Greetings! I am on business travel this week. That is why I have decided to pull out a few noteworthy reader comments from my archives this week instead of the usual Five for Fridays.

I am constantly inspired by your comments and I learn a lot from them. I want to say thanks to those who spend time reading my posts and leave a comment behind with some advice, helpful tips or a question for further research. Some of them have their own blogs, which I highly recommend you to visit whenever you get a chance.

Enjoy, and feel free to leave a comment of your own.

1. When a reader asked about food sources of vitamin D, Dr. Joanna Dolgoff listed these on her Ask the Expert post about Vitamin D deficiency
   

Foods that contain Vitamin D include fortified milk, fortified yogurt, fortified breakfast cereals, wild salmon, canned tuna, cod liver oil, sun-dried shitake mushrooms and egg yolks. I think the fortified milk, yogurt and breakfast cereals will work best for a toddler!

2. Nona Nita reminded us that dollars and sense is not everything in response to a Five for Fridays entry on home gardens:

Even if growing my own tomatoes will cost more, I like the idea that I am going to use heirloom seeds that have not been hybridized. I will be able to keep the seeds from my produce to grow more next year. Not only will I get tomatoes like they used to taste when I was a kid, but saving the seeds from the tomatoes to use next year will be a great lesson in the cycle of life for my grandchild. Hooray to the Obamas for being great role models! Hooray to you for a great blog!

3. Reiza was concerned about mercury in tuna when she read dietitian Janet Helms’s Ask the Expert article on sushi for toddlers

My kids have all eaten sushi since infancy. You raised some issues I never even considered. I don’t think we’ll stop (my twins are over 5, but not my son), but we’ll definitely be asking more questions.

One thing I want to know, though, is how much sushi with tuna would a child need to consume to be worried about mercury? I’ve always limited canned tuna, but I never thought mercury would be an issue with such small pieces like you find in sushi.

In response, Janet Helm added:

Thanks for your message. You’re right. The small amount of tuna in sushi should not be such a problem, since the recommended limit is 12 ounces per week. A 3-ounce portion is about the size of a deck of cards, so you can estimate the number of ounces your kids may be consuming.
So if you’re not eating tuna more than once a week, you’re probably well within the “safe” range for mercury.

4. Dr. Ayala offered her perspectives on healthy snacks and indulgences in response to a Five for Fridays entry on childhood obesity

I don’t particularly like the term “snack”, as it can mean a small meal, which could be very healthy, or, more commonly, a highly processed packaged food you can eat on the go anytime and anywhere.

I therefore don’t use “snacks”. No matter the name, I make the small meals between the other bigger meals healthy–fruits, vegetables, nuts, leftover food from yesterdays’ dinner. That’s what I serve my kids when they come home from school quite hungry and in between meals.

As for the indulgences that I do think should not be denied–I call them dessert, and my kids call them “junk”. A good time to eat them is after the meal. I think there’s a place for ice-cream, chocolate, cake or whatever indulgence one fancies, but the key to really enjoying those and eating healthily is moderation and great quality. A small dessert (when a kid isn’t too hungry) made of high quality ingredients is a pleasure. Snacking on chips, cookies and donuts (even if low-fat)is not particularly satisfying, doesn’t hit the spot, and is just a bad habit.

5. Alina shared her concern and hoped for better nutrition at schools in response to Ask the Expert article on managing concerns about daycare food

I like the idea of bringing food to daycare but unfortunately many daycares do not allow found to be brought in. Also, a toddler wants to eat what everyone else is eating since the kids all eat together. Improving the nutrition of daycare (and all school food in general) is a very important topic. It would be nice for policy-makers and law-makers to embrace the need for this change!!

Photo source: Robert Whitehead on Flickr
©2010 Littlestomaks.com

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, Family Physician Dr. Michelle May offers a few tips on helping your toddler develop a taste for fruits and veggies.

Question:My 2-year-old dislikes fruits and vegetables, but I want her to get these important nutrients—and learn to like them. How can I help her develop a taste for them?

Answer:

Congratulations for recognizing the importance of a healthy diet. Only 2% of all children eat the recommended number of servings from all of the food groups. It is common for children to have strong food preferences so it can be a challenge – just don’t make it a battle. Here are ten practical tips:

1. Relax- having a positive, low-key attitude about eating makes meal time more pleasant and therefore feeding more successful.
2. Follow the leader – make family meals a high priority and be a great role model by serving and eating a variety of fruits and veggies.
3. Don’t be a short order cook – fix one balanced meal for everyone in the family. Remember, it is your responsibility to decide what you will offer but it is up to them whether they will eat it.
4. Make it fun – when my kids were small, we played Guess the Color. They closed their eyes and tried to guess the color of the food I put in their mouth. They were having too much fun to realize that the most colorful foods happen to be vegetables.
5. Serve the vegetables first – they are more likely to eat them when they are hungry.
6. Don’t bribe or reward children for eating certain foods -they quickly realize that those foods must be yucky if you have to bribe them to eat them. They also learn to hold out until the reward is offered.
7. Involve your child in shopping for, preparing and serving food – they are more likely to eat it because they participated in the process. At two, my son’s job was to tear up the lettuce and drop it in the bowl. The first time he helped, we made the mistake of telling him to tear it into “bite-sized pieces.” You guessed it…he bit off pieces of the lettuce and spit them into the bowl!
8. Be creative – add carrots to spaghetti sauce, spinach to meat loaf, tomatoes to toasted cheese and bananas to peanut butter sandwiches. Keep fresh fruit and cut up vegetables handy for snack time and offer fruit-based desserts.
9. Easy on the juice and “fruit drinks” – they don’t pack much of a nutritional punch and may just add unnecessary sugar to your child’s diet.
10. Don’t give up!It can take up to ten exposures to a particular food before a child will accept it. Maybe she doesn’t like steamed broccoli and cauliflower but will have fun dipping fresh Trees and Clouds into a little ranch dressing.

©2009 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.

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 Preethi Rahul explains why it is important to know and track the general growth pattern of your toddler using growth charts.

Question: Why is it important to know the general growth pattern of toddlers?

Answer:

To understand the importance of growth pattern of toddlers it is very important to understand what growth is.

Growth is defined as increase in the size of an organism or part of an organism, usually as a result of an increase in the number of cells. Growth is a physical aspect which can be quantified. A child’s physical growth refers to the increases in height and weight and other body changes that occur as a child matures. Hair grows; teeth come in, come out, and come in again; and eventually puberty hits. It’s all part of the growth process.

How do you judge your child’s growth pattern?
There are various tools that can help parents understand their child’s growth pattern. Two most widely used ones are:

Growth charts
The National Center for Health Statistics has developed growth charts that are used to compare a child’s measurements with those of other children the same age. By plotting a child’s measurements on these charts, doctors are able to compare individual growth patterns with data collected on thousands of children. This helps to determine whether a child’s growth is normal compared with others the same age. The charts are a series of percentile curves that show the distribution of growth measurements of children from across the country.

BMI charts
Designed to measure body mass, BMI charts can help to determine whether a child’s weight is appropriate for their height. To get a quick picture of a child’s weight status, the health care professional enters the height, weight, age, and gender. The resulting number is then compared to other children of the same age to see if the child’s weight falls within the normal boundaries.

Here is a good article which tells you 5 things you need to know about growth charts.

Now why is it important to understand your child’s growth pattern?
Children are constantly growing and changing and periodic assessment of their progress allows any problems to be detected and treated early. Most children are assessed by health care professionals only when they are ill, at which time growth and development is not focus of care.

Growth measurements must be recorded at regular intervals to indicate growth patterns. Height and weight when taken only once do not lend themselves as interpretation of growth status. Children generally maintain their height and weight in the same growth channels during preschool and early childhood years, although these channels are not well established until after 2 years of age. Individual children sometimes grow at faster or slower rates; nonetheless; they should follow along their same growth channel.

Regular monitoring of growth enables trends to be identified early and intervention or education to be initiated so that long-term growth is not compromised. Weight that increases at a rapid rate and crosses growth channels suggests the development of obesity. A child who appears to be overweight may be advised to boost their physical activity a bit since overweight children have a higher risk of becoming overweight adults than their lighter peers. With early intervention, a small problem need not become a lifelong struggle.

Lack of weight gain or loss of weight over a period of months may be a result of under nutrition , an acute illness, an undiagnosed chronic disease, or significant emotional or family problems.So health care professionals and parents can work together to determine the best way to get the child back on track. Vitamin and mineral deficiencies can also be identified and if they are in the initial stages diet alone would be sufficient to bridge the gaps.
Thus as a responsible parent you need to constantly monitor your child’s growth and take necessary action as and when needed!

©2009 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.

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 Liz Marr offers a few practical tips for feeding a very active child.

Question: Can you give a few suggestions on feeding a very active child?

Answer:

Many parents of busy toddlers wonder if their child will sit still long enough to actually eat anything substantial. And I know from first-hand experience that can be a particular challenge with very active toddlers. Several points to keep in mind: Children will eat when they are hungry and it may not always be at a prescribed mealtime. Keep in mind, if a child doesn’t want to eat, he or she is probably not hungry. If you are presenting a variety of nutritious foods, try not to worry too much. One way young children express their independence through food, so allow them to make choices. Serve smaller, more frequent meals and snacks for active toddlers, if you know they won’t sit still. Or try letting them eat their meal in stages, if it seems they need an activity break. Allow flexibility to reduce stress at feeding time. In the long run, you’re helping your child develop a healthy relationship with food, which means not responding to prescribed external rules, like eating everything on the plate and specific meal times, but rather creating a solid connection with internal hunger cues and fueling the for health.

©2009 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.

On my Ask The Expert column each week, I have featured a reader-submitted question answered by a nutrition expert or a pediatrician. Here are the 10 questions answered so far, check them out and let me know what’s on your mind.

