photo credit: DesertNana aka majamom

Chances are you have not had a whole lot of opportunity to ask your family physician or pediatrician about a few rules of thumb for your child’s nutrition. After all, there is hardly any time to talk about nutrition even on a routine wellness visit. Our experience has been no different as the doctor always seems to be in such a big rush to get you out of there!

That is why, I read with great interest an article written by a physician and a registered dietitian published in the American Family Physician, which is a peer reviewed journal of the American Academy of Family Physicians. The title of this article is Nutrition in Toddlers and it contains a nice table of 7 consensus recommendations you can use to manage your child’s nutrition. I wanted to share them with you in this article.

A toddler diet should include 2-3 servings of milk or other dairy products  per day

Not a problem in most cases unless your child has a milk allergy or intolerance. Milk is a great way to meet your growing child’s calcium and vitamin D needs.

Toddlers older than 2 years old should get 30% of daily calories from fat

Not all fat is bad, even though we live in a world where low fat seems to be the golden rule. What you need to limit is saturated fat or trans fat and watch dietary cholesterol. Very easy to do if you reduce processed foods and rely more on home-cooked meals. Polyunsaturated or monounsaturated fats and fatty acids are among the healthy fats you must include in your child’s diet.

Limit fruit juices to no more than 4-6 oz per day and emphasize whole fruits and veggies

It is easy to get comfortable with the no-sugar 100% pure fruit juice label on the box, but fruit juices are no replacement for real fruit. Getting your child to love fruits and veggies takes effort and patience, but don’t give up!

Vitamin supplementation is unnecessary except in undernourished or chronically ill children

I could not agree more! It is natural to worry as a parent, and sometimes feel the pressure to start using a vitamin supplement just to be safe. There days we hear so much about vitamin D deficiency but a supplement is not needed unless your child doesn’t get enough sun exposure or if he does not or cannot drink at least 2 cups of milk. There are situations where you may consider a multivitamin for your toddler, but the general advice is to manage your child’s vitamins and minerals needs through diet and healthy lifestyle.

Good nutritional habits should be fostered by sitting at the table, turning off the television and interacting socially

Sometimes we get so focused on the what of eating, that we forget about the how of feeding! Having a family meal without the distraction of TV or video games is a very powerful way of building lifelong healthy eating habits. Dr Kathleen Cuneo of Dinner Together is an expert in this matter whose opinion I respect a lot. I really like her approach and belief that feeding is parenting. That is what matters in the long run, not the nutritional facts on the label!

Parents should offer children a variety of foods, expose them repeatedly to healthy foods and model healthy eating behaviors

Like it or not, you are a role model for your young child. And when it comes to building lifelong healthy eating habits, your attitude towards food and eating is the most important factor. Being a role model is not difficult; just be consistent and completely natural with your child.

To reassure parents and detect undernourished children, physicians should monitor growth patterns including body mass index

While it is natural to worry if your child falls below the 50th percentile on weight and height growth charts, body mass index is a better tool to assess if your child is overweight or underweight. Body mass index uses both height and weight. It is very easy and you can use an online calculator if you don’t want to wait until your next wellness check appointment.

I think these recommendations pretty much sum up the latest thinking in child nutrition. They are based on sound evidence and practical experience of doctors and dietitians. You don’t have to try to follow all of them on a daily basis. You can try to make them a part of your child’s overall eating habits in the long run. It is also a good idea to tailor your approach to your child’s individual personality without getting hung up on a certain best way to practice them.

Good luck!

©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.

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

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

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

Answer:

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

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

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

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

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

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

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

©2010 Littlestomaks.com. All Rights Reserved

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

Greetings! I thought of doing something different for this week’s Five for Fridays. Here are 5 videos which caught my eye as I looked for food and nutrition related news. Let me know what you think!

