Childhood Obesity Awareness Month Blog Carnival

This article was written for inclusion in the blog carnival hosted by Littlestomaks to promote awareness of childhood obesity as part of the National Childhood Obesity Awareness Month. Please read to the end of this article to find a list of links to the other carnival participants.

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Talk about childhood obesity and you are sure to be inundated by all kind of alarming statistics and cries for tax on soda, banning food ads on TV and regulating school nutrition. As a parent, you hardly have any control over any of these so-called solutions. Sure you can try to limit junk foods, encourage fruits and veggies and force your kids to sit down on the dinner table each night. It is a real challenge for nearly all toddler parents and success is not guaranteed, at least in the short term. If your child is already overweight or obese, you may have even a smaller chance of success and a clinical intervention may be needed to reverse the situation.

Is there a solution that can actually nip the problem of childhood obesity in the bud?

In my research, I was surprised to learn that there is indeed such a solution. Even more surprising was the fact that we don’t hear about it at all when solutions to stopping childhood obesity are discussed.

This surprising and simple solution is: Breastfeeding!

photo credit: c r z

The benefits of breastfeeding are well known. It provides all the necessary nutrients for your child’s growth and builds his immune system for a foundation of healthy growth during the toddler years and beyond. But did you know that it also significantly lowers the chances of overweight or obesity? Consider, for example, this conclusion from a CDC report which addresses the question: Does Breastfeeding Reduce the Risk of Pediatric Overweight?

In conclusion, breastfeeding is associated with a reduced odds of pediatric overweight; it also appears to have an inverse dose-response association with overweight (longer duration, less chance of overweight). While more research is needed, exclusive breastfeeding appears to have a stronger effect than combined breast and formula feeding, and the inverse association between breastfeeding and overweight appears to remain with increasing age of the child. The three meta-analyses reported in these review articles suggest a 15% to 30% reduction in odds of overweight from breastfeeding.

This conclusion was based on three different studies which analyzed data from over 50 studies between 1970 and 2004. In case you need more convincing, consider the conclusions of this German study which appeared in the British Medical Journal in 1999:

Prolonged exclusive breast feeding reduced the risk of being obese or overweight among school age children in Bavaria who were born in the early 1990s. This effect is more likely to be related to the composition of breast milk than to lifestyle factors associated with breastfeeding. Preventing childhood obesity and its conse­quences may be an important argument in the drive to encourage breast feeding in industrialized countries.

Now there are purists in the academia who say that such conclusions are not based on randomized trials, which means that it cannot be proven with enough confidence that breastfeeding alone is a cause of reduction in chances of overweight or obesity. Rightly so, because there are confounding factors present in most of these studies. Although, the conclusion about breastfeeding and a reduced risk of overweight does not change even though it becomes a little weaker. From a practical point of view, it does not matter in my opinion and breastfeeding should still be promoted as a solution to preventing childhood obesity.

Although there is considerable debate about why breastfeeding lowers the risk of overweight or obesity, these three reasons are commonly cited:

1. Breastfed babies develop better sense of when they are hungry and when they are full
2. Formula-fed babies have a higher and more prolonged insulin response which stimulates more fat and weight gain
3. Breastfed babies have a higher concentration of leptin, a hormone which regulates their appetite

If breastfeeding, and extended breastfeeding in particular, has such a protective effect on overweight or obesity in later life, why is this message not amplified in public media? How come the revised policy statement on breastfeeding by the American Academy of Pediatrics only casually mentions the benefit of breastfeeding for reducing the risk of obesity? If childhood obesity is such a huge problem, then the benefit of breastfeeding should be prominently highlighted. Why do they recommend exclusive breastfeeding for only 6 months, when extended breastfeeding to 9 or even 12 months of age show a significant risk of childhood obesity?

The rates of breastfeeding in the US are pathetically low. National average rate for exclusive breastfeeding until 6 months is only 11% (2004 data). Married women, older than 30 years with a college degree are more likely to continue breastfeeding until 12 months of age. There is clearly a need to increase the public awareness of this issue and tailor the message for different demographics of women.

During the month of September, which has been declared as the National Childhood Obesity Awareness Month, we will surely hear a lot about junk food, soda, poor quality of school nutrition, too much TV and negligent parents. There will be a lot of focus on alarming numbers and renewed cries for more Government regulation. But where is the voice of reason addressing the need to actually prevent the crisis, rather than react to finding a miracle solution? I hope you will join me in giving support to such voices wherever they are. Promoting and supporting breastfeeding seems like a simple thing to do without having to spend too much money.

©2010 Littlestomaks.com

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Please take time to read the submissions by the other carnival participants:

7 Things Parents Say That Cause Eating and Weight Problems in Kids Michelle May, Physician and author of Eat What You Love Love What You Eat, highlights a few things parents say which can have unintended consequences (@EatWhatYouLove)

Childhood Obesity Kia Robertson of Today I Ate a Rainbow suggests that prevention of childhood obesity should start with education and educating parents about basics of healthy eating by breaking it into achievable parts (@eatingarainbow)

Childhood Obesity: A Reality Check Dr Susan Rubin, founder of BSF, suggests we change our approach to looking at childhood obesity (@DrSuRu)

Childhood Obesity: Prevention Starts in Infancy Nutrition expert Sarah Fennell reminds us that prevention is the best cure and offers a few tips to raise healthy eaters (@FoodFunHealth)

Giving Our Children a Chance at Health Registered dietitian Susan Dopart offers tips to parents for taking charge of their child’s health in the world of over-processed “kid foods” (@smnutritionist)