1. My child is underweight. How can I get him to eat more?
2. How do I know if my child has vitamin D deficiency?
3. My child is on a 100% vegetarian diet. How can I ensure he gets a complete nutrition?
4. How can I tame my child’s sweet tooth?
5. I am thinking of introducing my toddler to sushi. What should I be concerned about?
6. My child is addicted to snacks. How can I get him to eat proper food?
7. My child does not get nutritious food at daycare. How can I improve her daily nutrition?
8. My nursing toddler does not eat solid foods. What should I do?
9. What are good nutritional supplements for toddlers 2-5 years old?
10. How can I model healthy eating behavior for my kids without emphasizing “dieting” at this young age?

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.

©2009 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.

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 Laurie Beebe recommends a simple method to stop your child from overeating and develop long-term healthy eating habits.

Question: How can I model healthy eating behavior for my kids without emphasizing ‘dieting’ at this young age?

Answer:

Recently, a client of mine asked me this question:

“My husband and I are both active and in good shape, but sometimes I eat a bit too much, especially in the evening, and go to bed feeling bloated.  I notice that my 3 year old and 5 year old also want second helpings sometimes and afterwards there are times they complain of a stomach ache.  How can I model healthy eating behavior for them without emphasizing ‘dieting’ at this young age?”

In my opinion, one of the best things you can do for your children is to teach them healthy eating habits while they are growing up.  They don’t need to have any information about what eating too much will do to their future health at this age; only that it might give them a tummy ache!  Just as you need to discover that the signal “you are full” does not reach your brain for 15 minutes after you really have had enough, this is something you can teach them, too.  Show them that you are setting a timer for 10 minutes when they ask for second helpings (especially if you allow them extra portions of foods that are low in nutrient-density, like desserts).  Let them know that their body needs time to realize they are full and if they keep on eating their only signal is a tummy ache when it is too late.  Assure them that if they still want more food in ten minutes then it is theirs, but you want to be sure they don’t get sick from eating too much.  (You don’t need to remind them in ten minutes by asking, “Did you still want more macaroni and cheese?” but do give them a small amount if they come to you for more when the timer goes off.)  Chances are, they will be distracted by some games or toys and forget about the desire for more of the tasty food when the impulse passes.

This is a healthy lesson they will learn for life and they will grow up, not with an idea that “food that tastes good is bad and makes us fat and sick”, but merely “I need to stop and think whether or not my body feels hungry before I take an extra helping”.

©2009 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.

Happy Friday! This photo touched my heart and reminded me the value of nutrition and care for our growing children. Sometimes, a picture really is worth a thousand words!

That said, here are the 5 interesting nutrition stories of the week that caught my eye. Enjoy and drop a comment to let me know what’s on your mind.

Eco-Atkins diet

A low carbohydrate, high protein Atkins diet is popular for weight loss, but carries the risk of increasing LDL (“bad”) cholesterol. Now some researchers are suggesting that a vegan diet rich in protein from plants and nuts reduces weight and lowers cholesterol, by as much as 20%. In a study published in the Archives of Internal Medicine, they concluded that a  plant-based low carbohydrate “eco-Atkins” diet resulted in about the same weight loss as a high-carbohydrate, dairy and whole grain vegetarian diet, but reduced the LDL cholesterol by a larger amount. Although the size of the study was small, it proves again the many benefits of a plant-based diet. Cutting down on meats which are rich in saturated fats and cholesterol is a good idea even though the specific results cited by this study may not be seen for everybody.

New FDA chief focuses on food safety

In an interview with the Associated Press, the newly confirmed FDA chief Dr. Margaret Hamburg put a high priority on restoring FDA’s credibility by using science-based information to drive decisions, and by implementing risk-based controls for early detection of food contamination in the farm-to-store supply chain. I don’t think there is anything earth-shattering here; this is precisely what the FDA is expected to do anyway. Also, this is what the public wants to hear in light of the peanut, pistachio, spinach, lettuce and tomato outbreaks. The public confidence in the nation’s food supply is shaken up, so naturally this is high on FDA’s agenda. What I would like to know is how she plans to fix the management system, improve visibility of problems and bring in a sense of accountability in the public office. Till then, these are simply nice sounding words and we will continue to remain one more outbreak away from another massive recall and public health scare.

Consumers want healthy food but unwilling or unable to pay more

According to the United Soybean Board’s 16th Annual Consumer Attitudes About Nutrition report, nearly 9 out of 10 consumers report wanting to buy nutritious and healthy food but only about half are willing to pay more. Of the remaining, about half say they want to but can’t afford nutritious food right now. A fairly large number of them also say that the food they buy is already healthy, and that the healthier version would not taste as good. There is a certain bias in this survey towards processed foods since that is clearly of interest to the soy industry. I don’t think they even considered asking questions about fresh vegetables and fruits and cutting down on meats. My guess is that the definition of healthfulness was limited to the nutrition facts label – the usual calories, fats, carbohydrates, sugars, proteins, vitamins and minerals etc. And the interesting fact about these labels is that even though most people do review them before buying, about half find the nutritional information confusing. With a limited definition of “healthfulness” and confusing nutritional information, how can we expect consumers to make the right trade-offs between buying healthy food and cost?

