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

photo credit: Lintilla

There is so much news about vitamin D deficiency these days that you have probably already considered taking a daily supplement to boost your vitamin D reserves. But did you know that taking a supplement is no guarantee that there will actually be an increase in your blood levels of vitamin D?

I was surprised to hear this from a friend over dinner this past weekend. He happens to be a physician, so the conversation was particularly worthy of attention. He shared that even after one year of taking a daily supplement, the 25-hydroxy-vitamin D level in his blood did not change. Even though this is the experience of only one individual, and may not apply to others, it is noteworthy.

Vitamin and mineral supplements are sold with a detailed list of each vitamin and mineral and their amounts on the package. The ingredient list shows the sources of these vitamins and minerals. But there is no information on how much will actually be absorbed in the body.

This is clearly quite disturbing. When the FDA approves a drug, they want to see all the data that proves its safety and effectiveness. Vitamins are not regulated, which means that they are not subject to this level of scrutiny.

What is your experience? If you are taking a supplement, or giving one to your child, have you considered this issue?

©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.

Calcium is very important for growing children as it helps them build and maintain healthy bones.  This week, Registered Dietitian Karen Kafer talks about calcium requirements for children and different sources of calcium.

Karen Kafer, RD B.S. Oklahoma State University VP Health Partnerships at National Dairy Council Past experience: VP, Communications for Kellogg Company Website: The Dairy Report Contact via email – karen.kafer@rosedmi.com

Question: There are several calcium choices I could provide for my child—which one(s) should I choose?

Answer:

Since children are often picky about what they eat, parents are challenged to find foods kids like that also provide the nutrients they need.  The Food and Nutrition Board of the National Academy of Sciences recommends children consume adequate calcium in their diets.  This means:

• 500 mg of calcium a day for kids who are 1 to 3 years old;
• 800 mg of calcium a day for kids who are 4 to 8 years old; and
• 1,300 mg of calcium a day for kids who are 9 to 18 years old 2 .

To reach these recommended calcium levels, there are several options parents can provide for their children.  Calcium can be found in dairy foods such as milk, cheese and yogurt, vegetables like broccoli, kale and spinach, as well as salmon, red beans and fortified juices and cereals.  However, different calcium sources provide various levels of calcium and also vary in how easily they are absorbed in the body.

To compare, a one cup serving of milk or yogurt or 1.5 ounces of natural cheddar cheese contains about 300 mg of calcium on average.  However, to obtain the same amount of calcium in one cup of milk, a child would have to eat 10 cups of raw spinach, nearly 4 ¾ cups of canned red kidney beans or 4 ¾ cups of cooked broccoli.  As for foods fortified with calcium, they vary in both their calcium content and quality, so be sure to read food labels to determine how much calcium these products contain.  Check the ingredient section of the food label to determine the type of calcium (such as calcium carbonate, calcium citrate, calcium malate, etc.) used during fortification.

Another option for children is calcium supplements or supplements containing calcium; however, it’s recommended that parents always consult a pediatrician before giving children supplements of any kind.  According to the National Institute of Health, “the two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. Both the carbonate and citrate forms are similarly well absorbed, but individuals with reduced levels of stomach acid can absorb calcium citrate more easily. Calcium citrate malate is a well-absorbed form of calcium found in some fortified juices. The body absorbs calcium carbonate most efficiently when the supplement is consumed with food, whereas the body can absorb calcium citrate equally effectively when the supplement is taken with or without food.”  Unless a child has a dairy allergy and must avoid dairy, it’s important to remember foods naturally containing calcium, such as milk and milk products, rather than supplements, are the preferred source of calcium for both you and your child.

Vitamin D helps promote the absorption of calcium and enhances bone mineralization.  In fact, a glass of milk fortified with vitamin D provides about 25 percent of the Daily Value for vitamin D, and aids in this calcium absorption and bone mineralization enhancement.  Milk is one of the few dietary sources of this important nutrient so it’s important for children to have their recommended amount of low-fat and fat-free milk and milk products every day.

Resources:

Milk’s unique nutrient package from National Dairy Council

Calcium content of select foods – USDA national nutrient database for standard reference

©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.

If you have a child with food allergies, naturally you worry if he is getting proper nutrition from his somewhat restricted diet. Perhaps you have considered giving a multivitamin but found yourself worrying about safety of those vitamins. This week, Registered Dietitian Brooke Schantz offers a few tips on what to look for when selecting a multivitamin for your child with food allergies.

Question: What kind of multivitamins are safe for my child with food allergies? What should I be concerned about?

Answer:

First, let me review the difference between a food allergy and food intolerance.  A food intolerance is an abnormal physiological response to food. Symptoms can affect the skin, respiratory tract, gastrointestinal tract (GIT) either individually or in combination. Some examples of symptoms of a food intolerance are gas, bloating, diarrhea, etc.  It can be difficult to determine the food that causes an intolerance because if the immune system is involved, the response takes place slowly. A food allergy is an immunological hypersensitivity which occurs most commonly in response to food proteins that are mistaken as harmful and therefore a defense system is created to fight them off. These allergic reactions have an acute onset (from seconds to one hour) and may include:  soft tissue, severe swelling of the tongue, hives, itching, nausea, vomiting, diarrhea, stomach cramps, nasal congestion, wheezing, shortness of breath, or anaphylactic shock.

