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.

Kids love Mac’ n Cheese! Sometimes, so much that they don’t want to eat anything else! This is challenging for toddler parents who try hard to provide a healthy, balanced nutrition. This week, registered dietitian  Lindsey Walder tackles this issue and advises parents to shift their focus from nutrient intake to establishing and maintaining a healthy eating environment.

Question: My child eats only cereal and mac & cheese. How can I improve his nutrition?

Young children commonly go through phases during which a few foods are accepted and everything else refused.  One reason these food jags occur is that young eaters are neophobic—in other words, they fear new foods and tastes.  Interestingly, toddlers’ taste buds become much more perceptive around the time they start walking, making them increasingly selective about what they eat.  Researchers believe that the sudden change around age two from eating a wide variety of foods to eating a limited number actually may have a genetic link that could have served to protect our prehistoric baby ancestors as they first toddled out of the cave.  What exacerbates children’s innate reluctance to try new foods at this age is the pure delight most toddlers take in attempting to, for the first time, exert control over some aspect of their lives.

While having a picky eater is extremely frustrating for parents, the good news is that nutritional deficiencies in the United States are rare.  If your children are growing normally according to your pediatrician, rest assured that they are more than likely adequately well-nourished.  So, take a deep breath and present your child with broccoli for the tenth time.  Even if you are turned away – again – take comfort in knowing that this stage usually only lasts until age four or five.  That said, the malleable years of early childhood are still crucial for establishing good eating habits, and parents should make the most of it.  It’s not as difficult as you may think.

First, to avoid driving yourself crazy worrying if your toddler is getting the right nutrition while also trying to accommodate his seemingly undying yearnings for macaroni and cheese, I recommend shifting your focus from nutrient intake to establishing and maintaining a healthy eating environment.  Doing so will lay the foundation for an appreciation of a wide variety of healthy foods.   In my practice, parents who fret and stress about their child’s eating (or lack thereof) during meal time are the ones who usually face the most resistance from their child.  In addition to not worrying so much, there are five simple things parents can do now to foster good eating habits and encourage venturing beyond mac & cheese.

Expose your toddler repeatedly to new foods

Offering the same new food every day for 5-14 days can be effective.  Including these unfamiliar or previously-rejected items at meal times without forcing your child to eat them helps him to become more comfortable with the food item and may increase his willingness to try it.  Remember, meals should be eaten together as a family (without any short-order cooking), so your child can see you enjoying a wide variety of foods.

Give 2-3 choices of healthy foods

One mother told me she successfully employs this tactic with her four-year old: for snacks, she asks her son if he would like an apple or a banana.  This is a win-win approach to avoid a power-struggle since both parent and child are part of the decision.

Avoid forging a connection between eating and good or bad behavior

Too often we use food to assist with parenting responsibilities—down the road this practice can lead to an unhealthy food relationship.  Consequently, do not bribe your child with food.  Instead of offering food for rewards or comfort, give your child stickers or a hug.  And, try not to put any food or food group on a pedestal; simply teach your child that some foods are healthier than others.

Keep the highly-processed, sodium and sugar-heavy, refined foods like packaged frozen meals, chips, high-fat meats, cookies, cakes, and sugary drinks out of the house

Your three-year old can’t take the car and go pick up a box of sugary cereal at the grocery store.  Take advantage of the fact that you are the food gatekeeper and have control over what foods get offered.  Go ahead–cross the hot dogs off your shopping list!

And finally, stock your kitchen with healthy, delicious foods such as fruits, vegetables, whole grains, nuts, beans, fish, lean protein, and reduced-fat dairy products

Not immediately, but over time, your youngsters will learn to prefer healthy types of foods if that is what they’re accustomed to.

©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.

Growing children need both calcium and iron in their early years. This week, Registered Dietitian Cindy Williams explains why you need to balance milk and meat for your toddler so he doesn’t miss out on these critical minerals.

Question: How much milk and meat should I feed my child?

Answer:

Milk

Milk is an excellent source of calcium. Children need plenty of calcium to build strong bones and teeth. Up until 12 months a baby should not drink cows’ milk because the protein is too large for the baby’s immature digestive system. After 7-8 months babies can have a little cooked cow’s milk as part of a milk pudding or custard. Yogurt and cheese are also fine for this age group – and a great source of calcium. Babies who drink cows’ milk before 12 months are at greater risk of iron deficiency.

Up to the age of two children should have full fat cows’ milk. They need the extra energy from the fat for growth. After the age of two toddlers can drink reduced fat milk so long as they are eating a good variety of food.

Up until the age of five, health authorities recommend children should drink about two cups of milk a day. Some toddlers love milk and would be happy to drink it all the time. Stick to two cups a day otherwise they will fill up on milk and have no room to eat their meat and vegetables. Toddlers who regularly drink more than two cups of milk a day are at greater risk of iron deficiency.