Healthy School Campaigns Works on Creating Healthy Food Environments A report on Chicago’s Healthy School Campaigns (HFC), a non profit dedicated to creating a healthy food environment in schools

How to Prevent and Manage Childhood Obesity Registered dietitian Jessica Levinson offers practical tips to prevent and manage childhood obesity (@JLevinsonRD)

Lessons I have Learned as a Mom Registered dietitian Alysa Bajenaru shares some of the lessons she has learned that have helped her develop a good understanding of what it takes to feed her kids (@InspiredRD)

Looking for a New Trend in Childhood Obesity? Registered dietitian Elizabeth Rahavi of the IFIC brings the focus back on family in the debate about childhood obesity (@FoodInsight)

Losing Weight: It Starts in Your Head Registered dietitian Cindy Williams reminds us of the power of attitude and mindset in losing weight and controlling obesity (@nutritionchic)

Making the Grade Registered dietitian Sally Kuzemchak evaluates her son’s school programs on healthy eating and physical activity (@RMNutrition)

Obesity and GERD: A Family Affair Jan Gambino, author of Reflux 101, writes about the link between overweight and GERD

Parents, Let’s Take a Positive Approach to Childhood Obesity Registered dietitian Ashley Rosales from the Dairy Council of California encourages parents to take a positive approach in helping their kids build healthy habits

Revolutionize the Way Your Kids Eat in Five Easy Steps Sociologist Dr Dina Rose suggests we shift our focus from nutrition to eating habits if we are serious about solving childhood obesity (@DrDrRose)

Surprising Easy Solution for Preventing Childhood Obesity Research shows benefits of extended breastfeeding in reducing risk of childhood obesity (@TwinToddlersDad)

The Problem Behind Childhood Obesity Ken Whitman, Publisher of Organic Connections, points out that our national priorities concerning childhood obesity are misplaced and calls for a renewed focus on the health of our nations kids.

Yoga Gets Kids Moving Registered dietitian Danielle Omar has an interesting suggestion for solving childhood obesity – get your kids into yoga! (@2eatwellRD)

This is a guest post by Lauren Morgan, a dietetic intern at the University of Maryland and blogger at The Blue Plate Special. Having grown up with food allergies, and because of her training as a dietitian, she has a strong interest and technical knowledge of this topic. In this article, she presents the latest research and recommendations for preventing food allergies in high risk infants.

photo credit: saia.neogaia

The American Academy of Pediatrics (AAP) reviewed older recommendations (from 2000) and the current research to publish their most current recommendations for the prevention of food allergy in high risk infants.  The AAP defines a high risk infant as a child with at least one parent or sibling with documented allergic disease.  Several factors stayed the same from their 2000 recommendations, but there were also newer recommendations thanks to research.  Here are some of the most important factors when it comes to prevention of food allergies:

Breastfeeding

The AAP, World Health Organization (WHO), American Academy of Allergy Asthma and Immunlogy (AAAAI), all recommend breastfeeding as the best source of nutrition for an infant as well as the best approach for preventing food allergy development.  According to AAAAI, breast milk strengthens the infant’s immune system and is the least likely food to trigger an allergic reaction.  The AAP’s recommendation is exclusive breastfeeding for at least four months.  While the evidence for breastfeeding preventing the development of food allergies is lacking, there is evidence for many other benefits that come along with breastfeeding.  Therefore, it is still the most highly recommended feeding method.

Maternal Pregnancy Diet

There is a long-standing thought that moms of high-risk infants should avoid certain foods during pregnancy; however this thought is not backed up by the research.  Researchers have not found conclusive evidence that moms should make any dietary restrictions during pregnancy.  In 2000, the AAP recommended there be no dietary restriction except the possible avoidance of peanuts.  The 2008 recommendations do not state an avoidance of peanuts during pregnancy is necessary.

Maternal Lactation Diet

Should moms avoid certain foods while they are breastfeeding?

The most recent research says no.  In the year 2000, the AAP recommended eliminating peanuts and nuts and consideration of elimination of eggs, cow’s milk, and fish.  However, in the updated 2008 recommendations the AAP states there is no dietary restriction needed.  According to the AAAAI, while research has been done on changes in mom’s diet, it has not proven to be as effective as the careful and timely introduction of foods to infants.

Soy Formulas

Should soy formulas be used for infants at high risk of developing food allergies?

The research again says no.  Previously, it was thought this might be an appropriate intervention; however, there has been no conclusive evidence to support this.  In fact, it is common for infants with cow’s milk allergy to be allergic to soy as well.  If breastfeeding is not an option the best alternative is providing the infant with a special hypoallergenic formula that has hydrolyzed protein.  These formulas need to be carefully considered and only used when necessary as instructed by your pediatrician.  These are very specialized and are much more expensive than standard formulas.

Introduction of Solid Foods

Should I wait to give my child certain foods like milk, eggs, and nuts?

Solid foods can be introduced between four and six months of age.  Cereal grains, vegetables, and fruits are the best to begin introducing.  Make sure you only give your child one ingredient at a time when introducing foods.  If they have apples, oranges, green beans, and grains and have a reaction you will not be able to tell which food they are allergic to.  Start with one food and wait several days before trying another one.  In the AAP’s 2000 recommendations it was recommended to delay introduction of foods with the most common allergens.  The recommendations included cow’s milk at twelve months, eggs at twenty-four months, peanuts, nuts and fish at thirty-six months; however, these recommendations have changed based on more current research.  The AAP now recommends no delay in introduction of any of these foods.  They state “there is no evidence for delaying introduction of any foods beyond this period [4-6 months], including those considered highly allergenic (e.g., fish, eggs, foods containing peanut protein)” (Greer).

