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

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.

***

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

***

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)

To find out more about Global Toddlers click here.

You can complete a short online survey if you would like to showcase your toddler’s profile. The only criteria is that you should have at least one child between the ages of 2 and 5.

©2010 Littlestomaks.com

photo credit: 11950mike

The recent recall of over half billion eggs due to an outbreak of salmonella has everyone worried about the safety of eggs they buy from the store. There is quite a buzz in the media over this recall, which is once again being used to create a sense of panic so people sit up and pay attention to the so called breaking news! Sure, there is reason to be careful, but there are many ways you can protect your family without giving up on eggs completely. Eggs are a good source of complete protein especially useful for growing children.

Recently I connected with Mitch Kantor, Ph.D., who is the Executive Director of the Egg Nutrition Center (ENC). He provided answers to a few questions about egg nutrition via email:

Question: What is the benefit of including eggs in my toddler’s diet? At what age should I start?

Answer: A  primary function at the toddler  stage is growth ,  and the high quality protein in eggs is an excellent source of all the necessary amino acids  needed  to promote growth. In  addition , choline, a nutrient found in eggs  (and not found in abundance in many other food sources) , helps support the development of the memory center in the child’s rapidly growing brain.

Question: Are there any egg allergies I should be concerned about?

Answer: The American Academy of Pediatrics no longer recommends refraining from introducing eggs beyond 6 months of age. Although eggs are one of the more common food allergies, pediatricians are now suggesting introducing small amounts of known allergens into the diets of children who are suspected to have allergic reactions in order to develop a tolerance.

Question: What is the benefit of organic eggs vs. standard eggs?

Answer: Organic eggs are eggs that come from hens whose diets contain grain grown without pesticides. Nutritionally, there is no evidence to support a nutritional benefit of organic vs standard eggs.

Question: What is meant by “free range”, “antibiotics free” on the label?

Answer: Free range eggs means that the hens have access to the outdoors. Their diets are uncontrolled so the nutrient value of their eggs may vary.  The use of antibiotics in laying hens is not a standard practice in the egg industry. So, for the most part, almost all eggs in the food supply are antibiotic free.

Question: I have heard that eggs contain a lot of cholesterol. Is that true?

Answer: A  large egg contains  around  212 mg of cholesterol according to the USDA. Scientific evidence has shown that dietary cholesterol like that found in eggs does not raise blood cholesterol in most people. Our liver makes most of the cholesterol that travels in our blood and unless there is an abnormality, excess dietary cholesterol is excreted by our body , or used in various bodily processes .

Question: What is the best way of cooking eggs to preserve their nutritional value?

Answer: The best way to preserve nutrients in any food is to keep it refrigerated until ready to use and cook it for a short time in a minimum of water. Using the microwave to quickly cook an egg would be the best way to preserve the many healthy nutrients in an egg.

Do you have an egg-related question not answered above? Leave it in comments below. I will follow up with Dr Kantor and get it answered. Feel free to also share any other comments or opinions.

©2010 Littlestomaks.com

Last weekend, I had an opportunity to talk to several parents of young children at a local cultural event. I did a short survey with them to learn more about their issues and concerns. One of the questions was designed to find out which sources of information they rely on for advice on child nutrition. I did a similar survey last year and I reported the results in this article. I have now added the new data for this update.

This data set now has  a total of 202 picks from 97 respondents from the blog, Global Toddlers and the recent cultural event.

Here is how the question was posed:

Where do you go for advice on toddler nutrition? Pick 3

1. Your pediatrician
2. Nutritionist or Registered Dietitian
3. Internet
4. Trusted friend/family
5. Books or Magazines
6. Networking group
7. Other

And here is chart showing the results:

Top 3 sources of child nutrition advice for most parents are Internet, Pediatrician and Books/Magazines.

I think that there is a tremendous opportunity for registered dietitians to connect with parents and offer them credible, science-based, actionable information. They get extensive training in all aspects of nutrition and many of them have graduate degrees. I believe they can bridge the gap between the pediatrician, who is unlikely to spend a lot of time addressing nutrition needs of a child, and the internet, where nutrition information tends to be largely fragmented across websites of dubious credibility. I have had a wonderful experience working with over 30 registered dietitians who have answered reader questions in my Ask the Expert column.

What do you think? Are you surprised by these results?

I would love to hear your opinion on the results of this poll. If you did not get a chance to vote in this survey, please feel free to leave a comment with your picks.