Children with various food allergies would not be allergic to vitamins or minerals in supplements themselves; but rather to a possible ingredient used in the making of the multivitamins.  The Food Allergen Labeling Consumer Protection Act (FALCPA) was passed by the Food and Drug Administration (FDA) in 2006 to require manufacturers to identify the use of the top eight allergens.  These allergens are eggs, dairy, soy, tree nuts, peanuts, fish, shellfish, and wheat.  Unfortunately, vitamins fall under the category of “dietary supplements” which are not included in this law.  A dietary supplement is defined as products taken by mouth that contain a “dietary ingredient” intended to supplement the diet.  This is important to note, because vitamins are not meant to be a substitution for a healthy diet or justify consuming a poor diet.

The FDA does not approve dietary supplements prior to being put on the market.  Therefore, if your child is allergic to a specific allergen it is important to familiarize yourself with all the derivative names for that allergen.  For example, if your child has a milk allergy, you would also want to look for words on the ingredient label that include but are not limited to: calcium caseinate, casein, caseinate, rennet, curds, hydrolyzed casein, hydrolyzed milk protein, lactalbumin, lactalbumin phosphate, lactate, lactose, lactoferrin, and lactoglobulin.

What you can do:

1. Check the ingredients label for the specific food allergen and its derivative names.  Some vitamin labels even include information on common allergens, even though the manufacturers are not required to list this information. Below is an example children’s vitamin ingredients list.
   Ingredients: Sucrose, Sodium Ascorbate, Stearic Acid, Maltodextrin, invert sugar, Vitamin E Acetate, Corn Starch, Gelatin, Niacinamide, Magnesium Sterate, Natural Flavors, Yellow #6, Riboflavon, Thiamine, Folic Acid, Vitamin D3, Vitamin B12
   Contains: Soy
2. Look for the USP seal.  The U.S, Pharmacopocia (USP) is a non-profit organization that has established standards of quality for prescritpion and nonprescription drugs.  Using vitamins and other supplements with the USP seal indicates some quality of control.  Vitamins that have the USP seal can be found here.
3. Follow the dosage directions correctly!  Your child doesn’t need more than the recommended daily dose.  Some parents believe that if their child has eaten really poorly for one day giving an extra vitamin is better and this is not the case.   An overdose of certain vitamins could be dangerous and also lead to the preventing other vitamins from being properly absorbed.
4. Discuss the use of all supplements with your doctor and registered dietitian.

©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.

photo credit: sly06

A recent article in the Pediatricss journal reported data on serum levels of 25-hydroxyvitamin D, the active form of vitamin D in blood and asked this question Do Children Need More vitamin D? There is a lot of buzz in the media these days about deficiency of vitamin D, especially in kids. Beyond the screaming headlines and soundbites, it is important to look at the data an scientific way before jumping to conclusions.

In this article,  I will first provide a brief background on vitamin D and explain why it is a concern these days especially for growing children. Second, I will describe the design of the Pediatric study and methods used to analyze data. Finally, I will summarize the results to support some of the key conclusions of this study.

Let me first say that there is no consensus on the threshold level of vitamin D in blood below which a child is considered deficient. Still, the authors concluded that millions of US children aged 1-11 years may have sub-optimal levels of vitamin D, especially non-Hispanic Black and Hispanic children. However, more research is needed before a decision can be made about recommending vitamin D supplementation in children.

Vitamin D – the sunshine vitamin!

Vitamin D is produced when our skin is exposed to the UV-B rays from the sun. That is why, sometimes it is also called the sunshine vitamin. It is also available from a few limited food sources such as milk, fortified orange juice and cereals, and fish such as salmon, mackerel, cod and herring. Vitamin D supplements are also available from both synthetic and natural sources. Deficiency of vitamin D is known to cause rickets, a condition which involves bone loss and deformation. Because vitamin D is also a prohormone, meaning it is involved in proper functioning of other hormones, recent research is linking vitamin D deficiency with many other diseases like diabetes, heart disease and even cancer.

Why the concern then? Well, the problem is that many parts of the world do not get enough sunlight through the year. When we do manage to get some sun, we have a tendency to overuse sunscreen because of the risk of skin cancer. Don’t stop doing that, but be aware that sunscreen blocks the UVB rays responsible for vitamin D production. As for nutrition, we know that children are picky eaters. They hardly eat fish or drink enough milk. Junk food has little vitamin D. Because of these reasons, there is a concern that kids are not getting enough vitamin D.

The Pediatrics study analyzed 2001-2006 NHANES data for kids 1-11 years old

Because of the concern over vitamin D, the Pediatrics article is very timely. Researchers from Harvard, Mass General Hospital and University of Colorado analyzed the NHANES data from 2001 – 2006, which is collected every 2 years by the National Center for Health Statistics. The NHANES uses a 4-stage sampling strategy to represent households across the country. It tends to oversample low income groups, blacks and Mexican Americans. However, statistical methods including appropriate weights are available to extrapolate the results to a nationally representative population.

In this study, the researchers obtained serum levels of 25-hydroxy-vitamin D – the “active” form of vitamin D present in the blood. They also had household interview data about the demographic, socio-economic status and vitamin use. Sample size for kids 6-11 years old from 2001-2006 was 3421 for household interview data and 2759 for serum 25(OH)D data. Sample size for kids 1-5 years old from 2003 – 2006 was 2677 for household interview data and 1799 for serum 25(OH)D data.