The Take Away

While there is still so much unknown about the development of food allergies, it is encouraging to have solid, science-based recommendations for the prevention of food allergies.  I have continued hope that there will be great revelations in research that help find answers to food allergy questions.  Until then I rely on recommendations like these from credible institutions to help guide my practice as a nutrition professional and in my personal life as well.

References

• American Academy of Allergy, Asthma, and Immunology.  Tips to Remember:  Prevention of Allergies and Asthma in Children.
• World Health Organization.  10 Facts on Breastfeeding
• American Academy of Pediatrics, Committee on Nutrition.  Hypoallergenic infant formulas.  Pediatrics.  2000; 106: 346-349.
• Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and Section on Allergy and Immunology.  Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.  Pediatrics.  2008; 121(1): 183-191.

Parents: do you have a child with food allergies? What steps do you take to prevent or manage your child’s allergies?

©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, Dr. Douglas Husbands provides an update on nutritional supplements with practical application for the health of your children.

Question: What is the latest development in nutritional supplements for children?

Answer:

Hello everyone!  I’m delighted for my second opportunity to guest post here.  Since I just recently came back from the 2009 International and American Associations of Clinical Nutritionists Scientific Symposium, I’d like to share some information on nutrition supplements with practical application for the health of your children.

Vitamin D3

• Adequate to optimal levels of serum vitamin D levels in infants and children (between 30 to 60 ng/ml) are associated with decreased asthma and allergies, better brain development and healthy bone development.
• When visiting your pediatrician or Functional Medicine doctor, serum 25-hydroxyvitamin D levels should be measured.
• It is estimated that between 50,000 to 70,000 deaths per year from various causes could be prevented by having adequate blood vitamin D levels.
• Many infants and children could benefit from supplementing with 1000 to 2000 IU of vitamin D daily, particularly during the winter months, if they cannot tolerate fatty fish, if they are darker skinned, or if their serum vitamin D levels are below 30 ng/ml.

Probiotics

• Probiotics help decrease abnormal intestinal permeability, or “leaky gut”.
• The appendix’s function is now known.  It is a repository for beneficial bacteria (probiotics) for the GI tract.  Supplemental probiotics help replenish the repository after antibiotic use or from use of corticosteroid creams or inhalers.
• Abnormal intestinal permeability allows gut-derived antigen exposure to the bloodstream; thereby distant, seemingly unassociated autoimmune symptoms can arise from a “leaky gut”.
• Due to immature GI tract development, it is best that infants are breastfed for at least his/her first 12 months.
• Many pregnant women and breastfeeding mothers would do well to supplement with the probiotic strain Lactobacillus GG (aka Lactobacillus rhamnosus) at a dose of 4 billion/day and Vitamin D3 at a dose of 4000 IU/day for potentially decreasing likelihood of asthma, eczema, allergies, type 1 diabetes, and autoimmune disorders in their babies.

Curcumin

• Curcumin, a component of turmeric, has powerful anti-inflammatory properties to inhibit inflammatory mediators, exhibiting therapeutic potential in asthma (and other inflammatory disorders)

©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.

It has been a while since I highlighted some of the great comments I have received from all of you. Since this week we are on vacation, I thought of posting a few insightful reader comments instead of my 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 – some on a very regular basis – 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. jessyz reaffirmed her belief in breastfeeding in response to Annie’s guest post Attachment Parenting and Toddler Nutrition:

I loved this post, I am planning to breastfeed until my daughter is 2 years and then decide if she is ready for weaning. My sister in law nags me all the time that my daughter is not eating enough but I’ve been watching my daughter and she’s almost one now and is growing steadily and happily. I offer lots of food choices but she’s still more dependent on breast milk. My mother is a nutritionist and always points out that if you don’t worry too much about the quantity of food but about the quality of food offered to toddlers you could be helping them combat life long diseases like diabetes and obesity.

2. In response to Study Suggests Kids Who Get Vitamins Don’tNeed Them, Kayris had this to say:

My kids get a chewable vitamin when I remember to give it to them. A whole one for the 4 1/2 year old and a half tablet for the 2 year old. Our previous pediatrician was very adamant about vitamin use and insisted that if I didn’t give my infant Vitamin D drops, he would get rickets. Strangely, my doctor routinely tests *my* Vitamin D level, and she says I am one of few patients with a normal result. I assume it’s because we eat so many eggs and get morning sun.

We changed pede’s, for a sort of complicated reason, and the new doctor doesn’t seem to care either way. He asked me if I give a vitamin, and when I said, “When I remember,” he just shrugged and went on.

Both my kids eat pretty well and healthfully, but my older child is a little pickier and there are foods neither one eats well. Vitamin C foods, for example, because while both devour their veggies, they don’t really eat a lot of fruit. So I figure a vitamin a couple times per week is extra insurance against anything that might be missing in their diets.

3. Samantha made a very insightful suggestion for Moms struggling to continue breastfeeding upon returning to work when I commented on a survey in Five for Fridays:

I have to comment on the pumping and returning to work. I nursed my daughter for 10 months, which also included pumping at work. (She self weaned, early probably due to her heavy use of the bottle from expressed milk. She got impatient when it came to eating straight from the breast.) I work for fairly large non-profit organization, and while it has been difficult to manage, I have found support. They do not have a set private space for me to pump, but between the executive director and the billing specialist, both have allowed me to use their offices when available. The executive director is even a single man. I think if you can relay how important continuing breastfeeding is, sometimes you can make an impact in the perception of pumping.