©2010 Littlestomaks.com

This is a guest post by Jan Gambino, author of Reflux 101 and an expert in infant/toddler acid reflux, feeding disorders, special needs and parents education. She writes at RefluxMom.

Picky eating is common and often occurs during the toddler years. After the intense growth and the seemingly easy going attitude about eating and drinking during the first year, the average toddler will often have a slower rate of growth and become more opinionated about what she eats and when.

Picky Eating May Include

• Eating a limited variety of foods.
• Avoiding one or more food groups such as: dairy, vegetables or fruits.
• Craving Carbohydrates such as crackers, bread, pasta.
• Requesting a particular type of food (for example: a child who will only eat French Fries from the local fast food restaurant or Brand X frozen chicken nuggets from the food store).
• Showing displeasure or having a tantrum when a new food is presented.
• Crying or refusing to eat when the favored foods are not available.

For more information about this normal stage, read my previous post about coping with picky eating.

Beyond Picky

A few children have significant difficulty eating a variety of foods and these worrisome symptoms needs to be discussed with the doctor. If your child has many or all of the symptoms of picky eating plus any of the concerns listed below, it is time to schedule an appointment with the doctor.

Worrisome symptoms that need to be discussed with the doctor

• Slow weight gain.
• Weight loss.
• Extremely limited diet that may lack key nutrients.
• Tantrums, fussiness or crying at meals or when food is presented.
• Fearful about eating or when food is presented.
• Choking, coughing or gagging when food is presented or when eating.
• Immature feeding skills (for example: eating pureed food only beyond infancy).

A toddler may be picky or beyond picky like my daughter due to a medical condition such as gastroesophageal reflux disease (GERD). A food allergy, food intolerance or a digestive condition such as GERD, Celiac Disease, Lactose Intolerance or another condition may cause eating and digestion to feel uncomfortable or painful. A child may try to “fix” this problem by avoiding foods or food groups or even limiting intake. Other causes of extremely picky eating include: sensory issues (textures, temperatures and flavors cause discomfort) or an oral motor problem such as a swallowing disorder, aspiration or poor muscle tone. In addition, a learned pattern of eating or adapting to digestive discomfort may lead to behavioral issues. Sometimes a behavioral reaction to eating (turning away, crying) may occur due to an undiagnosed medical condition. It is always best to work with your child’s doctor to look at medical and behavioral causes of picky eating and developing a treatment plan together.

©2010 Littlestomaks.com

Happy New Year everyone! It is great to be back blogging after a short holiday break. Hope you all had fun this holiday season. We took this time to reconnect with friends and did some housekeeping.

I want to start the new year with a short survey on your nutrition priorities in 2010. I don’t really like the idea of “resolutions” – they seem so fixed and you feel guilty when you are not able to keep up. Rather, I like to think of priorities – they are important, but they can also change depending on the situation.

So I would like to ask you to share your top 3 priorities related to the nutrition of your kids in 2010.

• Ensure proper nutrition
• Develop healthy eating habits
• Build immunity and good health
• Enjoy stress-free family meals
• Try new toddler-friendly healthy recipes
• Limit junk food
• More fruits and veggies
• Less meat and processed foods
• Eating healthy at daycare or school
• Healthy choices when eating out
• Other – please specify

Leave a comment, or you can also make your selection from the Poll in the second column on the right side of the blog’s homepage.

Enjoy and have a healthy 2010!

©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, Registered Dietitian Cindy Williams offers practical tips to help you get your growing toddler to eat a variety of foods including fruits and vegetables.

Question: How do I get my 3 year old to eat better? He never eats veggies and only eats a handful of items like chicken nuggets, pizza, pasta, rice, and cereal.

Answer:

Toddlers are notoriously fussy eaters. There are a couple of reasons for this. First, their growth rate has slowed so they usually don’t need to eat so much.

Second, as we fret about the nutritional inadequacy of two bites of toast for breakfast and desperately cajole them to eat a bit more, our darling child learns that with one tiny word – NO – they can make mummy and daddy act really funny. And if they keep on saying it long enough they might get really yummy stuff to eat. This is when the frazzled parents finally give in to the child’s incessant tearful demands for his favorite food and think ‘At least he’s eating something’. What can we do to win this power battle and come through it with a healthy child that eats a wide range of foods? Here are a few ideas.