Bode Miller the “ski champ” farmer

Did you know that Bode Miller grew up a vegetarian? I didn’t, until found this video on Phd in Parenting blog! I was so fascinated by it that I decided to dig up the original source. I finally tracked it down on Stonyfield yogurt’s website under their “Yotube” video channel. It makes a perfect pitch for Stonyfield – after all, Bode Miller is no ordinary champion. One unintended message out of this video may be that organic is for crazies only! I think the positioning needs to be a little more mainstream. In any case, this video has a great message aimed to inspire the younger generation.

Watch out! Jamie Oliver is bringing his food revolution to America

It’s official folks! We are a country of fat people. If you have doubts, just check out the statistics on Huntington West Virgina – half the adults are considered obese and rates of diabetes and heart disease lead the nation! Jamie has supposedly the secret formula that can change the mindset: we don’t wanna sit around and eat lettuce all day! It is hilarious and I think it is sure to get good viewership when the show airs on ABC in March. I think it will make great TV, and although I hope it makes a real difference, I am not holding my breath for it! Good luck Jamie anyway.

Tom Vilsack on child nutrition act

Secretary Tom Vilsack answers 5 questions about his plans to expand the child nutrition program. I am all for it; I continue to believe that hunger and obesity are two sides of the same coin. Improving access to nutritious food, including fruits and vegetables, and not just focusing on low salt, sugar and fat is a good idea. Childhood obesity is a serious problem we must address now.

Michelle Obama takes on childhood obesity

If you haven’t yet seen this video by the first lady, you have got to check it out. Even though I think her Let’s Move campaign is destined to disappoint, I do admire her initiative to improve the health of our nation. She has a great personality and her message is clear and in many ways quite inspiring.

Help! My baby is fat – are you serious?

Chubby babies are cute, but is there a thing called a “fat” baby? Well, according to some researchers, people who turn obese when they grow up, begin to show a sign as early as 3 months of age! I find that unbelievable and I think this is going to send a risky signals to new parents. Babies need healthy fat, which if they are exclusively breastfed, is very easy to accomplish. Don’t be afraid of fat; the key is to work towards developing healthy eating habits during toddler years. This is yet another example of how catchy headlines can create a sense of unnecessary anxiety. The video does have some good tips from Dr. Sanjay Gupta, so check it out!

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 Victoria Retelny offers a few practical tips to busy parents for planning their family’s weekly meals.

Question: Both my husband and I have full time jobs and we always feel rushed to put wholesome food on the table each day for the family. Can you give a few tips for planning our weekly meals good for both our toddlers and us?

Answer:

Certainly!

I am asked this question often.  The secret is: have a plan and stick with it.  When it comes to meals and snacks, keep a grocery list for the week and do your shopping on the same day(s) every week.  Remember, feeding your whole family the same foods – and not making special foods for your toddlers – is the best way to go.  By keeping to a shopping schedule you can compile a list of meals and buy ingredients for the week.  Also, you will not overspend at the grocery store by making random stops.

When planning easy, convenient meals for you and your family, think about including these components at all meals:

Vegetables/Fruit + Lean protein + Whole grains + Healthy fats

To maintain nutritional balance, half of your plate should be vegetables/fruit, one-quarter should be lean protein, and the other quarter should be whole grains.  Keep in mind, frozen veggies are fine to use – they contain just as much nutritional value, if not more, than fresh vegetables.

Here are some healthful meals for your weekly rotation:

• Vegetable Pizza with whole wheat crust (100% whole wheat Boboli, assorted vegetables, and shredded part-skim mozzarella and canned crushed tomatoes). Serve with a side salad and vinaigrette dressing.
• Chicken and Couscous Primavera (shredded chicken breast, whole wheat couscous, peas, spinach, and tomatoes with balsamic vinaigrette dressing).
• Mini Turkey Cheese Burgers & Sweet Potatoes Fries (turkey patties – cut in quarters, mozzarella cheese slices, whole grain buns – cut in quarters, sweet potatoes – cut into slices, drizzled with olive oil and baked).   Serve with side salad and vinaigrette dressing.
• Whole Grain Macaroni and Cheese (whole grain macaroni, low-fat milk, shredded low-fat cheddar cheese).  Serve with oven-roasted broccoli spears drizzled with olive oil, pinch of salt and pepper.
• Asian Chicken Salad (shredded chicken breast, scallions, roasted sliced almonds, sesame seeds, shredded carrots, romaine lettuce, whole grain angel hair pasta). Mix with dressing: soy sauce, lemon juice, sugar, rice wine vinegar, sesame oil, and canola oil. If your kids will not eat lettuce than just serve the chicken with the pasta – my kids call the pasta strands “worms” and love this dish!

