to salads and pasta.

Oats: another good source of zinc and a perfect breakfast food. Instead of using breadcrumbs, you can also add oats to meatballs and meatloaf.

Bell peppers, broccoli, citrus, kiwis and berries: These are all good sources of vitamin C. Research isn’t clear that extra vitamin C helps treat or prevent colds, but vitamin C-rich foods are packed with other antioxidants and nutrients, so it’s a good idea to include them daily. Clementines are especially nice for children because they are small, seedless, easy-to-peel, delicious and not as messy as other citrus fruits.

Mushrooms: Researchers at Tufts University suspect that the simple white button mushroom may enhance immune function by increasing the production of antiviral compounds. If your kids aren’t used to eating mushrooms, introduce them with foods they already like such as pastas and casseroles.

Finally, don’t forget that frequent hand washing and other good hygiene habits are also necessary to protect your health and your family’s health. Oh and get outside in the sunshine too.

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

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Ask the Expert – Managing Reactive Hypoglycemia

TwinToddlersDad — Tue, 14 Dec 2010 11:00:54 +0000

I did not know about reactive hypoglycemia until recently when a Mom asked me this question on our Facebook page. This week, Registered Dietitian Karman Meyer explains what it is and what you can do to manage the blood sugar levels to avoid potentially life threatening symptoms.

Karman Meyer, RD LDN

Education: Dietetic Internship completed at Vanderbilt Medical Center, B.S. in Dietetics from Miami University
Certifications: Registered Dietitian, Licensed Dietitian/Nutritionist in Tennessee
Experience: Clinical Dietitian, Diabetes Educator, Nutrition Writer
Twitter: @food_delights
Website: Nutrition Adventures
LinkedIn Profile
Contact via email: karman.meyer@yahoo.com

Question: I have a profoundly gifted, almost 3 year old, son with reactive hypoglycemia. Would love to know more about keeping his blood sugar level.

Answer:

Reactive hypoglycemia, also known as postprandial or alimentary hypoglycemia, is a rare condition that causes an individuals’ blood sugar, or blood glucose, to drop below 70 mg/dL typically within 4 hours after eating a meal. A significant drop in the blood sugar level after eating is caused by an excess production of insulin for digestion of carbohydrate-rich foods. Symptoms of reactive hypoglycemia are similar to diabetes-related hypoglycemia, which include light-headedness, sweating, confusing, hunger, and weakness. The cause of reactive hypoglycemia is still uncertain, but individuals who have had gastric surgery may develop this disorder.

Because a low blood sugar level can be potentially dangerous if not treated right away, it is best to prevent it from occurring. To help avoid hypoglycemia, individuals with reactive hypoglycemia should try the following:

Eat small meals or snacks every 3 hours
Make sure meals and snacks contain foods from a several food groups (protein, dairy, fruits, vegetables, and grains)
Limit foods that are high in simple sugars (soda, candy, cakes, pastries), especially if eating on an empty stomach
Choose foods high in soluble fiber (oatmeal, citrus fruits, carrots, and beans)

Be prepared and pack a carbohydrate-containing snack when the next meal is several hours away to prevent drops in blood sugar. If hypoglycemia does set in, be sure to take action and treat the low blood sugar immediately. Glucose tablets are effective for quickly raising blood sugar levels and should be carried at all times in case food is unavailable.

Living with reactive hypoglycemia can be very manageable. The most important point to remember is that people with reactive hypoglycemia need to eat a variety of foods at meals and snacks, and should eat at least every 3 hours. By planning balanced and appropriate meals and snacks ahead of time, low blood sugars can be prevented.

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Ask the Expert – Healthy Fats for Managing Toddler Underweight

TwinToddlersDad — Tue, 30 Nov 2010 11:00:31 +0000

We often hear about overweight and obesity in children, but underweight, or slow weight gain can also be a cause for concern. This week, Registered Dietitian Amy Braglia-Tarpey discusses the importance of including healthy fats in your child’s diet to manage the challenge of underweight.

Amy Braglia-Tarpey, MS RD

B.A. in Psychology from the University of Arizona
M.S. in Nutritional Science from California State University, Long Beach
Registered Dietitian, Certified Nutrition Support Clinician, and Board Certified Specialist in Renal Nutrition
Worked as a clinical dietitian at Salinas Valley Memorial Hospital , with over 10 years of experience working in the field of nutrition
Expert in nutrition support and nutrition for Chronic Kidney Disease
Twitter: @RD4Change
LinkedIn Profile
Contact via email – ATarpeyRD@gmail.com

Question: I have a very underweight toddler. What are the best ways to add calories to food? I am often told to add cream, olive oil, or butter, but that just doesn’t seem healthy.

Answer:

Many parents are concerned about the quantities and amounts of fats their children are consuming. Fear of fat has been instilled in us due to recommendations by the American Heart Association to reduce total fat, saturated fat, and cholesterol in our diets. However, this advice is meant for adults, and is currently under scrutiny as research provides new information about the roles of different fats in our health. Children require more fat in their diets than adults to support growth. Moreover, the type of fat is more important than the overall quantity in most cases. In pediatric underweight, adding calories for growth is extremely important. Because fat provides more calories per gram than carbohydrate or protein, adding more to the diet is the most efficient strategy to promote weight gain.

In humans, fats are essential for building the membranes of cells. In childhood, a balance of saturated, polyunsaturated, and monounsaturated fats is necessary to give new cells structure. Without any one of these components, cell membranes can become too rigid or weak. Therefore, some quantity of each of these types of fats should be provided by the child’s diet.

While it is true that the majority of calorie additions should come from monounsaturated and polyunsaturated fats, saturated fats in moderate quantities can add calories as well as palatability. Monounsaturated fats are found primarily in plant oils, although meat fats contain some as well. Olive and canola oils, avocado, and almond butter are good sources of monounsaturated fat. Most polyunsaturated fats come from plant oils as well, and appear in the largest quantities in vegetable oils such as soybean oil. Another type of polyunsaturated fat, Omega-3 fatty acids, are abundant in fish and marine oils, as well as flaxseed and walnuts. Saturated fats in the diet come mostly from meats and dairy, although smaller amounts are present in vegetable oils.

Adding calories to aid in weight gain can be quite challenging. Some calorie-dense foods are not well-tolerated by children, and some are rejected due to individual tastes. If there is an underlying disease or condition that is preventing weight gain, it may be difficult to find calorie additions that adhere to the restrictions of the child’s diet. Here are some suggestions for healthful calorie additions:

Avocado- Add to sandwiches, wraps, and soups. Spread on toast as you would butter, or make guacamole as a dip for veggies, crackers, and bread.
Almond or peanut butter- Add to hot cereals such as oatmeal. Use instead of butter when making cookies, spread on bread or crackers. Freshly ground flaxseeds can also be mixed into cereals.
Stir extra olive oil or canola oil into soups. Canola oil has a neutral flavor and can be added to most cooked as well as baked goods.
Drizzle olive oil over fish, chicken and pork. Add olive oil to pastas, sweet potatoes, and other side dishes. Make pesto, a calorie-dense blend of olive oil, nuts, and herbs (cheese optional).
Cheese is a great source of protein, calcium, and phosphorus, as well as calories. Kids love it! Try string cheese for snacks, and stir cheese into casseroles and dips. Melt it over eggs and vegetables.