1. Serve one new food at a time, along with familiar foods. Include one favorite food with each meal.
2. It can take up to 15 tries of a new food for your child to like it. Don’t give up on the first refusal. Try again in a few days.
3. Just like adults there will be some foods that your child won’t like even after 15 tries. Take a break and try again when they are a little older and their taste-buds have developed a bit more.
4. Add vegetables to the favorite foods e.g. pizza topped with cooked spinach, finely chopped red pepper or broccoli or pasta topped with thick vegetable soup as a pasta sauce.
5. Hide vegetables in favorite foods e.g. grated carrot and pumpkin in pasta sauce, mince and burgers. Fried rice with egg, corn, red pepper and carrot.
6. Try corn on the cob. Cut a cob in three to make it easy for little fingers to handle.
7. Toddlers can’t eat huge meals. Give them small snacks through the day. Try carrot sticks, baby tomatoes, cut fruit pieces, grapes and cheese cubes.
8. Try it raw. Serve raw sliced vegetables for your children to nibble while you make dinner. They may eat their whole vegetable quota before the meal.
9. Turn food into play. Give food fun names e.g. ‘moon squirters’ for baby tomatoes. Arrange food to look like a face, a house, a rocket ship or a train. My 4-year-old ate a pile of mashed potato with fish and vegetables because it was called ‘Tracey Island’ from Thunderbirds!
10. Make finger food. Toddlers prefer distinctive pieces of food that they can identify and pick up in their fingers.Eat as a family when possible. Children learn by example. If they see their parents and older siblings enjoying vegetables and other healthy food they are more likely to want to try it.
11. Involve your child in growing or picking fruit, vegetables and herbs. Taste it right there in the garden. It’s much more fun than eating at the table.
12. Point out interesting fruit and vegetables in the supermarket and let your child choose one to take home.
13. Let your child help out in the kitchen. They could drop tomatoes in the salad, shell peas, peel a banana, drop fruit into the blender or turn it on when making a fruit smoothie, pat out some pizza dough or sprinkle cheese.

REMEMBER…

You are not a restaurant

When a toddler complains that they don’t like their meal and that they want something different, empathize with them but don’t jump up and make something else.

You provide the quality, they choose the quantity

Young children are perfectly designed to eat when they are hungry and stop when they are full. They may miss a meal in protest at the ‘yukky’ food but their rumbling tummy will eventually have them eating whatever you have provided.

My niece went through this fussy stage as a toddler. One evening came the final showdown. She refused her dinner and demanded something else. Her dad told her that was fine; they would just keep it for her breakfast. Off she went to bed with no dinner and lots of tears, much to the horror of her mom. The next morning dinner was waiting. She refused it. Off they went to church. The dinner went too! Finally she gave in and the battle was won. Hopefully you won’t need to be this brutal, but it worked.

If necessary, give your child a temporary nutritional supplement

If you’re concerned that your fussy toddler isn’t getting enough nutrients, particularly iron which is critically important at this age, give him a temporary nutritional supplement. Nutrient fortified milk is great. Also give him fruit with his meals to increase iron absorption. Once you feel assured that he’s getting all his nutritional needs, you are less likely to fall into the ‘At least he’s eating something’ trap. You’ll be ready to take back the reins of power.

It’s a stage that will end

Hang in there. Keep serving up a variety of food and flavours. Take a few deep breaths, perhaps a glass of wine, and know that this stage won’t last forever.

©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 Jill Castle suggests a few alternatives to cow’s milk for your toddler if you are concerned about introducing dairy products.

Question: I am hesitant to give cow milk to my 15 month old daughter because I have heard that there are many problems with dairy. What other options do I have?

Answer:

Choosing which milk to feed your baby is an important decision, and one that requires thoughtful consideration.  With the plethora of milks available on the commercial market, it is often confusing to know which milk is appropriate for your child.  And many of these milks advertise their health benefits and are largely targeted at the adult.  The younger toddler (aged 1-2 years) continues to have unique nutritional requirements that are different from those of older children and adults, such as higher fat requirements, adequate protein and vitamins, and sufficient calories for growth. Additionally, liquid milk still provides the majority of nutrition (up to 60-70% of total caloric intake) in a given day for the younger toddler.

After a year of drinking breast-milk or infant formula, most emerging toddlers are ready to make a transition.  The gold standard, whole cow’s milk, has been the fluid milk of choice for many years, and many generations, and remains so in the eyes of the American Academy of Pediatrics (AAP).  Whole cow’s milk, when included with a variety of foods, can support the growth and development of children over one year of age. Whole cow’s milk contains about 150 calories per 8 ounces and is a good source of calcium, protein, fat, and Vitamins A and D.