Bon appétit!

©2010 Littlestomaks.com. All Rights Reserved

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

It has been an excellent year blogging about toddler nutrition! When I started writing back in the Fall of 2008, I did not realize how exciting it could be to learn and write about all aspects of a young child’s nutrition and growth. Blogging has also given me an opportunity to connect with both experts and moms in a unique way!

As we close on 2009, I would like to reflect upon the more than 220 posts I have published on this blog. Whether you are a brand new visitor, or a regular reader of this blog, I invite you to check out these top 10 posts of 2009 in terms of page views and comments.

Enjoy and let me know what is on your mind!

	Attachment Parenting and Toddler Nutrition This post by Annie of PhD In Parenting explains what it means to feed your child with love and respect. It is one of the 8 guiding principles of Attachment Parenting.
	All Natural Toddler Multivitamin My review of Floradix Kinder Love Children’s Multivitamin Liquid Extract Formula attracted a lot of attention because it is based on herbal extracts and fruit juices. It claims to be easy on the child’s digestive system while providing vitamins A, B, C, D and E. It is not a good source of minerals.
	Simple Recipes – Chicken with Quinoa This is a very easy recipe to make! Quinoa, in my opinion, is the unrecognized superfood because it is a good source of protein and low glycemic index carbs. It also provides a good mix of vitamins and minerals.
	Ask the Expert – Sushi and Toddlers If you are a sushi lover and you are thinking about introducing your toddler to sushi, you have got to read this informative piece from registered dietitian Janet Helm. She writes a great blog at Nutrition Unplugged with tons of excellent information about nutrition and food trends.
	Looking for a Multivitamin Supplement? This is a “mini” guide to toddler vitamin supplements on the market. If you are considering a supplement for your child, you can use a simple comparison chart in this post. Centrum Kids and Flintstones Complete offer a good balance of complete vitamins and minerals. But the most important advice is to rely on a balanced diet with plenty of fruits and vegetables.
	5 Reasons to Consider a Multivitamin Supplement I heard a variety of opinions from Moms who took my Global Toddler survey about use of multivitamins. In this post, I highlight 5 main reasons why you might consider it for your child. Vitamins should not be used to “fix” nutrition and eating issues; rather you should rely on them to supplement a balanced diet.
	Basmati Rice: It is Very Easy to Cook and You Will Love It’s Flavor and Fragrance We love basmati rice! It is an excellent source of low glycemic index carbohydrates. Try my simple recipe to cook it as a separate side dish. You can also try some of the links in this post for other great recipes.
	Help! My Kids Don’t Eat Enough Fruits and Veggies! This is a very common concern of most toddler parents. In this article, pediatrician Dr Ayala Laufer-Cahana offers a few practical tips to get your kids interested in fruits and veggies. Check out her blog at Ayala’s Herbal Water.
	Traffic Light and Food Labeling Clearly, consumers want simple and easy to understand front of the box food labels. FDA is worried about accuracy and manipulation by the food industry. A traffic light based food labeling system is gaining popularity in UK and Australia. It is not perfect, but clearly a step in the right direction.
	Think Play-Nutrition-Rest for Long Term Health of Your Children Play is an important part of your child’s physical, mental and emotional growth. Combine it with good nutrition and enough rest for long term health of your toddler.

Web statistics are surely important, but there are a lot of other articles which I am particularly very passionate about. Here are a few of my favorites. I hope you will check them out and leave me a comment with your opinion!