Serum levels were categorized as <25, <50 and <75 nmol/L. Although, there is no consensus on what constitutes as the level of deficiency in children, the Institute of Medicine has set it at less than 27.5 nmol/L while the Canadian Pediatric Society has set it at less than 25 nmol/L. Recently, a level of less than 50 nmol/L has been found to be linked to some level of bone demineralization.  In adults, recent studies demonstrated that healthy levels of serum 25(OH)D may be as high as 75 nmol/L or even higher. That is why, the researchers decided to look at prevalence data for the nationally representative population of 1-11 years old children at these 3 different levels.

Average blood levels do not show deficiency, but experts believe most kids have lower than desired level of vitamin D

The mean serum level for children 1-11 was 68 nmol/L. Children aged 6-11 had a slightly lower mean level at 66 compared to those aged 1-5 at 70 nmol/L.

When taken as a whole, following prevalence levels were found:
< 25 = 1%, < 50 = 18% and < 75 = 69%

In terms of actual population numbers, this translates to 320,000 children below less than 25, 6.3 million less than 50 and 24 million less than 75. If the “average” values of the serum level gave you a sense of comfort, simply look at these prevalence numbers. Amazing!

If you consider the level of 75 nmol/L or higher as optimal, like most experts, the prevalence of serum levels below 75 was higher for non-Hispanic blacks at 92% and Hispanic at 80% compared to non-Hispanic white children at 59%. In terms of numbers, 2 out of every 3 children in the US are below this level, and nearly all of the non-Hispanic black and Hispanic children are below this threshold. If the threshold is changed to <50, then over half of non-Hispanic black children 6-11 years old fall in this category.

The current daily recommended intake from the Academy of Pediatrics is 400 IU/day. Experts believe that this is insufficient to raise the serum levels to >50 or >75 and that vitamin D supplementation may be needed in at-risk populations.

More vitamin D is good for children, but do not jump to supplements right away!

Coming back to the original question “do children need more vitamin D”, the short answer is YES. It may be tempting to simply get on a daily supplement. But I think we should try to first make small changes in our lifestyle and eating patterns. Nature did not intend us to be deficient in vitamin D, even though she gave us all a different skin color. The fact that we see low numbers in our population is a result of our lifestyle and poor diet. Get active, get outdoors – even 10-15 minutes of sun exposure on your arms and legs without sunscreen is enough. Of course, you should worry about skin cancer and use sunscreen before it is too late. Get your kids to eat healthy including a diet rich in dairy and fish unless there is an allergy problem. There are many natural ways to ensure your child gets enough vitamin D before deciding to take a supplement.

Parents – are you concerned that your child may have a vitamin D deficiency? What steps are you planning to take? Share in your comments below.

©2010 Littlestomaks.com

FDA has issued a warning to parents about the risk of vitamin D overdose when using a liquid vitamin D supplement. It turns out that some products come with droppers that may allow an accidental overdose to infants. According to the FDA update:

…excessive amounts of vitamin D can cause nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion, and fatigue, as well as more serious consequences like kidney damage.

I think this is very a very confusing update! First of all, why does FDA allow such products with risky droppers in the marketplace? Secondly, what is excessive? Is there any standardization in dropper markings for infant vitamin D products? How can a parent tell if the dropper shipped inside the product packaging is the right dropper? What does the product labeling say about the safety and accuracy of the dropper?

So many questions are left unanswered in this update that I am surprised it was approved for publication!

Vitamin D is very important, especially for growing infants and children because it affects calcium absorption and bone growth. Now that there is so much news of vitamin D deficiency in infants and toddlers, parents are becoming ultra sensitive about it. When a warning like this comes from the FDA, it only adds to the anxiety. The FDA update does offer some recommendations, but I do not believe they offer enough guidance on safety or the level of risk.

The FDA supports the American Academy of Pediatrics recommendation of 400 IU of daily vitamin D supplementation for breastfed infants. It recommends parents to ensure that their infant does not receive more than 400 IU a day. The tolerable upper limit intake of vitamin D for infants birth through 12 months listed by the Office of Dietary Supplements of the NIH  is 1000 IU per day. That is 2.5 times more than what FDA is warning parents about. Further, adverse health effects are seen only after long term intakes above the tolerable upper limit.

What kind of a dropper is allowed to be packed inside a product which can dispense 2.5 times the recommended dose of any medication? I think that the FDA should also talk about what measures they are taking to ensure that unsafe droppers are not included in any product; not just infant vitamin D supplements. If the concern is so high, why not make sure that the maximum amount that can be dispensed from these droppers does not exceed 400 IU? Also, a list of potentially unsafe products should be made available to the public.

Parents – what do you think? If you are giving a vitamin D supplement to your infant or toddler, are you worried about this warning? What do you think the FDA should do?