Challenges of reducing sugar in (processed) foods

I certainly cannot relate to the “challenges” faced by the food technologists in formulating foods with artificial sweeteners. Nor do I want to! But I found this podcast interview with the manager of sweetener technology at Tate & Lyle posted on the FoodNavigator site quite interesting. Turns out that sugar not only provides sweetness, it also affects the texture and feeling of the food. That is why, a simple substitution of natural sugar with artificial sweetener doesn’t work so well except in beverages. In ice cream, for example, reducing sugar or adding artificial sweetener can change its freezing point, and as a result, the consistency. In baked goods, sugar affects the color, taste, bulk and shelf life, which makes it difficult to reproduce with artificial sweeteners. So I guess they make these food technologists earn their paycheck after all! Anyway, this manager also commented that consumers want taste and choice, and for those wanting healthy foods with low sugar, it is a challenge to offer them all three. Tells me that her interpretation of what consumers want is incredibly – though understandably – quite narrow. What happened to fresh, natural, locally sourced, green, organic and wholesome? Guess they have decided not to listen to those customers since they will probably not be helping Tate & Lyle’s bottom line anyway!

Simplicity is the new message for “affordable” healthy food

My blogger friend and registered dietitian Janet Helm was recently interviewed by ABC News (Go Janet!) on the recent trend of going “back to basics” when it comes to food advertising. Janet has written about these trends on her blog Nutrition Unplugged in a couple of very interesting articles. So check out her blog and the ABC interview via her post Simplicity Sells in Tough Economic Times. Janet is also a contributor to my Ask the Expert where she recently wrote a very informative post about sushi and toddlers.

Enjoy your weekend! And let me know what you think.

Photo source – Thiru Murugan on Flickr
©2009 Littlestomaks.com

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, Dr. Douglas Husbands recommends a few good nutritional supplements for your toddler.

Question: What are good nutritional supplements for toddlers 2-5 years old?

Answer:

The majority of the research shows that nutritional supplementation is currently necessary in addition to a healthy diet to meet adequate and especially optimal nutrient requirements, of most people.  In fact, according to an article published earlier this decade in the Journal of the American Medical Association (JAMA), it is advisable for physicians to  recommend nutritional supplements to their patients and that most people require nutritional supplements to make up for the shortcomings in their diet.  Additionally because many modern farming practices often do not adequately replenish the nutrients in the soil, the vegetables and fruits grown today commonly have lower nutrient content than the same vegetables and fruits harvested many years ago. Therefore supplements for toddlers are also advisable.

Since toddlers are often picky eaters, a good multivitamin/multimineral supplement formulated for toddlers is a good start.  There are various chewables on the market which often contain some type of sugar, but you preferably want one that is lightly sweetened with xylitol rather than fructose.  Avoid any brand sweetened with table sugar or high fructose corn syrup. Xylitol is a natural sugar causing minimal changes in blood sugar and insulin levels, and does not feed the bacteria causing tooth decay.

Another good way of getting a multivitamin/multimineral supplement into your toddler is to use a powdered supplement.  This is convenient in that many of these powdered supplements can be easily dosed according to the child’s age or weight for the proper amount.  They can also be easily mixed in some of the child’s beverages or foods.  There are various brands on the market, but be sure to purchase one especially formulated for toddlers, read labels carefully to avoid those with table sugar or fructose.   Any good one formulated for toddlers will not contain iron.

One of the supplements with the greatest amount of scientific research supporting its use in toddlers and children is fish oil.  Fish oil contains the essential omega 3 polyunsaturated fatty acids docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA).   Since a large proportion of brain tissue is made of DHA, this is particularly important in the toddler years where brain growth is occurring.  Fish oil given in children is also associated with decreased risk of developing type 1 diabetes.  A study published in JAMA in September 2007 found that among 1770 infants and toddlers at high risk for developing type 1 diabetes, those toddlers who obtained supplemental omega 3 fatty acids from cod liver oil had significantly decreased risks of the development of type 1 diabetes. Approximately 1 gram of fish oil each day is beneficial for many toddler aged children.

Since cod liver oil also contains vitamin D, the beneficial effect of supplemental vitamin D is also well supported by research for being protective against the development of type 1 diabetes in toddlers and children.  Additionally, since vitamin D has multiple benefits, the latest research supports toddlers getting a total of approximately 1000 to 2000 IU of vitamin D each day.  Supplemental Vitamin D comes in different forms, but the advisable form is vitamin D3 (cholecalciferol).   Do not purchase one that is made with ergocalciferol!  Vitamin D is essential for immune function, proper bone growth, proper brain function, and proper growth hormone output, among other functions, so optimal levels of vitamin D are vitally important for healthy, happy toddlers.

Probiotics would also be among my recommended supplements for infants and toddlers.  Probiotics is a general term describing various strains of the beneficial bacteria that should reside in adequate numbers within the mucous membranes of the gastrointestinal tract.  These strains have specific names such as Bifidobacterium infantis, Lactobacillus plantarum and variations thereof.  Probiotics have many functions in supporting a healthy and balanced immune system and in supporting proper nutrient digestion and absorption. It is critically important for newborns delivered via C-section to begin probiotics, and for any infant or toddler who has been given an antibiotic to be given probiotics.  The recommended strains of probiotic and dose are dependent on the age and physical state of the child.  A knowledgeable health professional well educated and experienced in nutrition should be consulted for specific dose and strains of probiotics for your particular child.