I now have my second child and am only working part time with him, and even still my place of employment allows me to clock out and pump as often as necessary, and even lets me schedule appointments around my pumping sessions. I think their flexibility has taken the stress out of pumping, and because I am able to relax about it, the process goes much more quickly and takes less time away from being productive.

I would encourage anyone struggling with pumping to schedule a time to sit down with their supervisor and explain the importance of breastfeeding, and what their needs are in terms of a private space. You’d be suprised how willing people are to work with you. I think sometimes we are just afraid to talk about it, which leads to embaressment, stress, drop in milk production, and early weaning. Thanks for giving us a place to share!

4. Vitamin D deficiency is a popular topic these days. When I commented on this in a Five for Fridays, Dr. Ayala of Herbal Water provided an interesting perspective:

You’re brave to tackle the vitamin D issue. I am both intrigued and confused by the proliferation of studies finding low vitamin D in practically every disease process, from cancer to heart disease to obesity.

The questions are:

• Is the low vitamin D a part of the cause of the disease, or a manifestation of an unhealthy state, i.e. just a marker of disease. It would be similar to blaming a fever for the inflammation of the ear or lungs during an infectious disease. Vitamin D metabolism is complicated, therefore low vitamin D can be a result of both unhealthy lifestyle (engaging in less physical activity, which could be related to less sun exposure and eating an unhealthy diet), but also a sign that some of the many body systems (skin, kidney, liver) that participate in vitamin D production aren’t functioning well.
• Can supplementation with vitamin D improve those conditions associated with low vitamin D? This question needs to be addressed in a large randomized clinical trial of vitamin D supplementation. Other vitamins were thought to be protective against disease and trails proved that not to be the case.

At this point, all we know is that low vitamin D has been correlated with many states of disease. We don’t know it’s a cause. We don’t know if supplementation will lead to a better outcome.

That’s for sure Vitamin D is a hot topic!

5. Susan Gardner shared her dilemma about her daughter’s food choices in response to my post Lunch in School Cafeteria:

This is very interesting to read. My daughter entered kindergarten this year and we allow her to buy her lunch one day a week. She always picks Friday – pizza day! I do know that the school offers vegetables and fruit, but I do not think she eats them and instead opts to buy a cookie or chips (she rarely gets these things in the meals we serve). It is interesting to see what goes on as kids get older and have the opportunity to make their own food choices. I hope that the cashier at my daughter’s school is as helpful as the one you observed.

Photo source: tirong on Flickr via everystockphoto
©2009 Littlestomaks.com

Greetings!This week is the World Breastfeeding Week. Organized by the World Alliance for Breastfeeding Action (WABA), the focus this year is In Emergencies, Breastfeeding is a Lifeline. I never thought about breastfeeding this way, but it makes sense. Children and infants are most vulnerable during a catastrophic emergency – whether natural or man-made. According to WABA estimates, child mortality can be 2 to 70 times higher than normal under these conditions due to diarrhea, malnutrition and respiratory illness. They believe that by supporting breastfeeding in non-emergency situations, we can be better prepared to save the lives of young children during emergencies. Here is a great post by my blogger friend Annie on this subject by Annie on PhdInParenting.

Here again are 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.

Millions of kids vitamin D deficient – here we go again!

It seems like our appetite for reporting vitamin D deficiency in kids is insatiable! In yet another study published recently in Pediatrics, researchers report an alarming prevalence of vitamin D deficiency in kids 1-21 years old. They find that 9% (about 7.6 million) children are deficient and 61% (about 50.8 million) have insufficient levels of 25-hydroxyvitamin D. This news got a lot of coverage this week, mainly because the numbers seem so high. Also, in the same article, these researchers highlight a link between low levels of vitamin D and increased risk of cardiovascular disease. This sounds really scary, and no doubt, makes a perfect headline for an attention-grabbing story.

I have a few problems with these types of studies. First, they rely mainly on the level of 25-hydroxyvitamin D in blood. There is no consensus among experts when it comes to estimating deficiency or insufficiency in children. Second, the biochemistry and processing of vitamin D is very complex, something I don’t claim to understand at all. But I am certain of this – it cannot be as simple as just the blood level of 25-hydroxyvitamin D which relates to cardiovascular health or bone density. But the real reason why I get frustrated is that these studies do not answer the “so what?” question a parent might be concerned about. Drink milk and vitamin D fortified OJ, let your kids out to play, not watch too much TV – well, that is old advice and should be followed with our without such sensational news.  Should you ask your pediatrician for a 25-hydroxyvitamin D test? Should you take supplements? There is no real, practical and actionable advice from these “experts”.

My 2 cents – when you hear this type of news, take a deep breath and don’t panic. Take a quick look at what your child is getting on average – milk, OJ, cereals, fish, eggs, cod liver oil etc. How much outdoor activity in the sun he gets on average. Take a long term view on this but continue to watch the diet and activity level regularly. If you still have doubts, ask your pediatrician if a supplement is needed.

No one wants to hang out with overweight kids

Why are overweight kids so picked on? A very interesting post from Dr Joanna Dolgoff – one of our Ask the Expert contributors – provides some insight. Appears that kids have more sympathy for children with handicaps, and would rather be friends with them, than hang out with overweight or aggressive kids. Deep down, overweight kids are blamed for their condition. They should be able to change it by losing weight is a common belief. I wrote about this in my post on childhood obesity because this kind of negativity leads to low self-esteem and a downward spiral of physical and emotional health problems among overweight and obese kids. Stereotypes about obesity form early in life it seems.