Photo source: FDA’s warning update
©2010 Littlestomaks.com

There is a lot of buzz about vitamin D deficiency these days. According to some reports, 40% of US infants and toddlers are not getting enough vitamin D which increases their risk of a variety of health conditions. No doubt, vitamin D is very important for health,  especially for growing children. That is why it is good to pay attention to your child’s needs but there is no need to panic. In the past, I have written several articles on vitamin D including 5 ways to tell if your child may have a vitamin D problem. Here, a few quick facts about this important vitamin:

1. Vitamin D actually is a prohormone; which means that it is converted into a hormone inside the body. In this way, it is different from all other vitamins.
2. Vitamin D is produced when our skin is exposed to UVB rays from the sun.
3. There isn’t enough UV energy above 42 degree north latitude (a line between northern California and Boston) during November to February to produce any vitamin D in the skin. In places farther north, this can last nearly 6 months during the year.
4. Vitamin D from food or supplements comes in 2 forms – vitamin D2 or vitamin D3.
5. Vitamin D3 is 3 times more effective than vitamin D2 in maintaining blood levels of the active form of vitamin D.
6. Vitamin D is fat soluble and any excess from sun exposure or diet is stored in fat cells available for release when blood levels fall low especially during winter months. This does not, however, happen very easily in overweight or obese individuals.
7. American Academy of Pediatrics recommends a daily value of 400 IU for young children. You can get this amount from 4 glasses of milk or vitamin D fortified orange juice, 1.5 oz of cooked salmon, or about a third table spoon of cod liver oil.
8. Vitamin D deficiency causes rickets in children. Recent research indicates a link between vitamin D deficiency and diabetes, heart disease and certain types of cancers.
9. Blood levels of less than 20 ng/ml are considered to indicate vitamin D deficiency.
10. Mushrooms when exposed to UV light during production are rich in vitamin D2.

Source: Vitamin D Dietary Supplement Facts Sheet from NIH

Just like thiamin and riboflavin, which I wrote about recently, niacin is another B vitamin commonly found in fortified foods such as cereals, breads from enriched flour, pasta, sauces, baby foods, energy drinks. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Niacin?

Niacin is also known as vitamin B3, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Sometimes, the word niacin is also used for nicotinic acid and nicotinamide or niacinamide. It can get very confusing, especially because most fortified foods contain nicotinamide as a nutritional supplement and the ingredient list may not explicitly show niacin. Although they are chemically different, the thing to remember is that they all do pretty much the same thing inside the body.

Niacin, like the other B vitamins, is soluble in water. Just like riboflavin, niacin is also involved in production of energy at the cellular level. It is also responsible for synthesis of fatty acids, cholesterol and steroids. Even more importantly, it is involved in gene expression, that is production of proteins when genes become active. When taken as a medical treatment, niacin lowers bad cholesterol (LDL) and increases good cholesterol (HDL) and reverses the clogging of arteries. Of course, you should not rely on supplements to achieve this effect if you have a cholesterol problem; you need to see a doctor!

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, niacin is involved in the conversion of carbohydrates, fat and protein into energy required for cell functions. It plays an important role in regulating your child’s metabolism and growth.

There is some recent research which shows a preventive effect of nicotinamide for type I diabetes. The data is far from conclusive, so you should talk to your doctor if you suspect your child might have a risk of type I diabetes because of family history or another medical condition.

How much niacin should my child be getting?
What are good sources of niacin?

For infants, the FDA has recommended a daily amount of 8 mg. And for toddlers less than 4 years old, the recommendation is 9 mg. Pregnant and nursing women are recommended to take about 20 mg per day. Healthy adults are also advised to take about 20 mg per day.

Niacin is usually present in meat, poultry, yeast, fish (salmon, tuna), whole grains, fortified cereals, breads made from enriched flour. Leafy green vegetables and milk also provide some niacin.  Here are a few examples of different food sources and amount of niacin per serving (source: wikipedia and Linus Pauling Institute):

1. Chicken, 3 oz (deck of cards), cooked = 7.3 mg
2. Turkey, 3 oz = 5.8 mg
3. Salmon, 3 oz = 8.5 mg
4. Fortified breakfast cereal, 1 cup = 5 mg
5. Portabella mushrooms, 3.5 oz = 3.6 mg
6. Lentils, 1 cup = 2.1 mg
7. Hazelnut, 100 g = 1.5 mg
8. Peanuts, 1 oz = 3.8 mg
9. Broccoli, sweet potatoes, carrots = 0.6 – 1.2 mg
10. Avocado, 100 g = 1.7 mg

It is not common  to get excessive amounts of niacin from food sources.

What happens if my child does not get enough niacin?

According to the PDR for Nutritional Supplements, niacin deficiency causes pellagra, which these days is very rare in the developed countries. In the old times, pellagra was a condition that resulted in dermatitis, dementia and diarrhea and even death.

Should I be concerned about niacin deficiency?

The short answer is no. There is a risk with corn rich diets unless the corn is processed in a certain way to release the niacin from its bound form. Too many refined carbohydrates, unless enriched with niacin – which they commonly are – can also present a risk. If you have known problems with digestion and absorption of food,  your doctor can advise a proper treatment including supplements.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough niacin?

©2010 Littlestomaks.com

Just like thiamin, which I wrote about recently, riboflavin is another B vitamin commonly found in fortified foods such as cereals, enriched flour, pasta, sauces, baby foods, energy drinks.  In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. I am following up on my article on vitamin A from a few weeks ago. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Riboflavin?