Soy milk is an alternative to cow’s milk, readily available, and is utilized frequently for children who are intolerant or allergic to cow’s milk, or who are following a vegan diet.  Soy milk is fortified with calcium and Vitamin D, and can provide adequate protein and calories for the growing toddler. Soy milk is processed to match the nutrient content of cow’s milk and often, sugar is added to mask the bitter tasted of the soy bean.  Research indicates that ~40% of children who are allergic to cow’s milk are also allergic to soy milk.

Rice milk is used in children who are allergic to both cow and soy milks, and also may be used with the vegetarian child.  Caution should be used when choosing rice milk for the younger toddler, as it contains low amounts of protein, fat, and calories.  Some research has shown evidence of growth failure in young children consuming rice milk due to its poor protein, fat, calorie, and vitamin/mineral content.  If it is necessary for your young toddler to consume rice milk, be sure to consult with your Registered Dietitian (RD) or your pediatrician (MD) so that proper attention can be given to assuring your child’s liquid and solid food intake will meet their nutritional needs.

Hemp milk is yet one other milk available in stores.  Hemp milk is a grain milk, from the cannabis plant, and contains many nutrients found in cow’s milk.  The flavored hemp milks (150 calories/ounce) are similar in caloric content to whole cow’s milk and soy milk, however, the unflavored variety (100 calories/ounce) is considerably lower in calories.  Protein and fat content are lower than cow’s milk, but higher than other grain milks.  Hemp milk can be a nutritious part of your toddlers diet when coupled with a variety of foods.

Nut milks, such as almond milk, also tend to be deficient in protein and fat when compared to the unique nutrient needs of the younger toddler.  Caution should be used in introducing nut milks to the toddler before the age of three, due to risk of allergic reaction.

Young toddlerhood is an important time for establishing healthy eating habits and is also a critical time for adequate nutrition, specifically fat, protein, and calories.  As the younger toddler is in the process of being introduced to new foods and establishing eating patterns, a nutritious milk is an important component of the daily diet.  Evidence of steady growth and acceptance of a variety of solid foods are good indicators that your young toddler is receiving adequate nutrition from all food sources.

©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 Wendy Reinhardt offers practical tips on how to make healthy choices when eating out with your kids.

Question: How often can we go out to eat and still be healthy?

Answer:

As a busy mom of two small boys, it often seems that eating healthy can be a challenge – anytime – anywhere.  But…I believe that we can eat out every day and still be healthy.  Yes, I said every day.  Many restaurants offer healthy food items. The challenge is we actually have to CHOOSE THEM.  Here are some of my top tips for making eating out healthy and happy:

Plan ahead.  Eating healthy at home and on-the go requires some planning.  Planning ahead can help you relax and enjoy your dining out experience while also getting some power-packed nutrition.  If there are certain restaurants you frequent, visit their Web sites to get nutritional information. Make a list of healthy selections to keep with you and determine what you and your family will purchase BEFORE getting to the restaurant.  Give your kids two or three meal choices (including beverages) that are higher in nutrition and lower on the calorie range.  Empower your kids by having them select their meal from the choices YOU provide; letting them pick builds their nutrition savvy!

Be portion size wise. If the restaurant offers several sandwich sizes, pick the smallest or order half a sandwich, if available. If you want a burger, choose the kid-sized hamburger (FYI: The kid’s meal is for big kids too.)  You can also consider taking half home or dividing the portion with a friend or your kids. The potential payoff: Sharing now can make dessert a reality in your future. YES!!!

Go ahead and “veg (and fruit) out”.  Most of us (and our kids) do not get the recommended amount of servings of fruits and vegetables each day. Instead of french fries choose a side salad with low-fat dressing or a baked potato. Or add a fruit cup to your meal. Other healthy choices include apple slices or carrot sticks, corn on the cob, steamed veggies or brown rice, or baked chips. For sandwiches or pizza, ask for extra veggie toppings and add more vitamins and fiber (and flavor) and only add a few calories. This can help turn a small sub, burger, or slice of pizza into something more substantial. Or…before you head out the door, pick-up that piece of neglected fresh fruit, turn good intentions into some good nutrition, and literally – run (NOTE: Kids love running; please remove hazards from running path before you attempt this)!

Enjoy your food…and your family! Savor the flavor of each bite. Chew your food thoroughly and encourage your kids to “come up for air.”  Talk between bits (but not with your mouth full).  Stop before you feel like YOU are the turkey at Thanksgiving dinner. If it is a special occasion, or you know you want to order your favorite meal, make sure your other meals that day are on the healthier side and/or take a family walk; play with the kids instead of watching on the sidelines.