©2009 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.

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 Preethi Rahul explains how to gradually wean a toddler by introducing different types of solid foods.

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: My nursing toddler does not eat solid foods. What should I do?

Answer:

Weaning foods need to be introduced in the child’s diet.

Now what do I mean by weaning?

Weaning is the stage when the child undergoes a transition from having only breast milk to semi solid foods; followed by a solid diet.

Need for weaning..

At birth, mother’s milk alone is adequate for the infant. Requirements of all the nutrients progressively increase with the infant’s growth. Simultaneously, the breast- milk secretion in the mother comes down with time. Thus, infants are deprived of adequate nutrients due to the dual factors of increased nutrient requirements and decreased availability of breast milk. Usually, these changes occur at about 4-6 months of age. Hence, promotion of optimal growth in infants, calls for introduction of adequate food supplements in addition to continued breast feeding, from the age of 4-6 months onwards.

When to start weaning..

There is no set rule about the age for weaning. As a general principle six months and above is considered as the ideal age. Weaning is a personal decision. In short, when one or both members of the mother-baby relationship are ready, it’s time to wean.

First foods..

Many of you would be wondering as to what kind of solids to start feeding your child with? It is very important to take food allergies into consideration here. So you have to start weaning foods that are generally least allergic and then move on to more complex ones. Generally foods high in protein are introduced last.

You could start by giving them

• Vegetable purees: just boiled carrots, beans, cauliflower, pumpkin, sweet potatoes etc. You need not add sugar or salt. Just boil them and make a puree but it is not necessary to strain it as by straining all the fiber content is lost. Green leafy vegetable water can be provided to infants which will be excellent sources of vitamins and minerals. Green Leafy vegetables are more fibrous than other vegetables and hence can lead to loose motions in infants if not cooked and pureed well.
• Try fruit purees next: It could be stewed apples, bananas or mashed pear, muskmelons or pears. Try avoiding strongly citric fruits like orange, berries, pomegranates as they are too strong for the delicate stomach lining.
• Move on to cereals: If your toddler has tolerated vegetables and fruits well, move on to cereals. It is best to start with well cooked, mashed rice. Try not to include wheat and refined flours initially as they may contain gluten, which may not suit some children.
• Weaning foods based on cereal:pulse combinations will provide good quality protein, adequate calories and other protective nutrients. Since infants cannot consume bulky weaning food in sufficient quantities, energy- rich foods like fats and sugars should be included in such preparations.
• Next step is to introduce lentils: Try giving simple ones like green gram and then move on to more complex ones like Bengal gram and rajma (kidney beans) after child completes the age of one.
• Finally Egg yolk and meat soup can also be included to increase the protein content in the child’s diet.
• At about one year of age, the child should share the family diet.

Amylase rich foods…

• Flours of germinated cereals, which are rich in the enzyme alpha amylase, constitute Amylase rich foods. Even small amounts this type of foods liquefy and reduce the bulk of the cereal- based diet.Thus ARF helps in increasing the energy density of weaning gruels and in reducing its bulk as well.
• Mothers can add ARF to increase the digestibility of low- cost weaning recipes prepared at home.

How to feed a todder..

Infants cannot eat large quantities of food in one sitting at a given time. So, they should be fed small quantities at frequent intervals (5-6 times a day). The food should be of semi-solid consistency which is easy to swallow. When such semi solid foods are offered initially the infant tends to spit it out. This should not be mistaken as a dislike for that food. The young infant cannot achieve full coordination needed for the act of swallowing, and hence, brings out the food by movements of its tongue. Physiological maturity of swallowing the semi-solid food develops when the food is regularly given every day.

In case child is still fussy about having solids..

• This is a period of change for the child and it is quite natural for there to be resistant. Have patience.
• Do not get obsessed with a particular food item – avoid it for a few days and then try again.
• Do not force-feed the child as whatever little the child has started eating by force, the child would avoid.
• Try innovative recipes and ways of presentation so that it will make your child eat better..

Hygiene practices to be adopted while preparing weaning foods

• Vegetables should be washed well to remove parasites, pesticides, contaminants before cutting.
• At the time of preparation and feeding of the recipes mother should observe proper personal hygiene.
• The utensils used for cooking should be thoroughly washed and sterilized.
• As feeding is likely to be time consuming, the cup or the plate from which the recipe is being fed to the infant should be kept covered to protect from flies.

©2009 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.

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, Pediatrician Dr. Joanna Dolgoff offers a few ideas on what to do if you are concerned about the quality of food your child is getting at the daycare.

Joanna Dolgoff, M.D. BA Molecular Biology, Princeton, Graduated Cum Laude MD, NYU School of Medicine Pediatric internship and residency at Presbyterian Children’s Hospital of New York 5 years private practice in Pediatrics CBS News Online correspondent: childhood obesity expert Child & Adolescent obesity and weight management expert Website:Online Weight Management Program Twitter:@joannadolgoffmd LinkedIn Profile Contact: via email from website

Question: My child does not get nutritious food at the daycare. How can I improve her daily nutrition?