Choose the majority of calorie additions each day from the above groups. Cream may also be used, but with greater moderation. ¼ cup of heavy cream supplies 200 calories, with one third of its total fat provided by mono- and poly-unsaturated types. Use to add calories to cereals, soups, casseroles, and scrambled eggs.

What has worked for you? Share your experience in comments below.

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Ask the Expert – Soy Milk Alternatives

TwinToddlersDad — Wed, 10 Nov 2010 11:00:56 +0000

This week, Registered Dietitian Preethi Rahul addresses concerns about soy milk and suggests a few alternatives.

Preethi Rahul

Registered Dietitian, Diploma in Clinical Nutrition & Dietetics, Graduation in Nutrition, Food Service Management and Dietetics.
Two years of rich experience in the field of nutrition, currently working with a Multinational Corporation
Expertise in the field of Child nutrition and Diabetes
LinkedIn Profile
Contact: via email

Question: I have heard that soy foods, especially milk, can be bad for kids because of a high estrogen content. IS this true and what is my alternative?

Answer:

The American Academy of Pediatrics (AAP) recommends that parents give soy formula only to infants who cannot digest cow’s milk or to those whose parents wish them to follow a vegan diet. For the majority of infants, the AAP says cow’s milk formula is still the next best thing to breast milk.

The main concern about soymilk is that it contains high levels of phytoestrogens — estrogen-like substances found in some plants. Soybeans are a significant source of mammalian lignan precursor secoisolariciresinol containing 13–273 µg/100 g dry weight. Another phytoestrogen in the human diet with estrogen activity is coumestans, which are found in beans, split-peas, with the best sources being alfalfa, clover, and soybean sprouts.

People who are worried about soy formula fear that these substances could interfere with a child’s development and even cause early puberty, thyroid problems, breast development in male children, or other difficulties. However, most of the research on soy has been carried out in animals and not in people. Soy may cause some endocrine disruptions in animals but humans metabolize soy differently. According to British Medical Journal there is virtually no data on the effects of phytoestrogens on children. However, the long-term effects of soy are still not known. So, use soy milk in moderation as research is still being carried out and it is highly controversial.

Other alternatives to soy milk are almond milk and rice milk unless of course you do not plan to use cow’s milk. Almond milk is rich in magnesium, potassium, manganese, copper, the antioxidants vitamin E and selenium, and calcium. Almond milk, then, may be one of the more nutritious milk alternatives on the market but it is expensive. Rice milk is processed from brown rice and usually contains rice syrup, evaporated cane juice or some other natural sweetener. It is typically fortified with calcium or vitamin D. Rice milk is largely a source of carbohydrates, so it’s important not to look at it (or either of the other two milk substitutes) as a nutritional replacement for milk (cow’s milk is a source of protein, fat and carbs).

Below is table comparing various milks:

©2010 Littlestomaks.com. All Rights Reserved
Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

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14 Healthy Habits We Can Learn from Our Children

TwinToddlersDad — Tue, 09 Nov 2010 11:00:41 +0000

This is a guest post by Michelle May, M.D., a physician and recovered yoyo dieter, and the founder of Am I Hungry?® Mindful Eating Program. She is the award-winning author of Eat What You Love, Love What You Eat: How to Break Your Eat-Repent-Repeat Cycle. Download the first chapter here.

Out of the Mouth of Babes….

photo credit: saia.neogaia

There are many important things that we need to teach children as they grow – but they have many natural behaviors that we shouldn’t try to change. In fact, we could learn a few things from kids. Here are some important lessons:

1. Eat when you’re hungry. From the time they are born, babies know when and how much they need to eat—and they cry to let us know too! As they grow, this important instinct can be un-learned. By the time they are adults, they may have learned to eat for many other reasons besides hunger—mealtimes, tempting food, stress, anger, boredom, and countless other triggers. By recognizing the difference between needing to eat and wanting to eat, adults can re-learn when and how much to eat too.

2. Stop eating when you’re full. An infant will turn their head away when they’ve had enough to eat, and a toddler will throw a plate of food on the floor when they’re done. But as adults, we clean our plates because “there are starving children” somewhere—or just because something tastes good. I’m not suggesting that we start throwing our plates on the floor again, but we need to remember that food is abundant in our society so there’s no need to eat it all now.

3. Being hungry makes you grouchy. Being hungry, tired, or frustrated are sure to make a child crabby—and they affect adults the same way!

4. Snacks are good. Kids naturally prefer to eat smaller meals with snacks in between whenever they get hungry. That pattern of eating keeps their metabolism stoked all day. Adults who need to fire up their metabolism should try this too.

5. Play with your food. Most kids love to examine, smell, and touch their food. Since eating is a total sensory experience, they get the most from every morsel. This childlike approach will help you eat less food while enjoying it more. You’ll appreciate the aroma, appearance, and flavors more if you aren’t driving, watching T.V., or standing in the kitchen.

6. All foods fit. Children are born with a natural preference for sweet and higher fat flavors. Though parents sometimes worry about it, these “fun” foods can be part of a healthy diet. In fact, overly restrictive food rules usually lead to rebellious eating anyway—just think about the last time you weren’t “allowed” to eat something on a diet! Children and adults both eat healthier when they learn to enjoy these less nutritious foods in moderation.

7. Be a picky eater. Kids won’t easily eat something they don’t like. Think of how much less food you would eat if you didn’t settle for food that tasted “so-so.”

8. You can learn to like new foods. Healthy eating is an acquired taste. Good nutrition is essential, so providing a variety of appealing, healthful foods will benefit the whole family. In our house, we have a two-bite rule. Everyone tastes two bites of everything; if they still don’t like it, they don’t have to eat it—but they have to try it again the next time we have it. Since that’s “The Rule,” there are no battles at the table and the kids (and parents) often surprise themselves by liking something they thought they wouldn’t.

9. Follow the leader. Face it, kids watch and often imitate everything we do. If they observe us eating a variety of healthful foods and exercising regularly, then they’ll learn to take good care of their bodies. Likewise, if they don’t hear us making comments like “I’m so fat” or “She looks fat” then they’re less likely to suffer from poor self-esteem and a judgmental attitude.

10. There is more to a party than cake and ice cream! Invite a child to a party and they’ll want to know what they are going to get to do. Invite an adult and they’ll wonder what food will be served. You don’t have to avoid parties to manage your weight; just focus on the real purpose of social events—to be social.

11. Eating with your family is fun. Since babies and toddlers must be fed by their parents, they naturally love eating with other people. Family mealtime is your opportunity to model good habits and connect with each other. We still play “High-Low” with our kids at dinner. Each member of the family takes a turn telling the others about the best and worst parts of their day. What a great door opener to dinner conversations.