In a day they could have milk on cereal for breakfast, a small glass of milk sometime during the day, a little cheese and perhaps a milk pudding or half a carton of yogurt. The amounts will vary according to the child’s appetite. Remember the parent decides the quality and the child decides quantity.

Meat

Meat, especially beef and lamb, is the best source of iron and zinc for a child. The type of iron found in meat is called heme iron and it is easily absorbed. Children can also get iron from non meat foods such as iron fortified cereal, legumes (split peas, dried beans, lentils) and green leafy vegetables. Only about 5% of this iron is absorbed but having vitamin C with the food will increase absorption. Give your child some vitamin C rich fruit such as orange or kiwifruit with their breakfast cereal and they will absorb about four times more iron from the food.

Research has found that children who eat fruit with their meals are less likely to be iron deficient than those who eat fruit between meals.

Babies are born with enough iron stores to last about six months. Premature babies have lower iron stores because iron is mostly stored in the last three months of pregnancy so it is especially important for these babies to start eating iron rich foods sooner rather than later.

At six or seven months a baby can eat cooked, pureed meat, chicken or fish. It provides essential iron for brain development but at this young age is still a top-up after the usual milk feed. By 7-8 months a baby should be eating two or three small meals a day with 2 tablespoons to 1/2 a cup per meal. Increase the amount gradually before increasing the number of meals. Include some cooked minced meat with mashed vegetables most days.

A one year old needs more iron than his or her dad. It is vitally important that toddlers get enough iron from their food. This is when their brain is developing the most rapidly. If they miss out on iron at this stage their brain will not develop to its full potential – and they can’t make up for it later. The American Academy of Pediatrics recommends two serves of meat (or protein equivalent) a day for children under six years. A serve is 1oz of meat, fish or poultry or 1 egg or 2 tablespoons peanut butter or 4-5 tablespoons legumes. Remember to give your child an orange or piece of fruit with the egg, peanut butter or legumes to increase iron absorption. Give your child a mixture of meat, chicken, fish and vegetarian meals each week. Variety is good for both their health and training their taste-buds to enjoy different flavours.

KEY POINTS

• Don’t drink cows’ milk before 12 months.
• Toddlers should drink no more than 2 cups milk a day.
• Eat fruit with meals rather than between meals.

©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 Emma Stirling offers a few handy tips on how to get enough protein in your child’s diet.

Question: What is the best way to get protein into a diet with a child who’s fussy?

Answer:

Air and water.  Well, so the saying goes that toddlers seem to survive on air and water, as their food intake appears so minimal at times.  But when it comes to optimal growth and development, it’s important to keep an eye on key growth nutrients including the powerhouse protein.  Let’s take a closer look at where you find protein, how much kids’ need and what you can do to help them power up.

What is it?

Protein is made up of chains of smaller components called amino acids, also known as the building blocks of our bodies.  Muscles, skin, hair and blood cells as well as hormones, enzymes and antibodies, are all made up of a combo of amino acids.

There are about 20 different amino acids that, in different combinations, make up the countless millions of proteins available in nature.   And there are two broad classes of amino acids: those that can be made by the human body (non-essential amino acids) and those that can only be supplied by food (essential amino acids).   A protein’s nutritional value is judged by how many of the essential amino acids it provides and in what quantity.

Where do you get it?

Different foods contain different combos and amounts of amino acids as proteins. Generally speaking, animal protein contains all of the essential amino acids.  Plant proteins usually lack at least one amino acid. There are exceptions to this like soy products and the seed of a leafy green called amaranth (consumed in Asia and the Mediterranean).

Nutritious sources of protein include: Meat, poultry and fish, eggs, dairy products, seeds and nuts, beans and lentils, soy products, grains especially wheat and less so rice, barley and corn.

In line with dietary guidelines it’s important to choose lean cuts of meat, trim the fat and go easy on processed meats like sausages and sliced ham as these are also high in saturated fat, sodium and artificial additives.

How much is enough?

Protein needs differ by age, weight, gender and life stage.  The US Recommended Dietary Allowance for children 1-3years is 13g/day of protein. In my country Australia, the NHMRC Recommended Dietary Intakes for 1-3 year olds is 14g/day of protein.  To put this in perspective, two large eggs provide 12.7g of protein or close to a toddlers total daily protein requirements.  So it’s no surprise to hear that nutrition surveys show that protein is not generally an at risk nutrient.  It is also possible for a toddler to consume enough protein for proper growth and development by following a vegan or vegetarian style of eating.  Make sure you speak with your health professional about balancing your child’s diet and seek expert advice from a Registered or Accredited Practising Dietitian.