Answer:

As the economy continues to sour, many moms are returning to work to help make ends meet financially.  Many working mothers are also working longer hours.  The result is that child daycare centers are often responsible for providing meals and snacks for many children.  Many families have expressed concern that foods provided by daycare are not as nutritious and wholesome as expected.  Snacks are often sugar-laden and high in calories and fat.  Kids are usually given juice and whole milk to drink.  And fruits and vegetables are often scarce.  When it comes to our children’s health and nutritional status, this is a recipe for disaster!

To be fair, daycare centers vary in what they provide.  How do you know if your day care center measures up?  The first step is to find out what your center provides for meals and snacks.  Don’t be shy to ask questions.
Here are a few questions to ask:

1. Is there is a dietitian overseeing the menu planning and meal preparation to ensure that balanced meals are being served?
2. Are foods fried or baked?
3. Are fruits and vegetable served with meals and snacks?
4. Will they provide water instead of juice or whole milk?
5. Is there a menu available for review?

If you determine that your daycare center is not up to your standards, speak up!  Let the center know your concerns.  You may need to stress the importance of a well balanced diet, exercise, and teaching children to eat healthy foods.  Often, if enough parents complain, the day care will make some changes.

Unfortunately, some facilities may not be willing to change.  Sometimes they are resistant due to financial reasons.  Fresh produce, for example, is more expensive than other snacks.  If your daycare is not willing to accommodate your requests, you should provide your child with a bagged lunch and snacks to make sure he is getting enough nutrition during daycare hours.

Here is a sample of a healthy day:

Breakfast:
1 cup Raisin Bran + ¼ cup skim milk
1 cup of mixed berries

Snacks:
12 almonds
1 medium pear

Lunch:
5 slices turkey breast
1 slice fat-free cheese
2 slices whole wheat bread
2 pretzel rods
½ sliced cucumber

Snack:
1 piece of string cheese
1 cup of grapes

Dinner:
1 cup whole wheat spaghetti with marinara sauce
1/3 cup ground chicken meatballs
1 cup Broccoli

It is important to eat a variety of different types of foods to ensure kids are getting enough vitamins and minerals.

©2009 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.

Ask The Expert is a new 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 Milton Stokes offers his thoughts on a common concern of many parents who worry that their child is eating too many snacks.

Milton Stokes, MPH, RD BS in Nutrition and Dietetics Registered Dietitian,Yale Masters of Public Health, Hunter College 10 years in Clinical Nutrition Website:One Source Nutrition Twitter:@Miltonstokes LinkedIn Profile Contact: via website

Question: My child is addicted to snacks. How can I get him to eat proper food?

Answer:

My response is to answer with a question: What’s he eating?  It’s possible that his diet is proper/healthy.  I’d need to know more about the composition.  Moreover, snacking is perfectly acceptable when the snacks comprise the right foods.  For example, carrot sticks dipped in ranch dressing is excellent—veggie plus healthy fat.  Yogurt with berries makes for another excellent example—calcium, protein, fiber, and antioxidants.  I could go on and on with examples.  The goal is to include one or more of the following: whole grains, vegetables, fruit, healthy fat, and/or protein.  The possibilities are endless!

Now, if you’re talking about soda and potato chips everyday, that’s another story entirely.  I’d like to know how long this has lasted and more about what transpires during meal times.  It’s normal for kids to experience food jags where they only eat one or two things, and it might be food of lower nutritional quality.  It always subsides with time, gentle encouragement, and ample role modeling of healthy eating.

Here are a few good ideas for fresh,  healthy snacks for toddlers. And here are  few tips for letting your kids enjoy snacks the smart way.

©2009 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.

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 Janet Helm offers a few suggestions on how to introduce your toddler to sushi. She is also a Mom of twins and writes a very informative blog called  Nutrition Unplugged.

Janet Helm, MS RD B.S. in Mass Communications and Nutrition M.S. in Dietetics, Registered Dietitian 15 years in Nutrition Communications Freelance writer, nutrition consultant, blogger Website:Nutrition Unplugged Twitter:@JanetHelm Contact: via website

Question: I am thinking about introducing my toddler to sushi. What should I be concerned about?

Answer:

If sushi is something you enjoy, then no doubt you’d like to share it with your child.  I think it’s great to introduce children to a wide variety of foods early in life.  I’m a big proponent of developing the preschool palate and getting out of the chicken-nuggets rut. However, you’re right that there are a few things to keep in mind.

First, the official food safety stuff.  Raw fish can harbor bacteria and children under age 5 are considered to be especially susceptible to foodborne illness.  Young children — along with pregnant women, older adults and people with compromised immune systems – are advised by FDA’s Center for Food Safety and Applied Nutrition to avoid raw fish or shellfish. So I would wait until at least age 5 before introducing raw-fish sushi.

