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.

Thinking about introducing your little one to fish and other seafood but worried about food allergy? Check out these handy tips from Registered Dietitian Keri Gans!

Question: We want to introduce our 2 year old to fish and other seafood. What should we be worried about? Are there any safe seafood we can try first?

Answer:

The good news is that as of January 2008 the American Academy of Pediatrics declared that there is no convincing evidence that delaying any food beyond 4 to 6 months reduces the risk of developing an allergy to it. So even though fish is one of the top eight allergenic foods, no need to worry, it is definitely time for your 2-year old to start enjoying it.

What is important to remember is that fish and shellfish are an important part of a healthy diet. They contain high quality protein and other essential nutrients that are low in saturated fat. The Omega 3 fatty acids found in fish are considered beneficial for cardiovascular health and preliminary research suggest they can enhance brain development and improve learning, behavior and vision. The American Heart Association currently recommends recommending two servings 2-3 ounces of fish a week for children as an early prevention of cardiovascular disease.

Follow these recommendations for your young child:

1. Do not serve shark, swordfish, king mackerel or tilefish because they contain high levels of mercury.
2. Ok for your child to eat up to 12 ounces a week of a variety of fish and shellfish that are lower in mercury, such as shrimp, canned light tuna, salmon, pollock and catfish.
3. Serve no more than 6 ounces of fresh or canned albacore (white) tuna. They have more mercury than light tuna.
   Make sure your fish is thoroughly cooked to avoid food borne bacteria and viruses.
4. Buy fish from reputable sources.
5. Introduce only one type of fish at a time.

After introducing any new food in your child’s diet wait 3 days until moving on to another food. Watch for signs of a food allergy, swelling of the tongue, lips or face, skin rash, wheezing, abdominal cramping, vomiting or diarrhea. If symptoms appear call your doctor right away.

Also remember that you are a food role model for you child. If they don’t see you eating fish they will not grow up eating fish. There is also no need to try and disguise the fish, by heavily breading and frying it. Serve it to them just as you would yourself, hopefully that is grilled, broiled or baked.  I remember when my niece was around 3 years old….she loved tilapia, but thought she was eating chicken.

Great resources on seafood:
Environmental Protection Agency
Seafood WATCH
Kid Safe Seafood

©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.

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 Rebecca Subbiah offers advice on how to ensure a balanced, nutritious vegetarian diet for your toddler.

Question: My child is on a vegetarian diet. How can I ensure he is getting proper nutrition? Should I give him any supplements?

Answer:

It is very possible for a toddler to follow a vegetarian diet along with the family, as long as it’s well balanced and varied to ensure nutritional adequacy.

Toddlers have unique nutritional needs based on their age and growth, needing between 1000-1400kcal a day, 3 -4 servings of grains, such as a slice of bread, ½ a cup of pasta, half of the servings coming from whole grains. A vegetarian diet should be rich in fruits and vegetables of all the colors of the rainbow in order to get the range of vitamin’s and minerals. Aim for 1-2 cups of vegetables a day and 1-2 cups of fruit per day.

In regard to dairy, aim for 2 cups of milk a day, full fat for the first few years, cheese and yogurt to meet calcium and vitamin D requirements for growing bones. Toddlers between the ages of 2-4 need 500mg of calcium and 400IU of vitamin D. If your child cannot tolerate dairy use calcium fortified cereal and soy products, some orange juice is also fortified with calcium.

A nutrient of concern in a vegetarian diet is iron as the most easily absorbed sources come from meat. Toddlers need 7mg of iron a day, especially after one year as their stores are depleted. Ensure your toddler doesn’t fill up on drinking too much milk and eats well at meal times. Provide iron fortified grains, tofu and beans. With meals serve them along with vitamin C rich foods, such as orange juice, broccoli, strawberries and tomatoes as vitamin C aids iron absorption.

It is also important to eat good sources of protein such as lentils, beans and pulses. Offer your toddler 3-4 servings of protein a day with a serving being ¼ cup of cooked dry beans, or one egg. Look up recipes from around the globe for inspiration particularly in countries that are predominantly vegetarian such as India. You will find a wealth of recipe ideas with dals using lentils, dishes like pongal that combine rice and lentils and many dishes for beans and wonderful ways to cook vegetables.

In Middle Eastern cuisine you will find hummus and falafel. Of course stir-fries are wonderful with vegetables and egg for protein, also vegetable fried rice. Pasta dishes also lend well to vegetarian options and pasta comes in such fun shapes and colors that kids adore.

Here is a simple vegetarian recipe you can try:

Savoury Pongal

Ingredients:

• Mong dal 1/3 cup
• Rice 1 cup
• Cumin
• Pepper
• Cut ginger
• Coriander leaves
• Curry leaves

Method:
1. lightly roast the mong dal
2. add rice and dal to pressure cooker with 4 cups of water and let the whistle go 2 times
3. then simmer for 5 minutes
4. heat oil or ghee and add spices, curry leaves and salt then add to the pongal
This is a easy and tasty traditional South Indian dish actually eaten on Pongal Harvest Festival in January. It is great eaten with spinach dal.