FDA and USDA get a budget of $125 billion

That is a giant number! Extra funding is supposed to go for improving food safety and farm subsidies. What surprised me though is the estimate that almost half of the budget for the two agencies is set aside for food stamps and Government nutrition programs. What kind of a return on investment can we expect from this level of spending? I find it ironical that on one hand we spend extra on healthcare in managing obesity-related diseases, while on the other, we have to also budget a huge amount fighting hunger and poverty. These two problems are two sides of the same coin in my opinion, but I do not yet see a comprehensive policy (and budget) to address them. We know that there is poor communication and cooperation between different Government agencies – the right hand does not know what the left is doing, but both want to get bigger and fatter and demand more funding! And as far as food safety is concerned, the approach is to focus on compliance rather than prevention. This smells of more bureaucracy to me!

So many cooking shows, so little cooking

Michale Pollan wrote a very good – although very long – article in the New York Times magazine this week. Out of the Kitchen, Onto the Couch takes us through the history of cooking shows starting with Julia Child to the likes of present day Iron Chef and Rachel Ray. We watch the Prime Time food network for entertainment value these days, not to learn anything about cooking the food ourselves! Pollan makes two great points – one, that the food industry along with the Television has been quite successful in taking over the “cooking” part from us by providing us with relatively cheap, readily available, packaged nutrition (poor nutrition I must admit). And second, that we are now quite comfortable ordering fancy items at restaurants and our appetite and desire for an ever increasing array of foods seem never ending. The less we cook, the more we eat and the more weight we put on. So how can we get back to cooking? We don’t have time for cooking, but we have time to watch a cooking show. Seems to me it is a matter of priority and attitude. I think we need to invoke Nike’s Just Do It! for preparing our own food. Not necessarily from scratch, as a lot of purists might want you to, but enough so that you can control what goes inside your body.

Check out this cookbook review and giveaway

Here is a shout out for my blogger friend Jenna of Kidappeal. She has done a great review of Vegetables Get the Royal Treatment by Jill Nussinow (aka The Veggie Queen!), and she is giving away a copy of this book to one lucky winner selected from the comments on the post. It is very simple to enter – all you need to do is to leave a comment about your favorite vegetable and your favorite ways to prepare and eat it. Check it out, the contest ends on August 16th.

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

Photo source -Raphael Goetter on Flickr via everystockphoto
©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, 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.

Happy Friday! A lot of talk about the Swine Flu this week. I don’t know about you, but I am already overwhelmed by the scary headlines and soundbites coming at us via the traditional media. I am sure there is cause for concern and we should all exercise common sense and the usual precautions to prevent its spread. But is it really necessary to create a sense of panic by all this talk about a pandemic?

This week, I want to highlight 5 posts from my fellow bloggers I admire. Go check out their blogs and Stumble these posts if you like them.

The economics of breastfeeding

The benefits of breastfeeding are well-known. Now there is a debate about the cost of breastfeeding, mainly to the working women who choose to breastfeed their children while trying to make a career. This insightful analysis of the costs and benefits of breastfeeding on PhD in Parenting tries to put things in perspective and draws attention to the gap between our desire, as a society, for promotion of breastfeeding on one hand and the risk to a woman’s work and earnings on the other. The cost argument against breastfeeding has a major flaw in my opinion – it is mainly focused on what I would call the “opportunity cost” to the breastfeeding mother. That is, she loses out on career and income growth if she decides to breastfeed her child beyond the duration of the standard maternity leave. In other words, the lost opportunity for career and income growth is worth more than the benefits of breastfeeding (to the mother). There are a lot of assumptions in this argument about what is valuable and worthwhile to the mother. I think it is best to let her decide the true opportunity cost of her decision to breastfeed.

And what about the cost of not breastfeeding, on the other hand, to the child and the entire healthcare system? The cost argument does not even address this aspect of the economics of breastfeeding! Instead of looking at the entire system of breastfeeding (mother, child, society, healthcare system), it focuses on a small portion of the total cost. A very weak argument indeed in my opinion. What do you think?

Watch out, those sugary drinks are also not good for your heart

Could sugary drinks be a risk factor for heart disease independent of obesity and diabetes? Dr Ayala highlights some recent research to answer this question in this post. Turns out that the risk of heart disease goes up by 20 – 40% for those who consume more than 2 sugary drinks per day. And this is after adjusting for a lot of other factors such as age, smoking, alcohol, family history, fitness, cholesterol, aspirin use, high blood pressure, dietary healthfulness (AHEI score) and Body Mass Index. Even for non-caloric artificial sweeteners, there was a higher risk for heart disease although the effect was not as strong. I don’t really understand the technical reasons why this should be the case, but the data is compelling. Advice from experts – eliminate sugary drinks at home, just don’t buy them!

Eating well is a matter of knowledge, money and time

Do you believe that healthful food costs more and is simply out of reach for many Americans? If so, you are not alone. The good news is that the committee working on developing the 2010 dietary guidelines for Americans is also focusing on drawing attention to the affordability of nutrient-rich foods in different categories. In today’s difficult economic environment, this attitude could not be more timely. This article on Nutrition Unplugged reflects the current mood among some experts who point out that healthful and nutritious food is not always expensive. I agree – just by cutting down on packaged food, you can save a lot of money while improving the nutritional value of what you eat. What it takes, though, is knowledge of nutrition and cooking, some time and of course pots and pans. I hope you all can manage that! Check out our simple recipes in this blog, and share yours if you like.