You also need to think about mercury, especially in tuna sushi.  It’s best to limit tuna and other higher mercury fish like swordfish, shark, tilefish and king mackerel to no more than 12 ounces a week.  A group called KidSafe Seafood, a coalition of chefs, pediatricians and sustainable seafood experts, is a great resource for parents.  They’ve identified the best seafood choices for children ages 3 and up that contain acceptable levels of mercury and other contaminants:  Wild Alaskan Salmon, Tilapia, Farmed Blue Mussels, Northern U.S. and Canadian Shrimp, U.S. Farmed Crayfish and Farmed Bay Scallops. You’ll even find recipes for kid-friendly “safe” sushi, such as California rolls with imitation crab meat and salmon rolls made with smoked salmon.

One last concern is the potential of parasites in raw fish, which can be particularly troublesome to small bodies.  One precaution is to eat only fish that has been previously frozen, which can help kill any parasites that might be hiding inside.

Yet with all of these caveats, it comes down to doing what you’re comfortable with and only going to sushi restaurants you trust.  I know a lot of parents who have been giving their children sushi at a fairly young age (almost always over age 2) and there’s never been any problem.  Afterall, children in Japan begin eating raw-fish sushi at a young age — although the Japanese do not eat as much raw fish as we think they do.

My twins are 5 and we haven’t been out for sushi yet, but that won’t stop us from going to a Japanese restaurant.  For now, I think I’ll start with vegetable rolls, tempura and rolls made with cooked fish.

Fortunately, they love fish that I make at home and I’m beginning to introduce new varieties.  Just be sure you talk with your pediatrician if your child has never eaten shellfish to discuss potential allergies.

Even if you decide to hold off giving your toddler sushi, perhaps you can have fun with this Sushi for Kids book or sushi toys.

©2009 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.

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 Dina Lindquist offers a few suggestions on how you can tame your child’s sweet tooth.

Dina Lindquist, RD BA in Psychology from Oakland University, BS in Dietetics from Madonna University Oakland County Health Department Dietetic Internship, Individual nutrition counseling for weight loss, Medical Nutrition Therapy for Diabetes, IBD, Renal Disease, etc Website:Nutritious Feast Twitter:@NutritiousFeast LinkedIn Profile Contact: via email from website

Question: How can I tame my child’s sweet tooth?

Answer:

Being a role model to your child is one of the most important things you can do. Children learn by watching their parents and other family members. Spend time with your kids and set a good example by eating a variety of foods with them. If children have a well rounded, nutrient dense diet, then offering them a few sweet treats is fine. The most important thing to remember is portion control. Keep the sweet treats small.

I’ve found that labeling food choices as “good” or “bad” can put an inappropriate significance on food. Instead, help your child see how any food can fit into a healthy eating plan. Some parents have admitted to me that once they label a food as “forbidden” or “bad,” their children start focusing on the particular food and ask for it. Children are curious! Also, I’ve talked to some parents who have never offered sweets to their children. That can be easy until your child enters daycare, goes to a friend’s house or even to grandma’s house. Once they try that “forbidden” treat, they may want it more than anything. If children are already aware of sweet treats and are used to eating in moderation, it won’t have as much of an impact. I’ve found that this topic can be controversial at times, so I always leave the final decision to parents.
Now for some tips on how you can tame your child’s sweet tooth:

1. Offer sweet treats as a dessert after a meal rather than as a snack. Snacks are an important part of a child’s diet and should be full of nutrients. Healthy snacks like celery with peanut butter, low fat yogurt with fruit, popcorn, dried fruit, hummus with veggies and whole wheat crackers with low fat cheese will keep your child focused and full of energy.
2. Limit the amount of sugary treats you buy so that you won’t have too many options available. Instead, buy fresh fruit and leave a bowl on the table. Put a few small boxes of raisins or dried fruit there as well. If children have easy access to it, they will eventually grab a banana or apple to tame their sweet tooth. Also, introduce your children to exotic fruits like mangoes, kiwi and clementines. They are sweet and satisfying! Make sure your children brush their teeth regularly! Even healthy treats like raisins can cause cavities.
3. If your child likes to drink sugary beverages such as soda, replace some of it with a healthier alternative like low fat milk, soy milk, water with lemon and sparkling water with a little 100% fruit juice. Just make sure to start with small, easy to achieve changes.
4. If your child likes breakfast cereal that is high in sugar, try slowly replacing it with a whole grain cereal with at least 5 grams of fiber and no more than 25% of calories from sugar. Mix a little of the new, healthier cereal into the sugary cereal. After a while, they should get used to the new cereal.
5. Many parents have told me that their children are more likely to eat foods they help prepare. Even toddlers can help out with food preparation! Have them wash fruit and veggies or put together small cracker sandwiches. They will feel accomplished and enjoy their healthy snacks even more. It’s like an adventure for them. Some may even forget about that bag of M&M’s in the cupboard.
6. Reward your children with affection and attention, not food. Some studies show that using food as a reward or punishment may result in unhealthy food attitudes. Next time your child cries, offer them their favorite board game or read them a chapter from their favorite book.