Riboflavin is also known as vitamin B2, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Riboflavin, like the other B vitamins, is soluble in water. Cells in our body need energy produced by special biochemical reactions. Certain types of enzymes help these reactions happen, but they too need help from coenzymes produced by riboflavin. Obviously, this is very complex chemistry, but the point is that riboflavin is an important player in the chemical reactions that produce energy at the cellular level. Recently, high doses of riboflavin have been found effective in preventing migraine headaches. Seek medical advice before using riboflavin for migraines.

It is also used as a food coloring because of its yellow or yellow-orange color. The more soluble riboflavin 5′-phosphate is called the E101 food color.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, riboflavin is involved in the conversion of carbohydrates, fat and protein into energy required for cell functions. Riboflavin also has antioxidant activity which protects your body from reactive oxygen radicals. Just like the other B vitamins, riboflavin plays an important role in your child’s metabolism.

How much Riboflavin should my child be getting?
What are good sources of Riboflavin?

For infants, the FDA has recommended a daily amount of 0.6 mg. And for toddlers less than 4 years old, the recommendation is 0.8 mg. Pregnant and nursing women are recommended to take about 2  mg per day. Healthy adults are advised to take about 1.7 mg per day.

Riboflavin is usually present in most plant and animal food sources although in small amounts. Yeast extract is exceptionally rich in riboflavin, and organ meats like liver and kidney are also good sources. Here are a few examples of different food sources and amount of riboflavin per serving (source: wikipedia and Linus Pauling Institute):

1. Cooked spinach, half cup = 0.2 mg
2. Asparagus, about 6 spears = 0.14 mg
3. Almonds, cooked, 1 cup = 0.8 mg
4. Fortified breakfast cereals, 1 cup = 0.5 – 2.0 mg
5. Milk, 1 cup = 0.34 mg
6. Egg, cooked, 1 large = 0.27 mg
7. Cheddar cheese, 1oz = 0.11 mg
8. Fish, salmon or halibut, 3 oz (deck of cards) = 0.1 mg
9. Chicken/beef, cooked, 3 oz = 0.16 mg
10. Bread, whole grain or enriched flour, 1 slice = 0.08 mg

Riboflavin is destroyed by ultraviolet light. As you can see, riboflavin is naturally available in many common food sources. There is really no need to look for a nutritional supplement for riboflvain although you will find many multivitamin products on the market. Check out my review of some of the popular kids brands of multivitamins.

Riboflavin is well tolerated without any adverse effects. There is no reason, however, to take a high dose of riboflvain supplement.

What happens if my child does not get enough riboflavin?

According to the PDR for Nutritional Supplements, riboflavin deficiency (also known as ariboflavinosis) can cause any of the following conditions:

1. Cracked or sore lips, especially on the outer corners
2. Sore throat, redness or swelling of the lining of the mouth
3. Magenta tongue
4. Skin lesions, dermatitis
5. Poor iron metabolism and absorption, lower hemoglobin levels
6. Vascularization of the cornea

These symptoms are medical conditions and should be interpreted by a doctor. It is not common for riboflavin deficiency to occur in isolation. Usually it happens when a lot of other vitamins are also absent because of poor nutrition, digestive disorders or other medical conditions.

Should I be concerned about riboflavin deficiency?

Since riboflvain is commonly available in many foods and cereals, it should not be a big concern. However, if your child’s diet is mainly junk food and not enough whole grains, nuts, fruits and vegetables, you may want to pay attention to his overall vitamin B needs.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough riboflvain? Do you have recipes that use food sources rich in riboflavin? I would love to hear from you!

©2010 Littlestomaks.com

If you read nutrition facts labels, especially on breakfast cereals, you may have noticed thiamin in the long list of vitamins and minerals. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. I am following up on my article on vitamin A from a couple of weeks ago. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Thiamin?

Thiamin is also known as vitamin B1, one of the 8 B vitamins needed for many important cell functions inside our body. In short, they are needed for healthy functioning and growth of child’s body. Together they are also known as vitamin B complex especially in nutritional supplements.

Thiamin, like the other B vitamins, is soluble in water. It was one of the first chemicals to be considered a vitamin early in the 1930′s when researchers discovered that thiamin deficiency caused beriberi (also known as extreme weakness). People with beriberi have difficulty standing, walking and controlling their muscles.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, Thiamin is involved in the conversion of carbohydrates into energy required for cell functions. It also helps convert some of the amino acids into proteins.

How much Thiamin should my child be getting?
What are good sources of Thiamin?

For infants, the FDA has recommended a daily amount of 0.3 – 0.5 mg. And for toddlers less than 4 years old, the recommendation is 0.7 mg. Pregnant and nursing women are recommended to take about 1.7 mg per day. Healthy adults are advised to take about 1.5 mg per day.

The best sources of Thiamin are whole grain foods and fortified cereals. Most cereals are fortified thiamin hydrochloride and thiamin mononitrate (check the label). Here are a few examples of different food sources and amount of thiamin per serving:

1. Whole wheat bread, one slice = 0.1 mg
2. Brown rice, cooked, 1 cup = 0.19 mg
3. Enriched white rice, cooked, 1 cup = 0.26 mg
4. Fortified breakfast cereals, 1 cup = 0.5 – 2.0 mg
5. Lentils, cooked, 1 cup = 0.17 mg
6. Pork chopped, cooked, 3 oz = 0.8 mg
7. Orange juice, 1 cup = 0.1 mg
8. Sunflower seeds, 1/4 cup = 0.8 mg
9. Spinach, cooked, 1/2 cup = 0.09 mg
10. Wheat germ cereal, 1 cup = 4.47 mg

As you can see, thiamin is naturally available in many common food sources. There is really no need to look for a nutritional supplement for thiamin although you will find many multivitamin products on the market. Check out my review of some of the popular kids brands of multivitamins.