12. It’s boring to just sit around! Toddlers seem to be in perpetual motion while they constantly explore their world. Young kids love to run in the grass, play on the playground, and challenge themselves and each other to increasingly more difficult activities. Of course, as they get older, television, computers, and electronic games compete for their attention. In our family, to encourage other activities, we use “screen time” which limits how much time our children are allowed to spend on anything with a screen. Sometimes adults would benefit by limiting their screen time and exploring their world a little more!

13. Sleep is good. After a full day, children need a good night’s sleep to prepare for all of the adventures that tomorrow will hold. Wouldn’t we all benefit from a consistent bedtime to make sure we get our rest too?

14. Live in the moment. Kids are masters at living in the present. They don’t waste a lot of energy worrying about what has already happened or what might happen tomorrow. They are fully engaged in small pursuits like discovering where the ants are going, chasing the dog, or seeing how deep they can dig with a plastic shovel. We, on the other hand, continue to scurry around, chasing after our dreams, and all the while, digging ourselves deeper and deeper. We could learn a lot from children!

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Where Food and Sinusitis Meet:Reflux

TwinToddlersDad — Thu, 04 Nov 2010 10:00:33 +0000

This is a guest article by pediatric ENT specialist Dr. Russell A. Faust, who blogs at Ask the Boogor Doctor.

We adults with reflux know it as heartburn. Other symptoms include burping and sour taste. That sour taste is regurgitation of stomach contents to the back of the throat (yuk!).

It’s called gastro-esophageal reflux (GER), and more than 135 Million, or about 44% of Americans, have reflux at least every month.

Babies, Infants, Children

We know reflux in babies and infants as “spitting up,” and we can all recognize the spitty baby from the white curds on their chin.

Most of these babies will outgrow their reflux without harm, and without intervention. Most will never have symptoms.

A small minority of infants and children with reflux will experience symptoms. Symptoms of reflux in children can be stealthy. They almost never complain of heartburn. The symptoms that they experience are usually indirect – they cough, wheeze, have chronic throat-clearing, recurrent bronchitis, or chronic sinusitis.

This is when simple GER becomes GER Disease, or GERD.

What I wanted to review here today is a connection that does not seem intuitive – that between reflux and sinusitis.

How in the World Can Reflux Cause Sinusitis?

Similar to the link between reflux and ear infections, there are two schools of thought on this connection:

The first is based on a theory called the Unified Airway Model. This theory states that, because the upper aero-digestive tract is derived of the same lining, any inflammation occurring anywhere in that tract will stimulate the other areas also. Simply put, otitis can cause sinusitis, can cause asthma, etc. There is pretty good scientific support for this theory.
The second thought it that if reflux reaches the back of the throat and lining of the nose, the resulting inflammation and swelling can cause sinusitis. There is pretty good scientific support for this theory too: studies have found gastric enzymes inside the middle ears (in cases of chronic otitis), or inside the sinuses (in cases of chronic sinusitis). This is pretty direct evidence that gastric contents has been regurgitated up to that level of the upper airway (not a pretty thought).

What is the Clinical Evidence for a Connection?

A study reported in 1999 (Bothwell) found that 89% of their pediatric candidates for sinus surgery were able to avoid surgery simply by treating for reflux. 89% avoided surgery!!

A study published one year later (Phipps) reported that 63% of children with chronic sinus disease had reflux, and that sinusitis improved in 79% of them when their reflux was treated.

That same year (2000), another group (Yellon) reported an even stronger correlation between reflux esophagitis and sinusitis: When they looked at the esophagus (food swallowing tube leading to the stomach) they found inflammation of the esophagus (esophagitis) in 100% of the children with sinusitis. That is, in their study every child with sinusitis had reflux esophagitis.

These correlations do not prove that reflux causes these symptoms, but there is strong implication.

What Can You Do With This Information?

Other symptoms to raise suspicion for GERD include:

Cough, worse at night
Wheezing, worse at night
Choking at night
Stomach ache, worse in the morning
Chronic throat-clearing, worse in the morning
Recurrent bronchitis
Recurrent and chronic sinusitis
Failure to thrive (difficulty gaining weight)

If your little monkey has chronic sinusitis, or any of these other symptoms, reflux should be considered as a contributing factor. Improving, or even eliminating, the symptoms might simply be a matter of treating the reflux. It still amazes me that I “cure” asthma or sinusitis in my clinic when I recognize reflux as the major causative actor and treat it.

Ask your pediatrician or pediatric boogor doctor about it.

Finally, Jan Gambino’s book, Reflux 101, is a great place to start if you have questions reflux in your infant or child, and what you can to do about it.

Next month I am reviewing how we test for reflux, and treatment options for reflux (conventional and alternative), and I invite y’all to come visit.

Resources:

Nelson, Chen, Syniar, Christoffel. Prevalence of symptoms of gastroesophageal reflux in infancy. Archives of Pediatric and Adolescent Medicine 151: 569-72; 1997.
Stroh BC, Faust RA, Rimell FL: Results of Esophageal Biopsies Performed During Triple Endoscopy in the Pediatric Patient. Archives of Otolaryngology – Head and Neck Surgery, 124: 545-549; 1998.
Bothwell M, Parsons D, Talbot R, Barbero G, Wilder B. Outcome of reflux therapy on pediatric chronic sinusitis. Otolaryngology-Head and Neck Surgery. Vol. 121(3): 255-262; 1999.
Phipps CD, Wood WE, Gibson WS, Cochran WJ. Gastroesophageal reflux contributing to chronic sinus disease in children. Archives of Otolaryngology-Head and Neck Surgery. Vol. 126: 831-836; 2000.
Yellon RF, Coticchia J, Dixit S. Esophageal biopsy for the diagnosis of gastroesophgeal reflux-associated otolaryngologic problems in children. American Journal of Medicine. Vol. 108: 131s-138s; 2000.

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Ask the Expert – Feeding a Picky Eater

TwinToddlersDad — Wed, 03 Nov 2010 10:00:58 +0000

Most toddlers are picky eaters and getting them to build lifelong healthy eating habits is a challenge for most parents. It is not unusual for a child to fill herself with drinks and only nibble on a few foods occasionally. This week, Registered Dietitian Ashley Rosales offers a few tips to bring variety in your child’s diet and encourage healthy eating habits.

Ashley Rosales, RD

B.S. in Clinical Nutrition from UC Davis, Dietetic Internship completed at Napa State Hospital
Project Manager Dairy Council of California
Past Experience: Clinical nutrition, nutrition communications, senior nutrition and food service management
Expertise: Registered Dietitian with a focus on effective nutrition education, providing parents with realistic approaches to raising healthy eaters, and blog writer for MealsMatter.org
Twitter: @Ashley_RD
Contact via email – arosales@dairycouncilofca.org

Question: My little one drinks and drinks and drinks but only nibbles on food here or there. Is this okay or should I try to make her eat actual food? Or maybe a nutrition shake?