The secret of the “freshness” additive in foods

Very informative post about the so-called “freshness” additive TBHQ by Cathy on A Life Less Sweet! Once again, she gives you the technical details, including the chemistry of this synthetic anti-oxidant routinely added to processed food products to increase their shelf life. She also explains some of the concerns about this additive since it has been shown to increase the risk of cancer in animals when given in high doses. So should you be concerned? First, it is added to foods in very small amounts, and secondly there is a lot of uncertainty about long term effects in humans. It is also known as E319 when used as a food additive, which has been implicated in the hyperactivity disorder in children. However, the data is not conclusive and considerable uncertainty remains. Bottom line – there is no reason to panic, however it is generally a good idea to cut down on processed foods anyway.

A very yummy fish taco recipe

Check out this recipe for fish tacos with cabbage and fish taco sauce from Jenna on her Kid Appeal blog. It seems like a very simple recipe and looks delicious and very healthy in the photos! I loved the colors of purple cabbage, tomato, avocado and of course the breaded fish fillet strips. Another great idea in this recipe is the sauce, which does not require any fancy ingredients; something you can make with what you already have at hand in your refrigerator. So, give it a try – I know we are going to give it a shot this weekend. And don’t forget to involve your kids in the preparation so they can really enjoy it when it’s ready.

Enjoy your weekend!

Image source: Miriam Poppe on Flickr
©2009 Littlestomaks.com

TGIF! Here is another installment of 5 interesting nutrition related articles I read this week. I invite your opinions and feedback.

1 in 3 new working Moms gives up breastfeeding within 7 weeks after returning to work

I was personally troubled by the results of this recent survey which brings to light the challenges faced by new working Moms in trying to breastfeed their babies. The situation is worse in the service and retail sector and among younger Moms where the dropout rate is more than half. Lack of private pumping environment and difficulty in scheduling a time for pumping were cited as the two top factors. I can’t believe that it is a matter of resources for most companies. After all, how difficult could it be to find a room and provide some privacy. It is really a matter of attitude and organizational priority about providing a supportive workplace. I would love to hear your comments if you have faced this problem at work or if your company has done something creative to solve this problem.

Regional differences in prices affecting affordability of healthy foods in Canada

Hard to believe, but true; in some parts of Canada, apples may cost 5 times more, and lean ground beef 3 times  more than some other parts. In this post about a recent poll, I was amazed to learn that 47% of Canadians go without fresh fruit, vegetables, dairy products, whole grain products, lean meat or fish because they are too expensive and 68% of Canadians identified price as extremely or very important when choosing what goes into their grocery cart. I think the situation is similar in the United States, although I am not sure if the difference in prices is so large. I find it difficult to believe that there is such a large gap in supply and demand of common foods in different parts of the same country. The author of the post (follow her on Twitter @phdinparenting) wonders if government should regulate the price of basic nutritious food. What do you think?

Yes there is choice, but should you really encourage your child to choose the “competitive foods” at school?

If you have a child in middle or high school, chances are he is getting nearly 200 calories from junk food (low nutrient energy dense if you want to get technical!) at the school vending machine. In another thought provoking post, Dr Ayala discusses the results of a recent study, which makes you wonder how we can accept to have our kids be put into this lose-lose situation! The subsidized school lunch is of low nutrition quality in the first place, and then the so called “competitive foods” do not offer anything better either. Seems like the only choice for the nutrition-minded parents is to pack their child’s lunch each day! I wonder if at least some of the kids would choose healthy alternatives if they were made available to them through vending machines.

Dannon will stop using milk from hormone treated cows

First it was General Mills, and now Dannon has annonced that their products will no longer be made from milk from rBST-treated cows according to this report. rBST (recombinant bovine somatotropin) hormone was approved by the FDA in 1993 for use in cows to sustain milk production at high levels. However, there has been rising opposition to its use by various consumer groups. As a result, the use of this hormone has been very controversial even though it is considered safe since it does not pass through the milk to humans. Still, concerns about the health of cows and extensive use of antibiotics seem to be valid. I wonder if this means they will increase the price of their popular yogurts. There is already a higher price organic option available to consumers, so that would not be really fair.

March is national nutrition month

The theme of this year’s National Nutrition Month® is “Eat Right“. This campaign is organized by the American Dietetic Association to improve the awareness of nutrition and healthy lifestyle. As if not to be left behind (joking! :)), the Dietitians of Canada have their own campaign and their theme is Stay Active. Eat Like a Champion. I am very impressed by both of these initiatives and hope that their message will bring a new focus and attention to the value of good nutrition. If you are a registered dietitian, I would love to hear your plans for this month. If you have a tip or advice for the readers of this blog, please leave a comment. I wish you good luck for your programs this month.

Have a great weekend everybody!

Image source: LaRuth on Flickr
©2009 Littlestomaks.com

This is a guest post by Annie, Mom of 2, and blogger who writes about the art and science of parenting at the PhD in Parenting blog.

When TwinToddlersDad asked me to write a guest post about attachment parenting and toddler nutrition, I wasn’t sure where to start. There are so many things I could write about. Rather than try to tackle them all, I’m going to give a brief overview of attachment parenting perspective on nutrition and then touch on one key issue in more detail.

Feeding with Love and Respect

Attachment Parenting International (API) has eight principles for attachment parenting. One of them is “Feed with Love and Respect”. At a basic level, this means that:

Feeding a child involves more than providing nutrients; it is an act of love. Whether providing for the very intense hunger needs of a newborn, or serving meals at the family dinner table, parents can use feeding time as an opportunity to strengthen their bonds with their children.