1. Twinkie tax will do nothing to reduce the sweetness
2. Shaking off a sweet addiction
3. Why we must address childhood obesity NOW
4. Good nutrition key to managing food allergy
5. Healthy fats for children

©2009 Littlestomaks.com

This is a very easy recipe for a quick salad! We stumbled on it in Recipes from the Heart, a cookbook we recently purchased to support the Operation STEM-ulus from the U.S. Foodservice to provide fresh fruits and vegetables to needy families. We adapted it slightly to match the ingredients at hand. We don’t normally eat avocado but this recipe turned out to be a great introduction and extremely simple to prepare. We are definitely hooked and plan to try this fruit in other recipes!

Ingredients

1. 2 avocados, peeled and diced into small cubes
2. 2-3 pears, peeled and diced
3. 1 large tomato, diced
4. 1/4 cup cilantro, finely chopped
5. 2 tbsp diced green onions
6. 1 tbsp extra virgin olive oil
7. 1 tbsp lemon juice
8. Salt and pepper to taste

Method

Combine avocado, pears, tomatoes in a salad bowl, toss together to mix well. Sprinkle cilantro and green onions. Mix olive oil and lemon juice in a small bowl and spread over the salad uniformly. Serve with baked tortilla chips or toasted bread.

About avocado

via Wikimedia

Avocado is a fruit native to the Caribbean region but now grown in many countries across the world. It is very popular in the US, which is in fact is the third largest producer in the world. 95% of the US production comes from Southern California (source: Wikipedia)

Avocado has very high dietary fiber, loads of vitamin B, C, magnesium, potassium and phosphorus. It also provides a lot of monounsaturated fats, which is one of the good fats you should aim to increase in your growing child’s diet.

©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, Family Physician and Registered Dietitian Dr. Shelley Meyer recommends you consider switching to 2% milk as long as your toddler is growing appropriately. Whole milk is recommended for children between 1-2 years old.

Question: How much whole milk is necessary? Should my nearly-17-month-old be drinking whole milk all the time? I worry about her fat intake a lot because there is heart disease and hypertension in our family in a BIG way – I want to get her started correctly down a road that will help her to avoid those issues.

Answer:

This is a great question that comes up quite a bit with parents of infants that are making their transition into toddlerhood.  Previously, the AAP recommended that any child between one and two years old have only whole milk.  The premise behind this idea was that the additional fat in whole milk was needed for appropriate development of the brain, as 80% of brain development occurs in the first two years.  In addition fat has more than twice as many calories per gram as carbohydrates and proteins, and is thus a great way to ensure adequate energy intake for the early toddler years.

However, due to the rising rate of childhood obesity and the increasing prevalence of cardiovascular disease in the general population, in 2008 the AAP revised their recommendations.  So, in your case, where there is a strong family history of heart disease, you may opt to use 2% milk as long as your child is growing appropriately.  In the case of an obese child 2% may also be the best option.   Remember, though, that fat is needed for brain development so be sure your young toddler is getting 45-50 grams of fat per day.

©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.

Although these whole grain puffs are beginner snacks meant for babies recently introduced to solid foods, our twins still love to munch on them! The only difference is now they can eat a whole lot more than the suggested one serving in the 6-serving box. They come in several flavors – we have tried the peach and strawberry flavors so far.

Here is what we like about this product -

1. Only 25 calories per serving, none from fat (although I think good fat is important for small children)
2. No trans fats, no saturated fats, no cholesterol, no sodium
3. Only 1 g of sugar per serving
4. Good minerals and vitamins – iron, zinc, potassium, calcium, vitamin E
5. Whole grains, real fruit purees and extracts, no HFCS

Here is what we don’t like about this product -

1. It is not organic
2. No dietary fiber
3. The small puffs are a mess to clean up afterward
4. It is still processed food – better to switch to fruits and other healthful snacks which will actually make your children feel full.

Overall, not a bad alternative to many other packaged foods and snacks on the market.

Disclaimer – I have not received any sponsorship or free samples of product from Gerber for writing this review. For complete nutritional information and other products, visit Gerber’s website.

©2009 Littlestomaks.com

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