Answer:

Many parents of young children question if their child is getting enough nutrients through food. It is important to remember that although they’re no longer babies, young children aren’t ready for adult-sized portions. Their little stomachs just aren’t big enough. Although it is true that they need the same nutrients as adults, the amounts do differ greatly. It is also very common for your child to show day-to-day appetite fluctuations. If your child is occasionally “picking” at a meal, chances are that he or she will make up for it later. If your child is growing normally, seems healthy, and has energy to play, then he or she is probably getting enough to eat. Despite this, it is still normal for parents to feel insecure about “what” or “how much” their child is eating.

One of the hardest things for a parent to do is trust in their child’s hunger and satiety cues. This is a critical time when your child is learning how to make food choices and is establishing patterns of healthy eating that they will take with them the rest of their life. If you are doing all you can as a parent to set your child up for feeding success, then you can feel confident that they will eventually make the right choices and that they will get enough nutrients in the process. Here are a few guidelines to consider to give you some peace of mind.

Establish a routine. Children do best with a routine, so try serving meals and snacks at about the same time every day. Limit snacks that are served as a “pacifier”, such as in the line at the grocery store or while running errands in the car, as these types of snacks can interfere with mealtime. Plan snack and meal times to coincide with your families schedule in order to ensure you have adequate time to prepare a healthy snack and eat meals together as a family when possible. When children don’t feel rushed, or when they eat with others, they tend to eat better.

Serve smart snacks. In addition to meals, young children need 2 to 3 snacks each day. Plan snacks that include something from at least one of the food groups. An example would be sliced apples with string cheese or whole grain crackers with hummus. If your child likes to sip on beverages for a snack try serving up a delicious and nutritious smoothie by blending fruit, ice and milk together. Snacks should be a nutritional complement to meals, so try offering snacks two hours before meals so that your little one is hungry again by mealtime.

Beware of beverages that compete with nutrients. Beverages are important for many reasons, with the highest being that they ensure your child is getting enough fluids for hydration. However, many beverages consumed by children today are loaded with calories yet provide no essential nutrients. These beverages, like soda, fruit and sport drinks, often replace nutrient-rich beverages like milk, which provides the calcium, vitamin D and potassium that children need each day. On the other hand, although your child needs nutrient-rich beverages, don’t be so quick to reach for those child “supplement shakes” unless directed by your pediatrician, as these really can interfere with your child’s hunger at mealtimes. So what should you serve your child to drink? The best rule is thumb is to serve milk with meals, provide 100% fruit juice in moderation (around 4-6 oz per day) and offer water throughout the day when your child is thirsty.

Be a good role model. What are your eating and drinking habits? Do you snack on nutritious foods and eat a balanced meal with your children? Do you drink milk at meals and choose water when you are thirsty? Children are observant and they rely on you to learn their habits, attitudes and beliefs around food. Role modeling is one of the most powerful and effective ways to help your child eat healthier.

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Ask the Expert – Packing a Healthy Lunch Your Child Will Love

TwinToddlersDad — Tue, 26 Oct 2010 10:00:50 +0000

Peer pressure in school can make your child feel insecure about her healthy lunch from home which may not have the poplar processed foods and snacks. This week, Registered Dietitian Katie Heddleston offers a few ideas to help your child feel good about carrying a healthy lunch from home.

Katie Heddleston, MS, RD, LD

B.S. in Nutrition from Case Western Reserve University, OH
M.S. in Public Health and Nutrition from Case Western Reserve University, OH
Expertise: Maternal/child nutrition, Gluten free recipes, Healthy lifestyle
Website: Healthy Heddleston
Twitter: @KatieHeddleston
Contact via email – HealthyHeddleston [at] gmail [dot] com

Question: According to my 1st grader “everyone” except for her packs a lunchable or other convenience foods. I need some suggestions on how to help my kids feel good about eating their healthy lunches packed from home.

Answer:

This is a great question and one parents are faced with more and more as convenience foods and busy lifestyles are becoming the norm. To help your kids gain confidence about eating their healthy lunch packed from home, my suggestions come from answering the following questions:

What is your child’s relationship with food like at home?
How appealing and appetizing is the lunch packed from home?

Let’s tackle the first question: What is your child’s relationship with food like at home? Maybe your child just comes to the table when dinner is ready; maybe your child likes to sit at the counter and watch the whole cooking process. Maybe your family doesn’t cook at home often and your child is used to the convenience of a restaurant or take out. Whatever the situation, the facts are simple: Kids are less likely to reject foods if they help make them. Getting your children involved in meal planning not only helps build confidence, but can lead to your child accepting those packed lunch from home (since they helped make them!) There are other benefits from having kids in the kitchen too; your child will:

Try and like more foods
Gain confidence, feel important, and proud
Learn early math and science concepts
Learn new vocabulary
Develop small muscle skills
Learn responsibility with cleanup

Now for an easier question to tackle: How appealing and appetizing is the lunch packed from home? I’m not here to criticize the way anyone packs their child’s lunch, but I am here to tell you children want to eat appealing and appetizing food (they are just like us adults!) This is why the packaging or uniqueness of a lunchable seems appealing to a child. I am also here to suggest ways to make your child’s school lunch more fun, appealing, and appetizing!Try these ideas:

Let your child choose their lunchbox.
Pack the lunch with fun, reusable accessories.
Make food fun.

Here is an example of how you can make it fun to try new foods as you capture your child’s imagination:

Basically, presentation is key. Try to incorporate your child in the kitchen and these suggestions to see how your child starts to feel good about those healthy packed lunches from home!

Useful Resources:

MyPyramid for Kids

Nutrition for Kid and Teens

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Ask the Expert – Meeting Your Child’s Calcium Needs

TwinToddlersDad — Tue, 19 Oct 2010 23:33:27 +0000

Calcium is very important for growing children as it helps them build and maintain healthy bones. This week, Registered Dietitian Karen Kafer talks about calcium requirements for children and different sources of calcium.

Karen Kafer, RD

B.S. Oklahoma State University
VP Health Partnerships at National Dairy Council
Past experience: VP, Communications for Kellogg Company
Website: The Dairy Report
Contact via email – karen.kafer@rosedmi.com

Question: There are several calcium choices I could provide for my child—which one(s) should I choose?

Answer:

Since children are often picky about what they eat, parents are challenged to find foods kids like that also provide the nutrients they need. The Food and Nutrition Board of the National Academy of Sciences recommends children consume adequate calcium in their diets. This means:

500 mg of calcium a day for kids who are 1 to 3 years old;
800 mg of calcium a day for kids who are 4 to 8 years old; and
1,300 mg of calcium a day for kids who are 9 to 18 years old 2 .

To reach these recommended calcium levels, there are several options parents can provide for their children. Calcium can be found in dairy foods such as milk, cheese and yogurt, vegetables like broccoli, kale and spinach, as well as salmon, red beans and fortified juices and cereals. However, different calcium sources provide various levels of calcium and also vary in how easily they are absorbed in the body.