API’s information on feeding with love and respect touches on a number of issues, including:

• Breastfeeding and attachment
• “Bottle Nursing”
• Nurturing through feeding
• Introducing solids
• Nurturing a taste for nutritious food
• Gentle weaning

Dr. Sears, who coined the term “attachment parenting” has said that parents should not feel responsible for their toddlers’ every meal. They do not need to worry about what their children eat or how much they eat. He says that the parents’ job is to buy the right food, prepare it nutritionally, and serve it creatively. The rest is up to the child.

Extended breastfeeding and toddler nutrition

In attachment parenting circles, a lot of babies are breastfed into the toddler years and sometimes beyond. In fact, breastfeeding until the age of 3, 4 or beyond is more common than people think. Breastmilk continues to provide many nutritional and other benefits to nursing toddlers. The problem is that most nutritional guidelines for toddlers are written with an assumption that the child is weaned completely from the breast and formula by 12 months. However, nursing toddlers still get a lot of their nutritional requirements met by breastmilk.

According to FitKids (published by the Heart and Stroke Foundation of Canada), children between 1 and 3 years old require between 1000 and 1200 calories per day on average. Kellymom.com’s information on the average breastmilk intake for toddlers demonstrates that a good portion of those needs can be met with breastmilk:

Several studies have measured breastmilk intake for babies between 12 and 24 months and found typical amounts to be 14-19 oz per day (400-550 mL per day). Studies looking at breastmilk intake between 24 and 36 months have found typical amounts to be 10-12 oz per day (300-360 mL per day).

Since 1oz of breastmilk is equal to about 22 calories, on average 33% of a nursing 12 month to 24 month old’s nutritional requirements are coming from breastmilk and 22% of a 24 to 36 month old’s nutritional requirements are coming from breastmilk. As such, parents that do chose to nurse their children into toddlerhood don’t need to worry if their child is not eating as much food as other children their age.

Weaning, whether child-led or mother-led should be a gradual process, with solid food slowly replacing breastmilk as the main source of nutrition. According to kellymom.com’s excellent information on nutrition for nursing toddlers:

It is normal for baby to keep breastmilk as the primary part of his diet up until 18 months or even longer. An example of a nice gradual increase in solids would be 25% solids at 12 months, 50% solids at 18 months, and 80% solids at 24 months.

Watch your toddler, not the plate. If your toddler is growing well and is in good spirits, don’t worry if he isn’t eating very much as he may still be getting most of what he needs from nursing.

Book recommendations

I hope this post has given you a taste of the attachment parenting approach to toddler nutrition. If you want to read more, if you are concerned that your child isn’t eating enough, or are looking for ideas to make mealtime more fun, then check out these books:

• The Baby Book (by William Sears M.D. and Martha Sears R.N.): Dr. Sears’ Baby Book is an excellent general information book for parenting in the first two years, containing parenting advice, developmental information, and medical information. It has a chapter specifically on “Feeding the Toddler” that has lots of suggestions for getting your toddler to eat and figuring out if your child is eating enough. It also touches on food allergies, choosing the right milk for your toddler, and avoiding pesticides.

• My Child Won’t Eat! (by Carols Gonzalez, M.D.):  Why  you shouldn’t worry too much about what your child is eating or what the growth charts say. This book looks at how eating problems start and how they can be avoided. It also includes many stories from mothers that have tried to get their children to eat and emphasizes Dr. Sears’ assertion that a parent’s only involvement should be providing healthful food choices (not forcing the child to eat).

• Mothering Your Nursing Toddler (by Norma Jane Bumgarner): This book provides great information about the normal course of breastfeeding a toddler, helping moms and dads know what to expect.

• Whining & Dining (by Emma Waverman & Eshun Mott): This is my preferred cook book for little eaters. It includes meals and snacks that the whole family will love and that are nutritious too.

How have you incorporated “feeding with love” into your relationship with your toddler? How do you ensure adequate nutrition while also respecting the fact that it is your child’s body?

Photo Source Inmagine.com

I have heard a variety of opinions from Moms through my Global Toddlers survey on the topic of nutritional supplements. Some are using them for their toddlers, while others are skeptical about their effectiveness. Personally, we have not used any multivitamin supplements for our twins so far, but we also think about it sometimes. So I decided to research this subject and thought about 5 reasons you may consider giving your child a daily dose of a multivitamin. I have relied heavily on two books, which I strongly recommend to all of you:

1. Dr. Spock’s Baby and Child Care, 8th Edition – The One Essential Parenting Book (Find on Amazon here)
2. Disease Proof Your Child by Joel Fuhrman, M.D. (Find on Amazon here)

If you are exclusively breastfeeding your child (0-24 months)

Breast is certainly the best and if you have made the decision to breastfeed your child, you should be congratulated. Breast milk provides all the necessary nutrients for your baby’s physical growth and brain development. It also builds a strong immune system which protects your child from disease later in life. However the actual amount of vitamins, minerals and other nutrients a child will get from breast milk depends on Mom’s diet and nutrition during pregnancy and while breastfeeding.

Breast milk contains very little vitamin D, and although you can compensate for it by supplementing your own diet or by having your child get some exposure to sunlight, it might be a good idea to consider a vitamin D supplement for your child. In fact, the American Academy of Pediatrics recommends that all exclusively breastfed infants and toddlers be given 200 IU vitamin D supplement beginning within the first 2 months after birth. Good nutrition and outdoor play is critical for avoiding vitamin D deficiency, which has recently been reported to be on the rise in infants and children.