Research has not shown any harmful effects of overdose of thiamin from foods or supplements. Oral thiamin is well tolerated upto 200 mg daily or higher (it is over a 100 times more than the recommended value). There is no reason, however, to take a high dose of thiamin supplement.

What happens if my child does not get enough thiamin?

According to the PDR for Nutritional Supplements, thiamin deficiency can cause any of the following conditions:

1. Cognitive and emotional changes – in short, it may affect memory and mood.
2. Although anemia (decrease in number of red cells) is not a direct result of thiamin deficiency, certain kinds of anemia respond well to thiamin treatment. It is understood this could be due to reduced absorption of thiamin or problems in conversion of thiamin inside cells.
3. Extreme deficiency of thiamin causes beriberi. Dry beriberi affects the muscles in the lower legs and feet. Wet beriberi involves the heart and blood circulation. The most extreme form of wet beriberi is called Shoshin beriberi, which can result in death if not promptly treated. Another form of beriberi is cerberal beriberi (Wernicke-Korsakoff) which affects the nervous system and causes problems with eye movement and even mental health.
4. Although not well-researched, some people think that thiamin deficiency may be involved in ADHD.

Thiamin deficiency is generally a problem with severe sustained malnutrition and alcohol abuse. Most healthy kids and adults with normal eating habits and lifestyle should not have to worry about it.

Should I be concerned about thiamin deficiency?

Since thiamin is so commonly available in many foods and cereals, it should not be a big concern. However, we live in the world of fast food which is usually made from refined carbohydrates. Refined carbohydrates, unless enriched, do not contain enough thiamin. In fact, the reason why they found out about beriberi was because it was first seen in people of Asia who mainly ate polished rice. If your child’s diet is mainly junk food and not enough whole grains, nuts, fruits and vegetables, you may want to pay attention to his vitamin B needs.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough thiamin? Do you have recipes that use food sources rich in thiamin? I would love to hear from you!

©2010 Littlestomaks.com

Greetings! Here are 5 nutrition related articles that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

Vitamin D is big business these days

According to the Nutrition Business Journal quoted in a recent New York Times article, consumers gobbled up $235 million worth of vitamin D supplements in 2008 compared to a mere $41 million in 2001! Also, more physicians are ordering vitamin D tests for their patients and prescribing supplements to correct for low vitamin D levels.

This is incredible! Clearly, there is a buzz about vitamin D these days. Screaming headlines about low levels in children and adults followed by all kinds of studies claiming a “role” of vitamin D in diabetes, heart disease and cancer are creating a mass hysteria. The message is – pay attention to your vitamin D level and start loading up on it just in case because otherwise you will have a high risk of getting these terrible diseases. This is quite misleading in my opinion.

I am not against taking a vitamin D supplement. But there are  few things you should consider before you take that step.

There is a reason why the current recommendation of 400 IU per day of vitamin D has not been revised. A lot of people believe that this amount is too low. Still, there are no clinical studies which show a prevention or treatment effect of vitamin D for these diseases. Taking high doses of vitamin D (like 1000 or 2000 IU per day) is no guarantee of good health and prevention of diseases if the overall nutrition and lifestyle is poor. Supplements are not a drug folks, even though some people may try to sell them to you like that.

Bottom line – rely on food sources for your vitamin needs first, not on supplements. And if you do have a medical condition, talk to your doctor and ask for a pharmaceutical grade vitamin supplement. Here are 5 ways to tell if our child may have a vitamin D problem.

Tax soda like cigarettes – here we go again

The state of New York is on a mission to tackle the problem of obesity. While it is a worthwhile goal, which will surely have a positive impact on long term public health and healthcare costs, their approach to solving this problem is not smart at all. In fact, I think it is driven purely by politics and motivated by their deficit problem.

Tax sugar sweetened beverages (SSB) including soda they say, because that will cause people to drink less of it, which means they will not become overweight or obese since SSB’s are known to cause obesity. They have released a sugar sweetened beverage tax toolkit to provide a rationale for this tax, which in my opinion is a lot of mumbo-jumbo and twisted logic. Still, it makes an interesting read and gives you an insight into the limited range of creativity among public health officials and regulators.

I no fan of soda. But I am totally against another tax in the name of trying to improve public health when the real motivation is to fix the deficit problem. I continue to believe that soda tax will do nothing to reduce its consumption, at least not in any significant way. There are many other ways to discourage soda makers to produce healthier products or encourage the public to limit their soda consumption. But then they are not as easy as slapping another tax!

Manage salt for better health

Salt is something we can’t live without. It is also something we consume too much of and – if we continue this way – there is little doubt that most of us will not live long enough to enjoy it for long. Dr Ayala has a nice article this week on her blog about how too much of (cheap) processed food in our diets is causing us to consume way too much than just a pinch of salt we need for good health. It is a great reminder because this week is world salt awareness week.