Visit www.kidnetic.com for more kid- and parent-friendly tips to keep your family healthy and happy.

©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.

When it comes to convenience, Campbell’s condensed soups are unbeatable. It is no wonder that Campbell is a powerful household brand. I personally like homemade soups made from scratch, especially lentil soup, but when you are in a hurry after a full day of work, these ready made soups provide an easy alternative for a quick meal for kids. My daughter loves their line of soups for kids like the Disney Princess, Dora and Goldfish brands! Sometimes she even wants to add colorful fruit loops to the soup – I know it sounds weird, but it works!

Recently, Campbell is trying to focus on the theme of affordable nutrition. We are careful to check the label because a lot of their soups are loaded with salt. The kids’ line claims to have 25% less sodium, but it is still high in my opinion on a per serving basis.

Here is what we like about this product -

1. Super convenient, our kids like the different shapes inside these soups
2. No saturated fat or trans fat
3. Less sodium and sugar than other soups – especially their own Tomato Soup
4. Contains vitamin A and iron
5. Provides 3g of protein per serving
6. Very affordable

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

1. Long list of ingredients – it is still processed food folks!
2. 480 mg sodium, still quite high for kids
3. It is not organic

Overall, I think not a bad alternative for a quick and affordable meal. Serve as a complimentary food with things like rice and vegetables.

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

©2009 Littlestomaks.com

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]]> http://www.littlestomaks.com/2009/11/product-review-campbells-kids-soups/feed/ 1 http://www.littlestomaks.com/2009/10/five-for-fridays-oct-30-2009/ http://www.littlestomaks.com/2009/10/five-for-fridays-oct-30-2009/#comments Fri, 30 Oct 2009 04:21:10 +0000 TwinToddlersDad http://www.littlestomaks.com/?p=3161

The media was abuzz this week with screaming headlines warning us of widespread vitamin D deficiency in kids. It followed a recent paper in the Pediatrics journal by researchers at the Children’s hospital in Boston, Massachusetts General Hospital, Harvard Medical School and the University of Colorado. The paper presented their research based on the 2001-2004 NHANES survey and posed the question Do Children Need More Vitamin D?

That the mainstream media latched on this latest research and gave it prime time coverage is not a surprise to me. I have written about such attention grabbing headlines on vitamin D before. I am so intrigued by the popularity of this topic in the press that I decided to look at this week’s news in more detail for today’s Five for Fridays. I would love to hear your comments and concerns about vitamin D for your children.

Here are 5 reasons why I believe we don’t need to let the mass media engulf us in mass hysteria about vitamin D:

There is no consensus on healthy levels of vitamin D in children

The Pediatrics paper correctly points out that:

There is controversy, however, about what a healthy level of 25-hydroxyvitamin D is for children and even what level of 25(OH)D should be used to define vitamin D deficiency

25-hydroxyvitamin D is what they measure in the blood to determine the level of vitamin D. Different agencies have defined vitamin D deficiency as blood levels less than 27.5 to 37.5 nmol/L. Many experts today believe that these levels are too low and should be revised to less than 50 nmol/L or even 70 nmol/L. By raising the number on the “safe” level, these experts suggest that a lot more people should be considered vitamin D deficient compared to current standards.

While there is some data to suggest various benefits of higher levels of vitamin D in adults (75 to 100 nmol/L), there is no such evidence and consensus for children. When even experts cannot agree on “safe” levels of vitamin D in children, I am not sure if it makes sense to raise a red flag based on this week’s report.

Average vitamin D levels in children are much higher than currently recommended

Amazingly, the Pediatrics paper reports that the average blood level of 25-hydroxyvitamin D was 70 nmol/L. Further, prevalence for levels less than 25 nmol/L was only 0.7% and that for levels less than 50 nmol/L was 15%. It is only when you consider a level of 70 nmol/L as the “safe” level that the prevalence goes up to 65%. Basically that means that most children have a sufficiently high level of vitamin D.

I am not suggesting that we should not worry about the 15% or so who had levels lower than 50 nmol/L. It is a cause for concern, but probably not as much as the rate of childhood obesity. The problem I have with these studies is that they tend to look at only one thing at a time and lose the big picture on our children’s health.

Perceived risks based on geography and ethnicity do not justify broad changes

We have all heard the usual reasons for low vitamin D – children do not get enough time in the sun which makes things worse for dark-skinned children of Hispanic and African-American background. Also children who live in the Northern altitudes do not get enough sun particularly in the winter months.