To compare, a one cup serving of milk or yogurt or 1.5 ounces of natural cheddar cheese contains about 300 mg of calcium on average. However, to obtain the same amount of calcium in one cup of milk, a child would have to eat 10 cups of raw spinach, nearly 4 ¾ cups of canned red kidney beans or 4 ¾ cups of cooked broccoli. As for foods fortified with calcium, they vary in both their calcium content and quality, so be sure to read food labels to determine how much calcium these products contain. Check the ingredient section of the food label to determine the type of calcium (such as calcium carbonate, calcium citrate, calcium malate, etc.) used during fortification.

Another option for children is calcium supplements or supplements containing calcium; however, it’s recommended that parents always consult a pediatrician before giving children supplements of any kind. According to the National Institute of Health, “the two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. Both the carbonate and citrate forms are similarly well absorbed, but individuals with reduced levels of stomach acid can absorb calcium citrate more easily. Calcium citrate malate is a well-absorbed form of calcium found in some fortified juices. The body absorbs calcium carbonate most efficiently when the supplement is consumed with food, whereas the body can absorb calcium citrate equally effectively when the supplement is taken with or without food.” Unless a child has a dairy allergy and must avoid dairy, it’s important to remember foods naturally containing calcium, such as milk and milk products, rather than supplements, are the preferred source of calcium for both you and your child.

Vitamin D helps promote the absorption of calcium and enhances bone mineralization. In fact, a glass of milk fortified with vitamin D provides about 25 percent of the Daily Value for vitamin D, and aids in this calcium absorption and bone mineralization enhancement. Milk is one of the few dietary sources of this important nutrient so it’s important for children to have their recommended amount of low-fat and fat-free milk and milk products every day.

Resources:

Milk’s unique nutrient package from National Dairy Council

Calcium content of select foods – USDA national nutrient database for standard reference

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Ask the Expert – The Case for Water

TwinToddlersDad — Tue, 12 Oct 2010 10:00:38 +0000

Water works very well to quench the thirst, yet kids hardly drink any of it these days. This week, Registered Dietitian Jane Harrison offers a few practical tips to get your child in the habit of drinking water and shake off the sugary drinks.

Jane Schwartz Harrison, RD

B.S. in Nutrition, Cornell University
Experience – 20 years as hospital outpatient dietitian and nutrition consultant, private practice and guest lecturer
Expertise -Registered dietitian, lifestyle writer and editor at myOptumHealth.com
Twitter: @myOH_Nutrition

Question: What is the best way to get my child drinking water instead of sugary drinks?

Answer:

Do you have a hard time getting your kids to drink a good old fashioned glass of water? Fierce competition from sports drinks, ice tea, lemonade, slurpies, fruit drinks and sodas doesn’t make your job any easier.

It all adds up
Consider Andy, a 4th grader, who starts his day with some orange juice at breakfast. Dad packs a juice drink for his morning snack. Lunch brings lemonade, followed by a sports drink during his afternoon baseball practice. For dinner, mom allows Andy to have “just one” cup of soda as a treat.

Though this may all sound harmless, Andy’s drinks amounted to 26 teaspoons of added sugar. This doesn’t even count his cookie at lunch or frozen yogurt after dinner.

Studies show that overall sugar intake has skyrocketed right along with the rise in childhood obesity. And sweetened drinks are the leading source of added sugar in the diet.

Studies also show that using water as a replacement is a simple and effective way to cut back on excess calories. Doing so could go a long way toward helping to prevent or treat childhood obesity as well as prevent cavities and other health problems associated with excess calories and sugar.

The case for water
We know that drinking water is the best way to quench thirst without providing added sugar and calories. But how do you encourage your kids to ditch the sugary drinks and fill up on water instead?

If you’re still in the toddler phase, take advantage of the opportunity to make water the go-to drink from the start. Remember, once kids get used to the taste and start choosing sugary drinks over water, it’s much harder to make changes.

If your kids are already hooked on sugary drinks, your task is more challenging but certainly doable! And it’s a good idea to plan on making it a gradual process to bring them back to water.

Use these tips for the best chance at success:

Educate

Teach your kids about the importance of water. They may enjoy these facts:

Water is the most needed nutrient of all. A person can live without food for a few weeks but a person can only live without water for a few days.
The human brain is two-thirds water.
Water carries oxygen and other nutrients into all your cells and organs.
Water helps to lubricate your joints.
Water helps to prevent constipation and keep your intestines running smoothly.

Set new rules

Have one meal or snack where you typically offer juice or another drink. At other times, simply ask “what would you like to drink – milk or water?”
Instead of juice drinks, send them to school with light-weight metal bottles that keep water cool and fresher tasting than plastic. Not only does the water taste better, but you don’t need to worry about leaching issues from plastics.
Bring only water to the park or playground.
Unless your child will be active for more than one hour, bring a water jug versus a sports drink to their game or practice.

Be creative

Keep chilled water in the fridge; provide a jug of water with slices of lemon or lime.
Make unsweetened ice tea with lots of added lime, oranges and/or lemon. Use flavored tea bags for added taste such as mint, ginger or raspberry. Consider adding fresh mint.
Give them their own ”grown up” glass for water (as opposed to plastic cup or sippy)
Introduce carbonated waters (flavored but not sweetened).

Other tips

Make a point of drinking water in front of your kids.
Offer fruit instead of juice. In addition to having fiber and other nutrients, whole fruit has water “built in” and is a natural thirst quencher.
Buy frozen cans of 100% juice and dilute by adding at least two cans of extra water. Do the same for lemonade.
Add a small amount of juice to seltzer as a soda alternative

Finally, don’t rely on diet drinks as a substitute. Their super sweet taste doesn’t allow kids to get used to the taste of less sugar. And long term effects are unknown.

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Ask the Expert – Feeding Twins

TwinToddlersDad — Tue, 28 Sep 2010 10:00:39 +0000

Nearly all parents of toddlers struggle to feed their little ones. But when it comes to feeding twins, it may be the ultimate extreme sport! This week, Registered Dietitian Aaron Flores, who is also a dad of twins, shares his experience and a couple of successful strategies of feeding kids.

Aaron Flores, RD

Bachelors in Family and Consumer Sciences and RD
Experience – 4 years experience as a clinical RD specializing in weight management
Expertise — General Nutrition, Weight Loss, Nutrition news, Sustainable eating
Website: Balance-Variety-Moderation
Blog: Balance-Variety-Moderation Blog
Twitter: @Afjamp
Contact: via email Aaron@bvmrd.com

Question: How can I get my twins to eat well and develop healthy habits?

Answer:

You would think that a dietitian would have an easy time when it comes to feeding their own children right? After all, we do consider ourselves the nutrition experts. I find it is quite the contrary. Knowledge does not always equal 100% success when it comes to feeding your kids. Along with being a dietitian, I am also the proud father of not-quite 3-year-old twins, Reuben and Shira. Being a father of twins and a registered dietitian, I think I’ve gained some unique perspective on feeding children.

Before being father, I remember sitting in school earning my bachelor’s degree, and learning about Ellyn Satter. I found out she was a dietitian who had very interesting insights into feeding children. I knew she wrote many books on the subject I never was motivated to read them until I found out my wife was pregnant. Until you have children of your own, you never really know what kind of parent you will be or how you will handle any given situation. You think you will handle it one way but until that actual moment is there, you never really know. Feeding my children was a perfect example of this.