References:

1. Nutrition guide for toddlers on Kids Health
2. Infant and toddler nutrition on MedlinePlus

©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.

8 toddler servings, 4 adult servings

Ingredients

1. 1 cup red lentil
2. 2 medium sized potatoes cut in small cubes
3. 4 – 5 baby carrots, grated
4. 1 small onion, cut into small pieces
5. 1 teaspoon butter (optional)
6. 1 teaspoon flour
7. A pinch of turmeric (optional)
8. 6 cups warm water

Method

Wash lentil with cold water in a 1 quart saucepan. Pour off the wash water. Add about 4 cups of warm water to the washed lentil. Add grated carrots and potatoes. Make sure there is enough water in the pot to cover the lentil and the vegetables. Cover and cook on very low heat for about 30 – 45 minutes, stirring occasionally. Do not increase the heat otherwise it will boil over and spill off the pot. Keep adding warm water as needed. Once cooked, the potatoes will soften and the lentil will turn yellow. Add more water to desired consistency. Add flour, butter, turmeric and mix gently. When fully cooked, add the mix to a food processor and blend at medium speed. Serve with a piece of bread. Make sure it is not too hot for your toddler.

Sometimes, we also add chopped cilantro right after blending and let it simmer for a little while.  It adds a nice smell and flavor to the soup.

About Lentils

Source: Wikipedia Commons

Lentils are a very good source of protein (about 26%); therefore they are a very important part of a vegetarian diet. They come in a lot of different colors such as red, yellow, green, brown and black. They are also very rich in fiber, minerals, iron, folate and vitamin B1. We like the red lentils because they are easiest to cook. You can also make a lentil curry and serve it with Basmati rice.  There are many recipes on the web; I found one here that looks quite good. Also, there are a few interesting variations on GreenLiteBites, a site you can find on my Links page.

Imagine driving through a busy intersection that has no traffic lights. Instead there are boards showing the driving rules in large print that you must read and quickly understand so you can pass through safely. And to make things worse, every intersection has different rules even though the boards look pretty much the same from a distance. It would be a disaster!

I think this is exactly the case with food labels. They all look the same but they pack a lot of information that you are supposed to digest (pun intended!) so you can make a healthy choice. And remember, all the bad stuff is usually hidden in the fine print on the label! Let us say your grocery cart on your weekly shopping trip has about 50 different items. Even if you spend just 1 minute trying to figure out the food label, it would take you almost an hour just to read and understand the information. Add to that all the walking through the aisles you need to do to get everything on your list, and you can be sure to spend your entire Saturday afternoon in the store. And if you have a screaming toddler trying to jump out of the cart, then simply forget it! You will likely look for the same items and brands every week without even looking at the label.

Traffic lights work because they are simple and easy to understand. The red-yellow-green lights have become a part of our nature. This leads to automatic action, which by habit and practice, is the correct action (in most cases, unless you are drunk!). So why not use the same idea and make the decision-making simple when it comes to food shopping?

I was really excited to learn that this is exactly what many supermarkets in the UK have started doing for their store brands. The standard nutrition label has not gone away, rather there is a simple color chart on the front panel of the package showing in red-amber-green, the levels of fat, saturated fat, salt and total sugars. We know that if we want to eat a healthy diet, one of the key things we should be doing is trying to cut down on fat (especially saturated fat), salt and added sugars. The message from the traffic light label is simple and clear – choose foods that show more “greens” than “reds” if you are trying to decide between two similar products.

One of the early adopters of the traffic light labeling system recommended by UK’s Food Standards Agency (similar to our FDA) was the Sainsbury supermarket chain, which now has nearly 5000 of its own branded food products showing this front-of-pack multiple traffic light (MTL) nutritional labeling. Even better, they have now developed a new ‘Just for Kids’ multiple traffic light labelingspecifically for the nutritional requirements of children.  This is based on Guideline Daily Amounts (GDA) for 4-6 year olds. Not surprisingly, the consumer response has been overwhelmingly positive. In a recent survey, 92% of the customers found the MTL labeling easy to understand and 54% felt that MTL labeling, rather than the corresponding GDA approach, gave the“best at-a-glance indication of the healthiness of the food”. In another survey, they found that out of those aware of the MTL labeling, 57% said the symbol has helped them eat more healthy, with 17% saying it helped them eat ‘a lot more’ healthy. Clearly, the system works for most consumers.

Not everyone is equally excited of course. I was browsing through the comments on a blog post by Andrew Wadge of the FSA on this topic. Some find it too simplistic and arbitrary. Others see it as a tool to pressure the food industry to adopt a new labeling requirement. One particularly interesting criticism was that the color coding system does not work for color blind people!

Surely, this cannot be a substitute for the detailed nutrition information label. In addition to avoiding the bad stuff, we need to also look for the good stuff like proteins, vitamins and minerals. Still, I think that such a system, if adopted by the food companies here at home, could make life easier for us busy people. What do you think?

Here are a few links if you want to learn more:

1. A detailed overview on Netmums.com
2. An article on food labels from FSA
3. Sainsbury’s traffic light labeling system
4. Traffic light label adopters in UK