These observations are all true. However, aside from skin color and average sun exposure there is also an effect of poor nutrition in general. It is probably not a conincidence that children in these same demographic groups have also been reported as either overweight or obese. Under these circumstances, even if these children were put on vitamin D supplements, I am not convinced that it will do anything to improve their prospects of future health. I think that a narrow focus on vitamin D misses the big picture on children’s nutrition.

Based on these studies alone, I don’t think a sweeping across the board recommendation of higher vitamin D can be justified.

There is no evidence for preventive powers of vitamin D by large randomized clinical trials

A fascinating article appeard in last week’s Financial Times which posed the question To D or not to D? Recent research reports a link between higher vitamin D and lower risk of certain types of cancer. On the flip side, low levels of vitamin D have been reported to increase the risk of osteoporosis, heart disease, multiple sclerosis, type 1 diabetes, depression and rheumatoid arthritis. One recent review of health records of over 13000 Americans found that people with the lowest vitamin D levels were 26% more likely to die in an 8 year period compared to those with the highest levels.

How can you not have the sense of urgency about recommending everybody to have higher vitamin D? It seems like a no brainer.

Not so fast say the international health authorities! Even the International Agency for Cancer Research of the WHO issued a report last year that basically concluded there was no need to raise vitamin D recommendations. The Institute of Medicine in the US also does not appear to be in any hurry to change the current recommendations.

The main reason for this reluctance is that the preventive power of vitamin D has not yet been proven by large scale randomized clinical trials. The Financial Times article provides a good understanding of why such clinical trials may never take place. There are some clinical trials going on for senior citizens, but nothing on the horizon for children or young adults.

I am impressed by the commitment of today’s vitamin D researchers. However, I think there ambitions are out of proportion with their findings. I have nothing against targeted intervention in high risk groups, but it is meaningless to stretch the recommendations to everybody across the board.

These studies imply relying on supplements instead of nutrition and active lifestyle

Finally, this is the main reason why I am not a big fan of these studies. The underlying implication is that we can easily solve this problem by vitamin D supplements. The Pediatrics paper asks the question:

Considering these prevalence data, would there be risks associated with recommending that all children have vitamin D supplements until the short- and long-term health outcome data are elucidated?

It does address the concern about vitamin D toxicity but suggests that it is rare and happens only when really excessive doses of vitamin D are taken. Clearly, their agenda is to promote vitamin D supplements for children:

As suggested recently by the Canadian Pediatric Society and a recent stateof-the-art review on vitamin D, higher supplement doses may be required for children to reach the safe and potentially healthier levels of 25(OH)D of <50 or <75 nmol/L.

I think there is a real danger in such linear thinking. Instead of promoting healthy nutrition and physical activity first, and nutritional supplements second, the supplements are considered a primary means to good health. I reject that notion even though these studies get very high profile coverage in the press.

I am glad that a few Moms I talked to on Twitter about this topic calmly suggested that the real solution is to get your children to eat well, drink plenty of milk and play outdoors. At least they are not falling for this propoganda!

Have a good weekend and do let me know what is on your mind.

Photo Source: Wikimedia Commons
©2009 Littlestomaks.com

Greetings! Fall is in the air and I really love this time of the year. There is a cool, crisp freshness in the air, especially in the morning and just before the sunset. We are having a lot of fun with the twins playing outdoors in the yard or going around the block with them on their tricycles. Hopefully you all are having fun too. And yes, the Holidays are not that far off either!

It’s Friday, which means it’s time for another Five for Fridays! Here 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.

Maximize your child’s nutrition at every stage

Registered Dietitian Maryann Jacobsen has written a very nice and comprehensive guide to help you maximize your child’s nutrition at every stage, from birth to school years. What I liked about her post is that she describes very clearly the recommended levels of different nutrients and offers great feeding tips at every age. For preschoolers, it is important to build healthy eating habits early on by striking a balance between their desire for sugary, fatty and high energy snacks and balanced homemade meals. Eating as a family is highly recommended, although it is no easy feat to accomplish!

For school-age children, watch out for deficiencies in vitamin E, D, calcium, magnesium, potassium and fiber. Get them to eat with you as a family and encourage them to eat more fruits and vegetables.

Most of all, don’t give up, keep trying and fight the battle by being a role model.

Too much marketing hype behind probiotics

There is a lot of buzz around probiotics these days! People have been eating yogurt for a long time, but it is only recently that food marketers have realized they can make it sexier by using the immunity claim on the package. This kind of advertising is hard to resist, especially when it comes to products for kids. Even we fell for the DanActive Immunity Probiotic Drink, which claimed to have a new more absorbable yogurt culture but it contained a lot of sugar and it was super expensive. All kinds of claims are being made to pull customers. I was surprised to lean that Dannon recently settled a class-action lawsuit Activia yogurts and DanActive yogurt drinks.