What I loved about Satter’s theory is that focuses on responsibilities. She believes that a parent’s job is to provide healthy, balanced meals to their children. Then it is the child’s responsibility to eat the meal. A parent is not a short order cook and should not run to the kitchen to make a whole new meal just because he/she doesn’t like what is being served. Sounds simple? In theory it is but until you experience the five-minute tantrum that your son is having because he doesn’t want pasta with vegetables, you don’t know how hard that is.

Having twins adds another complexity to all of this. Some think that twins (no matter if they are identical or fraternal) should be similar since they have the same birthday, are raised together and share most of their experiences. Wrong! Twins are really just siblings who share a birthday and can be as different as night and day, especially when it comes to food. My kids eat the same meals as each other but how they react during a meal is totally different. One is more likely to get upset and the other is more likely to lose attention quickly and eat only one or two bites of food before asking to leave the table. We learned that there were differences very early on. Our daughter was colicky for the first four months of her life. We tried everything to relieve the symptoms. There was one point when she had different bottles, nipples and formula than our son. It was our first lesson that what applied to one would not necessarily apply to the other.

If you want some insight into chaos theory, come over for dinner one night. It is a bit of a circus but despite all of this, my wife and I have two kids that are actually very good eaters.

So how did we do it? They key is that with most things behavioral, there is no quick fix. It takes time and consistency but pays off in the end. Here’s what’s worked for us and maybe it can work for you too.

Everyone sits down at the dining room table with the TV off for dinner. (Unless there is a big football game on!) This gives us structure at night and allows us to connect with each other
Have regular snack times. If one child doesn’t eat at dinner for any reason (mood or not hungry) my wife and I know that they won’t starve. They will have a balanced and nutritious snack in a couple hours that will satisfy them
As your children get older, involve them in the meals. I made falafels at home for the first time last month and the kids helped by adding the ingredients in the food processor. Since they were apart of the process they were more interested in trying this new food.
Grow some vegetables with your kids. They will love watching the plants grow and be excited to see how a cucumber started from a seed to the long green vegetable that is now on their plate.
As they get older, give them a choice between two things for dinner. Every night I ask, “Ok, do you want this or that for dinner tonight,” and that’s it. I don’t give them more choices and I try not to get into a negotiation.

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Ask the Expert – Get Your Child to Love Fruits and Veggies

TwinToddlersDad — Tue, 21 Sep 2010 10:00:50 +0000

We all know that growing children need to eat a variety of fruits and vegetables each day. But getting them to actually do that is every parent’s most difficult challenge. This week, Registered Dietitian Patricia O’Keefe offers 10 ways to get your kids eating (and loving) fruits and vegetables.

Patricia O’ Keefe Girbal, RD

B.S. in Dietetics from Montclair State University
B.A. in Communication from Rutgers University
Experience: Nutrition Research Associate II for Cooperative Extension of Alameda County, University of California at Davis; Nutrition Educator for Share Our Strength: Operation Frontline; Nutrition Panelist for Shop Well
Expertise: Healthy cooking, food allergies and intolerances, early childhood nutrition
Website: Dish by Trish
Twitter: @DishByTrish
LinkedIn Profile
Contact: via email patricia.girbal@gmail.com

Question: How can I get my child to love eating fruits and veggies?

Answer:

We already know that fruits and veggies are associated with good health and reduced disease risk. Unfortunately, very few of us are meeting recommendations for these foods, particularly our little ones. Less than 10% of kids are eating the recommended amount of fruits and veggies.

Two of the biggest things that predict whether kids will eat veggies are preference and availability. Let’s first start with making these foods available. Let’s give our kids veggies regularly and let them taste-test different foods. Even if they don’t like it or try it the first few times, they may eventually warm up to it.

A new study finds that the more (higher amount) a certain veggie was given to kids, the more they ate that veggie. Here they discuss carrots:

As the amount of carrots the kids were given increased, from 30 grams to 60 grams (about a half cup) to 90 grams, so did the amount eaten. Doubling the portion size of the carrots resulted in the kids eating 47% more

The kids ate up to twice the amount- but after that there was no effect. Studies have also shown that kids are more likely to try new foods if they helped prepare them or grew them from a garden.

Top 10 Ways to Get Kids Eating (and Loving) Vegetables

Serve them. As obvious as it sounds, serve veggies with every meal or snack. Young kids need about 2-3 cups of vegetables every day. Make half the veggies leafy greens or orange veggies, such as spinach, broccoli, sweet potatoes, and carrots.
Display them. Keep a bowl of fresh vegetables on the counter. Refrigerate cut up vegetables in small bags or containers for easy snacking so they’re ready to go.
Experiment. Encourage kids to be experimental and let them regularly taste-test different veggies. By trying new foods, kids are more likely to grow into adventurous eaters. Try pairing some new foods with some of their favorites. Don’t forget to praise your child for being brave and trying new foods.
Taste-test. Offer small tastes at first and introduce one new food at a time. Try to offer new foods at the beginning of the meal when they are hungry.
Beautify. Try to make food fun and beautiful. Cut veggies up into fun shapes, such as cubes or matchsticks. Make the plate beautiful using color. Serve a rainbow of foods, such as white fish, brown rice, red tomatoes, and green broccoli.
Vary your cooking style. Try using different textures and temperatures of foods. For an exciting change, alternate between pureed, lightly cooked, roasted, and raw veggies. Along the same lines, alternate between serving veggies cool with a chilled dip and heated in a casserole or warm soup.
Name it. Give a veggie a clever name, such Fire Engine Red Peppers, Sunshine Yellow Squash, and Mighty Strong Spinach.
Involve kids. Let kids help out with the food shopping, prepping and cooking. Let them help set the table, bring food to the table, chop herbs and greens with safe scissors, crack eggs, and be in charge of stirring. Here are some more quick tips on involving kids in cooking and shopping.
Plant veggies. Try planting a small vegetable garden, if you have the space, or a tomato plant. Research shows kids are more accepting of veggies and eat more of them when they plant them themselves.
Set a good example. Kids pick up on adult attitudes towards foods. Eat at the table with them and encourage conversation about how the food tastes, smells and looks. So eat your veggies too!

Remember, kids may take a while to warm up to veggies. Try to be patient. Studies show some kids need to be offered a food up to ten times or more before they will taste it.

Don’t give up and stay positive.

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Do Milk Allergies Cause Ear Infections?

TwinToddlersDad — Mon, 13 Sep 2010 10:00:31 +0000

This is a guest article by Dr. Russell A. Faust, PhD, MD, FAAP, who blogs at Boogor Doctor. Recently, I asked him if there was a link between milk allergy and chronic ear infections. His article below offers an excellent understanding of what an ear infection is and why it is commonly seen in young children.