If your diet is primarily vegetarian, you may also consider a vitamin B12 supplement for your child. Vitamin B12 is one of the 8 B vitamins needed for normal functioning of the nervous system and the brain, and for the formation of blood. It is only available from animal products such as meats, dairy and eggs.

Although breast milk contains a highly absorbable type of iron, the overall amount is low. If your diet is iron-deficient and if your child is not eating iron-fortified complementary foods (formula, cereals, baby foods), you may consider an iron supplement. Iron is very important for maintaining blood oxygen levels and brain development.

If your child’s diet is mainly vegetarian (2-5 years)

Raising your child on a meatless, low fat and mainly plant-based diet is now highly recommended by many nutrition experts and pediatricians. Such a diet has many positive health benefits over the long term. It is indeed possible to get all of the major nutrients from fruits and vegetables. Having said that, we realize that it is not easy to develop a 100% meat-free diet, nor do we think it is necessary. We do believe in reducing the overall meat consumption, particularly red meats. We try to eat only chicken and fish as much as possible, although sometimes we do make a few dishes with lean beef, and once in a while, we do relish some of our lamb recipes.

Vitamin B12 deficiency is a major risk for children on a vegetarian diet. Another risk could arise if they are eating only a limited range of veggies and not including lentils, beans and nuts in their diets. If this is the case, you should consider a multivitamin supplement for your child.

If your child is not eating enough fruits and vegetables (2-5 years)

By far, this is a major concern of most parents! Eating a variety of fruits and vegetables is absolutely essential for healthy nutrition. However, most parents struggle with their children as they try to encourage them to eat more fruits and vegetables. Why this is so, I do not know right now. I do intend to research this problem and think about it some more for future posts.

While you can try to make up for it by selecting so-called “healthy” (vitamin and mineral fortified) processed foods for your child, it is not really a good alternative. Be really careful about sugar, fat (particularly trans and saturated fat), cholesterol and sodium, which may be lost in the fine print on the carefully designed package. But most importantly, even though the processed food may contain all the right ingredients, usually their absorption by our body is not very good. Our digestive system has evolved over a very very long time to extract energy and critical nutrients from natural foods such as fruits and vegetables without overloading any of its critical organs. It is indeed a complex machinery! The science of food – even though great advances have been made in recent years – still is in its infancy. We can add minerals and vitamins to processed foods, but do we really understand how they interact with each other or what happens to them inside the human body? I do not think so.

If you find yourself in this situation, you can consider a multivitamin supplement. Driven by research, these supplements now are formulated to maximize absorption. Since these supplements are not yet regulated by the FDA, there may be huge differences in quality and risks of different brands. Always do your research and consult with your doctor for recommendations.

If you have a picky eater (2-5 years)

Having a picky eater on your hands is another common problem. Although in most cases, it is a behavioral and communication issue, it is possible that your child may have a strong aversion, or even allergies to certain foods. In most cases, the advice I have heard is to be patient and offer different foods to your child at different times. I like to call it a 5-times-5-ways approach, which involves introducing new foods (including fruits and veggies) slowly and in different forms so your child can begin to develop a taste for them on his own and at his own choosing.

The risk in this case is that your child does not get a balanced nutrition and she may develop a deficiency for certain essential nutrients. In fact research has shown that 65% of those who did not use supplements, and even 9% of those who used supplements, had vitamin E intakes of less than the Estimated Average Requirement (5 mg/day). And recently, there have been many reports of vitamin D deficiency in infants and toddlers.

A multivitamin supplement may be considered in this case. In the words of Dr. Spock, “one vitamin pill a day is preferable to fighting with your child to finish his vegetables or eat more raw food“.

If your child’s growth profile is slower-than-normal (2-5 years)

Sometimes you may feel that your child is too thin, or too short in comparison to other children of his age. Whatever you do, he just does not seem to be growing that much. It is a very natural for a parent to feel this way; however this is a very complex issue and you should not take any drastic steps without consulting with your Pediatrician.

Tracking your child’s height, weight and BMI (Body Mass Index) using growth charts is a good way to understand his growth pattern in comparison to a normal growth profile for children of his age. As I have written in my post 5 Things You Need to Know About Growth Charts, these charts are based on a large amount of data collected from various national surveys. You should not worry about a single data point on these charts if it happens to fall below the “50th percentile”, but you should look at the trend over a period of time to see how it looks in relation to the norm. With online tools, you don’t have to wait for your next doctor visit. Resist the urge to check it every week; a quick check every 5-6 months should be sufficient.

If after tracking the growth chart for your child you find that his growth is slower than normal, your doctor may suggest an appropriate diet and a nutritional supplement.

So you have decided to give your child a multivitamin supplement, now what?

Here are few things to keep in mind once you have made a decision to use vitamin supplements:

• Research the brand for quality; not all vitamin supplements are created equal!
• Read the label carefully and do not exceed the recommended dose. There can be dangerous side effects due to vitamin toxicity.
• Look for one without vitamin A – it can lead to loss of calcium in the urine. Instead rely on yellow/orange colored fruits and veggies which provide beta carotenes so that our body can make vitamin A at its own rhythm.
• It should not have more than 2500 IU of beta-carotenes; studies have linked high does beta-carotene supplementation to higher rates of cancer and heart disease.
• It should have the full spectrum of minerals, most importantly calcium, iron and zinc.
• No artificial colors, sweetners or flavors.
• Taste and form acceptable to your child. No use picking a fight over the multivitamin!

Do you use a multivitamin supplement for your child? Why? And what kind? Please share in your comments.