The food industry is taking notice. Many companies are quietly working on reducing the sodium content of their products while preserving taste and texture. New salt reduction technologies are being developed and deployed in these products. Some may still have an issue with it; but I have a more pragmatic approach. There is a reason why processed food sells – it offers convenience at a reasonable price. There is no reason to completely eliminate it, just balance it with more cooking at home, read the nutrition facts labels and select the right products. Try to limit daily sodium to less than 2300 mg (1 tsp of salt) and avoid products where a single serving has any more than 15 – 20% of this daily value. Another thing you can do is to reduce the portion size of these foods both at home and in restaurants.

5 out-of-the box ideas for helping your kids eat well

Jenna of KidAppeal has a great blog post this week with a few out-of-the box ideas for you if you need help getting your kids to eat well (who doesn’t!). I really liked her idea of “making food relevant” and “having fun”, because you do need to be able to engage them at the table. We have recently discovered that story telling works with our twins in capturing their attention long enough for them to try the food at the table. Talking about diesel food for a diesel engine does not make sense to an adult, but it captures my son’s attention! You can also play a game, read from their favorite book, solve a puzzle or simply have a conversation about what they did at school or daycare. It will help if the TV is off so they can focus on you and the food.

By the way, Jenna has a weekly feature Big Words Little Foodies every Tuesday where she invites parents to share funny things their kids say about food. Check it out and share your funny stories!

Food rules from Michael Pollan

“Eat food. Not too much. Mostly plants”. This is the essence of Mr. Pollan’s message in his new book Food Rules – An Eater’s Manual which gets a nice review in this week’s New York Times. I think this is sound advice, one that was commonly practiced as late as just a few generations ago prior to the modern day (processed) food revolution. But it also requires not only a change in your mindset about food but also a change in lifestyle. Giving up the western diet (meat, refined sugars, fat and salt via processed food) may sound simple in a book, but difficult to accomplish and sustain unless you make significant changes in your lifestyle.

What food rules do you live by these days? What changes, if any, do you plan on making in the near future?

Enjoy and let me know what is on your mind.

Photo Source: adactio on Flickr via everystockphoto
©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 Liz Marr explains why you need to exercise caution when considering a multivitamin for your child.

Question: How important is taking daily multivitamins and when should kids start?

Answer:

While parents may worry that their toddlers are not taking in adequate nutrients, normal, healthy children, even picky eaters, typically don’t need multivitamin supplements. According to the American Dietetic Association, the best strategy for meeting nutritional needs, for children and adults alike, is eating a wide selection of nutritious foods. Studies suggest that positive health outcomes are related more to overall dietary patterns rather than intakes of individual nutrients. Foods contain an array of health-promoting substances beyond vitamins and minerals, for example flavonoids.

Parents believe supplements provide children nutrients that may be lacking in their diets, according to research. However, by introducing supplements at an early age, parents may be unwittingly sending the message to children that supplements are a substitute for healthful eating patterns.

No solid evidence exists that children’s health is improved by multivitamin supplements. Nonetheless, about one third of children in the United States take multivitamin supplements. However, that figure is down from the 1970s. Compared to infants and adolescents, children ages 4-6 are most likely to take supplements. Interestingly, national surveys suggest that supplements may be taken by those who have healthful diets and lifestyles more often than those at a greater risk for vitamin and mineral inadequacies.

Because many foods that are consumed by children are already fortified with various vitamins and minerals, children are probably consuming more nutrients than parents might think. For example, many foods common in children’s diets are typically fortified, including breakfast cereals, breads, dairy products and juices.

One nutrient for which some infants and children may require supplementation is vitamin D. Because of the role of vitamin D in healthy bone formation, the American Academy of Pediatrics recommends 400 IU of supplemental vitamin D for the following:

• Breastfed infants
• Non-breastfed infants consuming less than one quart of vitamin D-fortified formula
• Children consuming less than one quart of vitamin D-fortified milk
• Adolescents with intakes less than 400 IU per day.

So, if parents choose to give children multivitamins, they should make sure the supplement contains vitamin D.

A particular caution with keeping multivitamins (children’s or adult’s) in the house with young kids, is risk of overdoses. Of particular concern with multivitamins is iron, an overdose of which can be fatal. Many children’s vitamins are designed for kid appeal, available in a variety of colors, flavors and branded characters. And children may view them as candy. If parents choose to keep multivitamins in the house, the supplements should well out of reach of young children.

©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.

There is a reason why you might remember grandma’s eat your carrots advice! Vitamin A is really a very important vitamin for both you and your child. There is more to vitamin A than carrots though! That is why I thought of researching this topic  from a variety of sources and writing about it in a simple Q&A format. Let me know how you like it! Feel free to share your ideas, opinions and unique insight on this subject.

What is vitamin A?

Vitamin A is a general name for a class of nutrients which are important for our health, particularly eye health. Chemically, they are related to a substance called retinol. Most vitamin A supplements are formulated to have a certain form of retinol, for example retinyl palmitate or retinyl acetate. These compounds are soluble in fat. They are stored in the liver when taken from diet or supplements.

You might have heard that carrots are a good source of vitamin A. Well, that is only partly true. Carrots in fact contain a compound called beta-carotene, which is what gives the orange color. Beta-carotene is not vitamin A, but a provitamin A; that is, it is converted to vitamin A when it is absorbed in our intestines.

Why does my child need it?