When it comes to probiotics, not every strain of the bacteria is equally effective. Consumers should be informed about the specific probiotic strain in the product and its scientifically proven benefits. The L. Casei Immunitas^TM strain in DanActive drinks has been shown to reduce illness in children attending daycare. But there is very little evidence of general immunity or resistance to disease from these probiotics. In my opinion, these new products are not worth the extra money and you should watch out for added sugar. In the meantime, plain yogurt with home-made fruit puree is a very decent affordable option!

Schools start cooking fresh food for a healthier lunch

Yes there are a lot of regulations for school kitchens, there is little or no equipment and there aren’t any skilled cooks on the staff. Plus it is simply easier to serve straight out of a package after a quick reheat. No wonder over 80% of the school districts in the country cook less than half of their entrees from scratch according to a 2009 survey by the School Nutrition Association. School lunches have neither appealing nor appetizing for kids!

I was happy to read about one middle school in New York which is trying to do things differently to encourage kids to eat better at lunch. Mostly due to the efforts of its principal and the cafeteria manager, a few new ideas are being implemented. A curry chicken recipe is one such idea especially popular among the students. The bread is whole wheat, pasta is whole grain and milk is low fat. There are salad bars and deli bars. More importantly, these leaders believe that “the children need a little flair in the food, it is good for their brains”. Amen to that!

Omega-3 cheese may soon become available

A new study shows the promise of formulating cheese with fish-derived omega-3 without the fishy smell. Scientists have developed a technique to add omega-3 as an emulsion to the cheese to make it stable and mask the fishy smell. It is still at the research stage but I am sure there will soon be a commercial product given the huge consumer interest in omega-3 fatty acids. I think it is a good innovation even though only a small amount of omega-3 can be added to cheese by this technique.

Omega-3 fatty acids are called essential fatty acids because the human body cannot make them. They are good for growing children because they help in visual and brain function development. Diet and supplements are the only source of these nutrients. Cheese is popular among children, therefore omega-3 fortification of cheese makes sense. When it becomes available, watch out for saturated fats and trans fats before tossing it in your shopping cart!

A fun way to learn about nutrition

Cathy of A Life Less Sweet provided a link to Nourish Interactive, a website which is trying to educate parents and kids about nutrition by using online games. It looks very interesting, and best of all, membership is free. Parents and kids can learn together by trying out these games, puzzles and challenges. You will need to create an account for your child to play free. There are many useful interactive tools such as a healthy meal planner which helps you calculate the daily calories for different foods based on your child’s age. I plan to check it out in detail. If you do try it, let me know what you think.

Enjoy your weekend!

Photo source -chefranden on Flickr via everystockphoto
©2009 Littlestomaks.com

We just got back from a week-long visit to the Disney World!

It was a great vacation and we had a lot of fun at the Magic Kingdom, Epcot and our own cabin at the Fort Wilderness Resort.

But it was a nightmare trying to feed our twins during the entire trip. The usual kids menu items like the fried chicken tenders, pizza and hot dogs didn’t go well at all and they only nibbled at the Mac ‘n Cheese and carrots. Surprisingly, they also rejected the milk and took only a few sips each time. The only somewhat healthy option we found was at Epcot’s Le Chefs de France restaurant, which offered grilled flounder and fresh green beans on the menu in addition to the usual chicken tenders and pasta. Sadly however, it didn’t turn out to be a pleasant dining experience for us because by that time the twins were tired and fussy!

We came to the realization that we don’t eat out and we don’t go on vacations often enough to prepare us for proper eating outside of home!

So to all of you more experienced toddler Moms out there, I have a question this week:

How do you manage your child’s nutrition on extended vacations out of home?

Please share your tips in comments below. Leave your twitter ID, blog or Facebook profile  so I can link to you when I compile your tips in a future post.

Thank you!!

©2009 Littlestomaks.com

Hello everyone! Seems like I still can’t let go of summer – this picture was so cute, I had to post it this week to remind us of summer fun on the beach. We did manage to get out a few times to the nearby beach, although my daughter refuses to step on the sand! She finds it too yucky – go figure!! Luckily both of our twins love the pool, so that is where we spent most of our summer this year.

It’s Friday, which means it’s time for another Five for Fridays! Here 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.