Remember that all foods can be part of your child’s healthy eating plan, even sweet treats!
Here is an interesting article that discusses children and why they may love sweet-tasting foods:

©2009 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.

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 Preethi Rahul explains how you can ensure a complete nutrition for your child on a vegetarian diet.

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: My child is on a 100% vegetarian diet. How do I ensure he gets a complete nutrition?

Answer:

Many people globally are certainly getting converted as vegetarians because of the many virtues a vegetarian diet has.

A vegetarian diet by itself is balanced as it has the cereals and sugars that provide the carbohydrates; pulses, milk and milk products that provide the proteins; Vegetables and fruits that provide the vitamins and minerals; Oil, ghee and butter that provide the fats. However, it is important that you give a balanced vegetarian diet to your child which on average, for a 4 – 9 year old child, would be around:

*1 serving is 30 g raw weight
*1 glass is 150 ml
*1 cup is 100 g

However the quality of vegetarian proteins is lesser than that of the non vegetarian sources. Thus, as a parent you need to ensure that you give good quality vegetarian proteins to your child. In order to improve the protein quality you can also make cereal-pulse combination recipes like Idlis, dhoklas, khichdi etc. Sources of good quality vegetarian proteins are soya, tofu, milk, curd, skimmed milk powder, paneer (cottage cheese), lentils, sprouts etc.

Highlight of a vegetarian diet are the vegetables and fruits! They make the food preparations colorful which is very essential for a child. Children love color and variety in their food. Vegetables and fruits contain vitamins and minerals which are needed in small amounts but have very specific actions in the system. For E.g. Vitamin D is needed for bone development; iron is needed for hemoglobin formation. This group also contains fibers- both soluble and insoluble that are needed to improve the bowel health, keep the digestive system healthy and functioning properly.

A colorful diet not only looks good on your plate but also provides all the necessary nutrients that help the body in its growth. For eg: Anthocyanines that cause the purple color regulate the blood circulation; They are richly present in berries. Quercetin that causes yellow color as well as anthocyanines helps to maintain good health of the retina. They are present in corn, apples and leafy vegetables such as spinach. The antioxidant Beta Cyanine present in beets causes the scarlet color in vegetables.

Thus, by having a vegetarian diet your child is getting a complete and a balanced nutrition and has a lesser chance of getting long-term health problems.

©2009 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.

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, Pediatrician Dr. Joanna Dolgoff explains how you can find out if your child is vitamin D deficient.

Joanna Dolgoff, M.D. BA Molecular Biology, Princeton, Graduated Cum Laude MD, NYU School of Medicine Pediatric internship and residency at Presbyterian Children’s Hospital of New York 5 years private practice in Pediatrics CBS News Online correspondent: childhood obesity expert Child & Adolescent obesity and weight management expert Website:Online Weight Management Program Twitter:@joannadolgoffmd LinkedIn Profile Contact: via email from website

Question: How do I know if my child has vitamin D deficiency?

Answer:

New studies are proving that vitamin D is an important nutrient that can help prevent many diseases such as cancer, depression, diabetes, hypertension, osteoporosis, chronic fatigue, autoimmune diseases and cardiovascular disease.

There are a few different ways to get vitamin D.  Vitamin D may come from foods or vitamin supplements; vitamin D can also be made by the skin when it is exposed to ultraviolet rays (UV light).

Vitamin D deficiency is often missed because there are no real symptoms associated with it.  Rickets and osteomalacia (softening of the bones) are the most common signs of vitamin D deficiency but there is no way for parents to tell if their child is suffering from these illnesses.  The only way to prove that your child is vitamin D deficient is by completing a blood test which screens for a particular form of vitamin D, called 25-hydroxyvitamin D (25(OH)D).

Think that name sounds complicated?  Unfortunately, many doctors do too.  In fact, doctors often order the wrong blood test when assessing vitamin D levels.  Be sure to ask for 25(OH) D blood test not 1, 25-dihydroxy-vitamin D (aka calcitriol).  With such complicated names, it is no wonder that such mistakes are made!

Vitamin D deficiency exists when 25(OH) D levels fall below 25 ng/mL.  Levels may vary depending on time of year, direct sunlight exposure, skin color and vitamin D consumption.  Levels should be between 50 – 80 ng/mL year-round for both children and adults.

As a doctor, I am finding more and more children with low levels of vitamin D, mainly because kids are spending less time in the sun.  These days, toddlers are more often inside watching TV than playing outside.  And if they are in the sun, they are lathered with sun block, which reflects the sun’s rays and decreases vitamin D formation.  Obviously, sunscreen is important and should not be avoided!  But it does lead to lower levels of vitamin D. Also, many toddlers do not get enough vitamin D to meet their needs since there are limited food sources of high vitamin D content.

The current recommendation is 400 IU per day in the form of of vitamin D3 (cholecalciferol).    New studies are showing that higher levels may be needed to prevent the diseases discussed above.  Many are now recommending 1,000 IU per day in the form of vitamin D3 (cholecalciferol).  If your child doesn’t get this amount of vitamin D in his diet, you may want to consider a multivitamin that contains vitamin D.

©2009 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.