Russell A. Faust, PhD MD FAAP

PhD – Molecular and Cellular Biology, University of Washington
MD Otolaryngology, University of Minnesota
Fellowship training in Otolaryngology at Johns Hopkins University
Faculty appointments at Ohio State University and Wayne State University
Contributor and instructor for Baby Boot Camp Nutrition Solutions program
Expertise: pediatric ENT care, rhinitis and sinusitis, minimally invasive surgery for children
Books: Robotics in Surgery
Website: Boogor Doctor
Twitter: @boogordoctor
Contact: via website

Do milk allergies cause ear infections?

Without giving a straight “yes” or “no” answer, the following describes the factors that link food allergies (specifically milk) and otitis media, in a 1-2-3-4 stepwise fashion.

Otitis media is a complex disorder, and I want to simplify this link as much as possible. Please write and let me know whether I have succeeded:

As a pediatric boogor doctor, I see plenty of ear infections – Otitis media is what we call the disorder in medicine. It is affected by both inherited and environmental factors.

(1) The highest incidence of otitis is among infants and toddlers.

This is the first factor to keep in mind: the age group – infants and toddlers.

Some Definitions

Let’s define some basic terms before going further. Otitis media is inflammation of the middle ear space (see Figure).

Eustachian tube (the blue arrow) and middle ear cavity (bright pink)

Acute otitis media (AOM) is acute infection of the middle ear. Signs and symptoms are usually rapid in onset, and include fever, earache, and purulent fluid in the middle ear (pus). No signs and symptoms are universally accepted as definitively proving the diagnosis.

Otitis media with effusion (OME) is inflammation of the middle ear with a collection of fluid in the middle ear space. This fluid may be thin and watery, thick mucus, or pus – any of these, just fluid, but without acute symptoms.

Chronic otitis with effusion (COME) is the label given to OME when it has been present for more than 3 months.

Hearing

The ear simply does not function when the middle ear space if full of fluid – hearing is reduced in the presence of middle ear fluid. When the fluid clears, hearing (nearly always) returns 100%. More on this in a little bit.

Some Anatomy

The middle ear cavity is normally air-filled. Anything else is considered pathology. Air or any gas within a closed cavity will be absorbed by the body. I don’t remember all of my partial-pressure formulas from physics classes, but if there is no way to get air into the middle ear cavity, this absorption will create a vacuum.

Let’s look at the Figure. The way air normally gets into the middle ear is through the Eustachian tube.

So here is the problem for infants and toddlers: the Eustachian tube is floppy.

Ever notice how a baby’s ears are soft and almost floppy? The cartilage inside is young and soft – just like the cartilage around their Eustachian tubes. So young Eustachian tubes are more floppy than mature Eustachian tubes.

Hence, infants and toddlers don’t get air into their middle ears very well. The result is:

(2) “Eustachian tube dysfunction” (ETD)

That’s the term for Eustachian tubes that don’t work normally. This is the second factor in the link between milk and otitis.

We can relate to what ETD feels like, at least for s short while – we are all familiar with the sensation in our ears from traveling in a plane, or going rapidly up or down many floors in a fast elevator. It feels like pressure, and our ears feel “stuffy” and our hearing is muffled.

When the Eustachian tubes don’t work normally, a vacuum is formed in their middle ears, this draws fluid in from surrounding tissues – OME.

This fluid can become infected –AOM, potential COME. This is one reason why infants and toddlers have a higher incidence of otitis media. Another reason is their immature immune systems – their immune systems are just not as wise and experienced as an adult’s, so they may be unable to fight off those infections.

Inflammation

We have seen that the Eustachian tubes in toddlers and infants are floppier than older children and adults. In addition to this given tendency to collapse, ANYthing that adds inflammation will make the collapse worse.

(3) Any inflammation of the lining of the Eustachian tube can worsen ETD.

This is the third factor in the link between milk allergy and otitis:

Inflammation worsens collapse of the Eustachian tubes. Chronic inflammation can increase the risk of otitis.

What can cause inflammation of the Eustachian tubes?

Viruses, Bacteria
Reflux
Allergies – hayfever
Allergies – food allergies
Air Pollution – most commonly tobacco smoke, but any airborne irritant
Chemical irritants – example: chlorinated pool water

For infants and toddlers, upper respiratory infections (URI) with viruses is the most common cause of inflammation that causes ETD.

Reflux (regurgitation of gastric contents) in babies and infants. Medical studies have shown that reflux can cause otitis media.

Allergic Effects

Studies that have looked for a link between otitis and allergies suggest that there is a link between allergies to milk and COME.

If we think about it, this link should not be surprising:

Remember, any inflammation, like allergies, will worsen Eustachian tube dysfunction in our age group with ear infections – infants and toddlers.

What is the most common allergy found in infants and toddlers? Allergies to the airborne allergens (the things that we react to) don’t really develop until later. In this age range, the most common allergic reactions are to foods.

(4) What is the most common food allergy in infants and toddlers?

Right: Dairy – milk and eggs. This is our fourth and final link between milk allergy and otitis.

So yes, there is a link between milk allergies and ear infections, but no, milk does not cause ear infections. Not any more than an allergy to grass or flowers causes ear infections.

Note that in those people who do respond to milk allergens, it often thickens their mucus secretions. This is not a good effect when we are talking about Eustachian tube function – thicker mucus makes it harder for the Eustachian tubes to work normally.

So, to recap:

Otitis is common in infants and toddlers
Eustachian tube dysfunction is common in infants and toddlers, and increases risk of otitis
Inflammation of the Eustachian tubes, including inflammation from allergies, increases risk of otitis
The most common food allergy in infants and toddlers is milk

What Can You Do With This Information?

Well, for starters, if your little boogorhead has recurrent ear infections, consider eliminating dairy from their diet for a few weeks. A good place to start is the recent article Preventing Food Allergies on Littlestomaks. When it is time to visit a doctor, try to visit a pediatric boogor doctor (Ear, Nose, & Throat specialist). Yes, any ENT doctor can place ear tubes to treat recurrent ear infections. You will find that a pediatric ENT doctor’s office will be more “kid-friendly” – their waiting rooms are usually full of books and toys for children of all ages, their nurses are devoted to the care of children, and their medical instruments are kid-sized. Not to mention that the docs themselves have devoted their lives to the care of children, exclusively.

During that visit, they may obtain a hearing test, they may consider allergies, or reflux, among many other potential factors for causing your child’s otitis. Be patient. Otitis media is a complex disorder, influenced by hereditary and environmental factors, and it can take awhile to sort it all out.

Hearing

As an integrative holistic pediatric ENT specialist, my goal is to combine the best of conventional and alternative medicine to get my patients healthy. As a result, I am ultra-conservative with regard to surgery, especially for things like otitis media. The balance between aggressive and conservative can be tricky.

I waited too long to have my first son’s COME treated (he never complained, had no acute infections, just fluid), and his start of speech was delayed due to the reduced hearing while the fluid was in his middle ears. So – get it evaluated by a specialist, get it treated if necessary.

My son got his set of ear tubes (the only way to eliminate the chronic fluid in the middle ear cavity), hears normally now, and his speech has taken off (can’t shut him up, wouldn’t want to).