Finally some guidance on daily sugar intake for Americans

I almost fell out of my chair when I read that Americans consume a whopping 22 teaspoons of sugar every day. That is about 355 calories, nearly 20% of the 2000 recommended daily caloric intake. I am sure you have noticed that on a typical nutritional facts label, there is no daily percentage for sugar content. This is because a daily limit has not been established, although there is good consensus on limiting the daily intake to less than 25% of total calories. As a result, it is very difficult for consumers to keep track of their daily sugar consumption. A while ago, I wrote about how to take the guesswork out of daily sugar to help set some boundaries and regulate the sugar intake.

Now, for the first time, the American Heart Association has come out with fairly clear guidelines on daily sugar which suggest that most women should limit it to less than 6 teaspoons and most men should limit it to 9 teaspoons. Note that these are still not official USDA recommendations, which I hope will follow soon. I think the breakfast cereal makers will respond first since their products tend to make heart-healthy claims although they contain a lot of sugar per serving. But I hope to see it change other food products as well. It is possible that this will drive the use of zero-calorie sweeteners in food products.

Ideas for packing a healthy lunch your kids will actually eat

My Twitter friend @RelevantMom alerted me to this article by the Associated Press which highlighted a few interesting school lunch box ideas from TV food stars Rachel Ray and Melissa d’Arabian. It is hard to resist the ready-to-go lunchables but they can end up costing a lot without providing good nutrition. Simple ideas like peanut butter, hummus, canned tuna, beans and lentils are good source of protein. You can mix them with breads, pitas and rice to create a quick and easy nutritious item. Add fruits and veggies selected by your child on the last grocery shopping trip to make sure he will actually have an interest in eating them. Get creative on snack ideas and skip the packaged snacks to save money. Their last tip is the best – add a loving note to the lunch box; it costs nothing but it can make your child feel special and loved when out of home in school where they might still not be very comfortable.

Share your tips for the school lunch box this back-to-school season. Here is what @themenumom suggested when I asked this question to my Twitter followers:

What has worked for you so far?

How normal is your eating?

Ever wonder if you practice normal eating? I can see you rolling your eyes and thinking “please, not another diet buzzword to make me feel guilty about my eating behavior”!

I was intrigued by a short note in the Well column of the New York Times by Tara Parker-Pope this week which asked this question. I am sure if you ask different people, they will come up with their own answer, and be quite sure that their eating preferences are perfectly normal. Turns out that the term normal eating was coined by famous dietitian Ellyn Satter. She explained that normal eating is when you “listen” to your body, eat when hungry and stop when full. Sounds simple and common sense. Except that we now seem to listen more to our tongue than to our stomach when it comes to eating. There are some who believe that the food industry has figured out how to rule the tongue by loads of salt, sugar, fat and other taste enhancing chemicals in processed foods. Self-control is lacking, especially when most family meals are consumed in front of the TV. We no longer have a sense of portion control. We try hard when we are motivated to go on a diet, only to give it all up and return to our old ways when things don’t work out the way expect. From this point of view, today’s normal eating is hardly normal the way nature intended it to be. I think it is about time we paid attention to it, especially when it comes to raising healthy children.

Functional food is nothing but dressed up junk food

That seems to be the opinion of many nutrition experts such as New York University’s Marion Nestle as cited by one of my favorite bloggers Dr. Ayala on her recent post “Are functional foods healthy foods?” I liked her article very much because she reminds us that with a little bit of right information, planning and effort you can prepare your own nutritious foods without having to waste money on these so called functional foods. It is easy to slap catchy slogans like low cholesterol, zero trans fats and fortified with brain-boosting omega-3′s without really changing the basic nature of the food inside the box. Sad truth is that such marketing works since such fortified functional foods deliver over $27 billion in sales each growing at up to 20% each year.

I am not personally against all processed foods. To our busy lives, they offer the convenience of immediate consumption although there is a cost to it. I do want to credit the food industry for many innovations that have made the modern life possible. I am not suggesting we turn the clock back by making all of our food from scratch. What I don’t like is that the industry at its heart is no longer concerned about the health of its consumers, rather the profit motive has become the main driver of innovation. Surely there are exceptions, which I hope will become the norm in future.

One Hungry Monkey and a dad committed to raising a healthy eater

I was finally able to finish reading a delightful book by Matthew Amster-Burton called Hungry Monkey! If you did not get a chance yet, check out my review of Hungry Monkey published this week. And let me know what you think.

Enjoy your weekend!

Photo source -sara.atkins on Flickr via everystockphoto
©2009 Littlestomaks.com