Vitamin A is very important for a growing child. According to the 2nd edition of the PDR for Nutritional Supplements, vitamin A is critical for healthy vision and its deficiency is known to cause night blindness. It is also important for healthy skin, bone development, brain development and development of blood cells. It also supports proper functioning of our immune system.

How much vitamin A should my child be getting?
What are good sources of vitamin A?

In general, the daily recommended amount of vitamin A is 5000 IU (IU means International Units). For infants, however, the FDA has recommended a daily amount of 1500 IU. And for toddlers less than 4 years old, the recommendation is 2500 IU.

Since breastmilk is one of the best sources of vitamin A, the FDA recommends a daily amount of 8000 IU for pregnant and nursing women.

Now, if you are using a supplement, it is easy to keep track of the IU’s. But what if you are relying on fruits, veggies and other dietary sources of vitamin A? Here are a few guidelines for you (ref: Wikipedia.org):

1. One serving of milk (1 cup) typically has 10% of the recommended daily amount (RDA)
2. 1 hard-boiled egg (yolk) has about 10% of the RDA
3. 100 g of raw carrots will provide close to 100% of the RDA
4. 100 g of sweet potato will deliver about 80% of the RDA
5. 100 g of spinach has about 50%, collard greens about 40%, kale about 80%, pumpkin about 40% of the RDA
6. Cantaloupe, apricot, papaya, mango etc have lower amounts, but they are a good, diverse source of vitamins and minerals
7. Liver (beef, pork, turkey, chicken, fish) is a very rich source of vitamin A; 100 g provides over 700% of the RDA!

If you are using a supplement, be careful not to exceed the recommended dose and frequency. Also, select a brand known for using high purity ingredients. Check out my review of some of the popular kids brands of multivitamins.

What happens if my child does not get enough vitamin A?

When vitamin A rich foods are missing from your child’s diet over a long period of time, and you are not using any supplements, there is a possibility that your child may develop vitamin A deficiency. In case of certain medical conditions such as cystic fibrosis, Whipple’s disease, Crohn’s disease, ulcerative colitis, pancreatic disease and liver disease, there may be a problem with absorption of not only vitamin A from food but also other essential nutrients. Chances are, you are already consulting with a doctor if you are in this situation. If not, you should talk to your doctor about it as soon as possible.

In the rare case (at least in the developed countries), if your child does not get enough vitamin A and develops a deficiency, it can lead to dry eye and vision problems including night blindness. The range of vision problems associated with vitamin A deficiency is called xerophthalmia (xeros means dryness, ophthalmia means of the eye). It can make your child more prone to infections and compromise his immune system. Under extreme conditions, it can also slow down the child’s growth.

Should I be concerned about vitamin A deficiency?
Since vitamin A is stored in the liver, you do not need to worry about it on a day-to-day basis as long as your child is getting a balanced diet on average which includes a nice blend of fruits, veggies, dairy and meat products. In most of the developed countries, vitamin A deficiency is not a problem.

Having said that, clinical vitamin A deficiency (VAD) is a big problem in poor countries of Africa and Asia according to this World Health Organization (WHO) report. Unicef’s childinfo.org has a nice summary of the global vitamin A deficiency problem, especially among children, which indicates that over 5 million children of pre-school age could have clinical VAD. And as many as 190 million pre-school age children and 19 million pregnant or nursing women do not have enough vitamin A in their daily diet, which puts them at a very high risk of VAD. This should be troubling to us even though it may not affect us directly in the developed world.

What do you think? What changes, if any, would you consider making to your child’s diet so she gets enough vitamin A? Do you have recipes that use vitamin A rich ingredients? I would love to hear from you!

©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.

Plenty of news about deficiency of vitamin D in children these days and plenty of advice on how to get it from foods like fish and milk or supplements. But did you know that UV light zapped mushrooms are full of vitamin D? UV light from the sun is what makes vitamin D in our own skin. This is a great way to enhance the vitamin D content of mushrooms without any additives. Mushrooms are also a good source of vitamin B, iron, protein and fiber.

This is good news for those who may be allergic to fish or dairy, or simply want to look for more options before getting on the vitamin D supplements bandwagon. The US Department of Agriculture has been actively developing a method to treat common mushrooms (white, portobello etc.) with help from Monterey Mushrooms, a large national-level producers of fresh mushrooms. Although, we have not stumbled upon it in our local store, they now have the  Sun Bella brand UV-treated mushrooms available in major supermarkets nationwide.

There is another competing method of treating mushrooms using high energy flashes of UV light. This patent-pending method has been developed by the Xenon Corporation and used by Dole in treating their portobello mushrooms. I am sure they will soon hit the store shelves all over if not already there.

The reason it works is that mushrooms contain a sterol (a class of chemical compounds, for example cholesterol) called ergosterol, which is converted to vitamin D2 (also known as ergocalciferol) when it is exposed to UV light. It appears that a strong focused exposure to UV light is needed for conversion because it does not happen on its own when mushrooms are cultivated.

The other form of  vitamin D available from food, especially animal sources, is vitamin D3 (also known as cholecalciferol). Vitamin D3 is more effective than vitamin D2 in raising the blood levels measured in a typical test.

I think this is great news, although I am sure these companies will charge a premium for the vitamin D “enhanced” mushrooms. Look for them in your supermarkets and let me know if you come across any other brands.

Photo source: Wikimedia
©2009 Littlestomaks.com