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Ask the Expert – Irregular Eating Pattern

TwinToddlersDad — Tue, 07 Sep 2010 10:00:48 +0000

Nearly all toddlers are picky eaters. As if that is not enough of a challenge for parents, they also show irregular eating patterns. One day they might eat a lot, while another day it is only a few nibbles. This week, Registered Dietitian Alysa Bajenaru offers a few tips to help your little one develop regular eating habits.

Alysa Bajenaru, RD, CPT

B.S. in Nutritional Sciences, University of Oklahoma
Registered Dietitian, Certified Personal Trainer and Group Fitness Instructor
Experience: clinical dietetics, personal training, former owner/current instructor Baby Boot Camp
Expertise: Family nutrition, weight management, new mom fitness, nutrition education
Contributor and instructor for Baby Boot Camp Nutrition Solutions program
Mom to two toddlers (1 and 3)
Website: Inspired RD
Twitter: @InspiredRD
Facebook: Inspired Results
Contact: via email InspiredRD@gmail.com

Question: Sometimes my son won’t eat for days, except nibbles – and other days he will eat like crazy. Is this normal and healthy? Should I enforce more regular eating patterns?

Answer:

It is totally normal for a toddler’s eating habits to vary. With that being said, here are some tips that may help bring more consistency to your toddler’s diet.

Plan Snack Times. Many toddlers tend to “graze” all day on crackers, cereal and other snacks. Make “snack time” an actual time when your son sits at the table and eats a quality snack. Combining carbohydrates, protein and fat will help keep him satisfied until the next meal. Examples are string cheese and applesauce, peanut butter and celery with raisins on top, cheese and crackers with some grapes, plain yogurt with strawberries and granola.

Watch Liquid Calories. Offer milk (low-fat or fat-free after age 2) only at meal times. Toddlers who drink juice or milk all day may be drinking too many calories to be hungry at meal times. Offer water throughout the day and fresh fruit as part of meals and snacks instead of juice.

Involve your Toddler in Cooking and Meal Planning. If you have the space to grow a garden, I highly recommend gardening with your kids. From personal experience, my son will try anything that we have grown ourselves because he has a connection to the food. If I brought the same item home from the grocery store, he might wrinkle his nose at it. If you can’t plant a garden, involve your toddler in the grocery shopping by asking him to pick out fruits and vegetables that he wants to try. Make it fun and exciting! Invite your toddler to stand on a chair or sit on the counter while you prepare meals. Let him help with age-appropriate tasks. When kids are involved in the process, they feel a sense of accomplishment and are much more excited to eat.

Don’t Stress. Toddlers are always changing. Week to week, day by day, moment by moment. If you are setting up healthy eating patterns for your son, there’s a good chance that he will still have days when he doesn’t eat well. Don’t stress too much about it. He will most likely make up for it the next day.

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Ask the Expert – Food Allergy and Multivitamins

TwinToddlersDad — Tue, 31 Aug 2010 10:00:08 +0000

If you have a child with food allergies, naturally you worry if he is getting proper nutrition from his somewhat restricted diet. Perhaps you have considered giving a multivitamin but found yourself worrying about safety of those vitamins. This week, Registered Dietitian Brooke Schantz offers a few tips on what to look for when selecting a multivitamin for your child with food allergies.

Brooke Schantz, MS RD LDN

B.S. in Dietetics with Honors from Purdue University
M.S in nutritional sciences from University of Illinois at Urbana-Champaign.
Experience: Outpatient Clinical Dietitian II at Loyola University Medical Center, Private Practice, The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), North Shore Pediatric Therapy, and Camp Calcium at Purdue University
Expertise: Pediatric Nutrition, Adult Weight Management, Cardiovascular Health, Prenatal and Postpartum Nutrition, Type 1, 2, and Gestational Diabetes, and Allergies and Intolerances
Website: Bitchin’ Nutrition
Twitter: @BitchnNutrition
LinkedIn: Brooke Schantz MS RD LDN
Contact: via Website or Twitter

Question: What kind of multivitamins are safe for my child with food allergies? What should I be concerned about?

Answer:

First, let me review the difference between a food allergy and food intolerance. A food intolerance is an abnormal physiological response to food. Symptoms can affect the skin, respiratory tract, gastrointestinal tract (GIT) either individually or in combination. Some examples of symptoms of a food intolerance are gas, bloating, diarrhea, etc. It can be difficult to determine the food that causes an intolerance because if the immune system is involved, the response takes place slowly. A food allergy is an immunological hypersensitivity which occurs most commonly in response to food proteins that are mistaken as harmful and therefore a defense system is created to fight them off. These allergic reactions have an acute onset (from seconds to one hour) and may include: soft tissue, severe swelling of the tongue, hives, itching, nausea, vomiting, diarrhea, stomach cramps, nasal congestion, wheezing, shortness of breath, or anaphylactic shock.

Children with various food allergies would not be allergic to vitamins or minerals in supplements themselves; but rather to a possible ingredient used in the making of the multivitamins. The Food Allergen Labeling Consumer Protection Act (FALCPA) was passed by the Food and Drug Administration (FDA) in 2006 to require manufacturers to identify the use of the top eight allergens. These allergens are eggs, dairy, soy, tree nuts, peanuts, fish, shellfish, and wheat. Unfortunately, vitamins fall under the category of “dietary supplements” which are not included in this law. A dietary supplement is defined as products taken by mouth that contain a “dietary ingredient” intended to supplement the diet. This is important to note, because vitamins are not meant to be a substitution for a healthy diet or justify consuming a poor diet.

The FDA does not approve dietary supplements prior to being put on the market. Therefore, if your child is allergic to a specific allergen it is important to familiarize yourself with all the derivative names for that allergen. For example, if your child has a milk allergy, you would also want to look for words on the ingredient label that include but are not limited to: calcium caseinate, casein, caseinate, rennet, curds, hydrolyzed casein, hydrolyzed milk protein, lactalbumin, lactalbumin phosphate, lactate, lactose, lactoferrin, and lactoglobulin.

What you can do:

Check the ingredients label for the specific food allergen and its derivative names. Some vitamin labels even include information on common allergens, even though the manufacturers are not required to list this information. Below is an example children’s vitamin ingredients list.
Ingredients: Sucrose, Sodium Ascorbate, Stearic Acid, Maltodextrin, invert sugar, Vitamin E Acetate, Corn Starch, Gelatin, Niacinamide, Magnesium Sterate, Natural Flavors, Yellow #6, Riboflavon, Thiamine, Folic Acid, Vitamin D3, Vitamin B12
Contains: Soy
Look for the USP seal. The U.S, Pharmacopocia (USP) is a non-profit organization that has established standards of quality for prescritpion and nonprescription drugs. Using vitamins and other supplements with the USP seal indicates some quality of control. Vitamins that have the USP seal can be found here.
Follow the dosage directions correctly! Your child doesn’t need more than the recommended daily dose. Some parents believe that if their child has eaten really poorly for one day giving an extra vitamin is better and this is not the case. An overdose of certain vitamins could be dangerous and also lead to the preventing other vitamins from being properly absorbed.
Discuss the use of all supplements with your doctor and registered dietitian.

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