Top toddler tips to slip in more protein:

Keep it coming – aim to include small serves of protein at each main meal and slip in extras at snack time.  Try:
Breakfast

• Wake up to a poached or hard-boiled egg with wholegrain toast fingers
• Whip up fruit smoothies with reduced fat milk and natural, Greek style yogurt

Snacks

• Spread nut butters on celery sticks for home snacking, away from nut-free zones
• Blend up a quick hummus with canned chickpeas

Lunch

• Make a baked bean toasted sandwich for lunch
• Mix up a tiny tuna mornay with cheese sauce

Dinner

• Toss some small cubes of tofu with bite-sized veggie stir-fry
• Make mini-meat balls for homemade cheeseburgers on round dinner rolls

Chew on this – overtired toddlers can find chewing meat at dinner time challenging, so make sure you use slow cooking methods to tenderize meat or cook with a sauce like a casserole style or mince bolognaise.
Petite is sweet – don’t overwhelm your child with a huge serve of meat.  As a rule of thumb adults should stick to a portion-controlled palm size serve of steak and little kids…well, just a thumb size may do!
Add flavor – experiment with different flavours too. Your three year old may soon learn to love curry, especially if they have been exposed to the cooking aromas as a baby.
Maximize variety – if your toddler wants mince meat all the time, extend their variety by branching out into different recipes….that still look like mince.  Think tacos, spaghetti, meatloaf, shepherd’s pie or your own masterpiece.

As a general guide aim to clock up 3-4 serves of lean red meat per week for valuable iron and zinc and 2-3 serves of fish for brain boosting omega 3 fatty acids.  And remember, research shows us that young children are naturally wary of new foods (known as neophobia) so the key is to try and try and try and try again.  One of the best health head starts you can give your young child is exposure to a huge variety of different nutritious foods and dishes.

Play your protein cards right and before you know it, your toddler that lived on air and water, will become the “I just don’t know where he puts it” ravenous teenager.

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

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

Answer:

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

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

©2009 Littlestomaks.com. All Rights Reserved

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

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Victoria Retelny explains why omega-3 is important for growing children and suggests a few food sources of these essential fatty acids.

Question: Is Omega 3 proven to be helpful for children? Can you recommend a few good sources and brands of Omega 3?

Answer:

Yes, omega-3 fatty acids, particularly docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are found in breast milk, are beneficial for children’s normal growth and development.  For infants, DHA has been found to be vital for visual and brain function and development.  Some research has shown these essential fats to help children with attention deficit & hyperactivity disorder (ADHD). As children grow into adults, there is evidence that omega-3s are a great way to keep the heart healthy, too.

As always, food sources should be the first choice for your child’s diet.  Omega-3 fatty acids come from two sources: plant foods like walnuts, flaxseeds, tofu, soybeans, and canola oil, which contain alpha-linolenic acid (ALA) and fatty fish, which contain both DHA and EPA.  Some of the best fish sources of omega-3s are salmon, albacore tuna, lake trout, mackerel, and herring.  Since some fish can be high in mercury and other contaminants, there are limits to how much children (and adults) should eat.  According to the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency, up to two average fish meals or 12 oz per week – is safe for children.  Since albacore tuna is higher in mercury than chunk light tuna, limit the serving to 6 oz. per week.

The types of fish that children (and adults) should avoid due to high mercury levels:

• Shark
• Swordfish
• King mackerel
• Tilefish (Golden bass)

The Dietary Guidelines for Americans 2005, advise people to check local advisories to learn about the safety of fish caught in nearby local lakes, rivers, and coastal areas. Advisories may recommend that people limit or avoid eating some types of fish caught in certain places. If no advice is available, young children may eat up to 1 meal per week of fish from local waters, but no other fish during that week.

The U.S. dietary supplement market is exploding with omega-3 capsules. Use caution, particularly with young children, when giving supplements – of any type.  Dietary supplements are not regulated by the federal government.  According to the FDA’s Web site, supplements ingredients may be reviewed for safety, but not effectiveness.  The ultimate responsibility for product safety is on the manufacturers and distributors before the supplements reach store shelves. The FDA will step in if products are found to be unsafe or if they contain false or misleading claims.

So what are good sources of omega-3s for children?  The best sources are fish and “designer” foods like omega-3 fortified cereal, yogurt and eggs.  Although, a recent article in Journal of the American Dietetic Association states that there is no specific recommendation for EPA and DHA individually right now, the need to get a balanced diet that includes essential fatty acids like omega-3s is important, particularly for growing children.  As always, consult a physician before giving fish oil capsules to children under 18 years old.

References:
Kris-Etherton P, Hill AM.  n-3 fatty acids: food or supplements?  J Am Diet Assoc (2008):108(7);1125-1130.

US Food and Drug Administration, Dietary Supplements: What You Need to Know.

Omega-3 fatty acids, fish oil, alpha-linolenic.  The National Institutes of Health, Medline Plus.

Dietary Guidelines for Americans. MyPyramid for Preschoolers.

©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.

This post is part of the Attachment Parenting Month 2009 blog carnival, hosted by Attachment Parenting International. Learn more about how you can stay “Attached at the Heart Through the Years” by visiting API Speaks, the blog of Attachment Parenting International.

This also happens to be my 200th post on Littlestomaks. So I am doubly excited!!

I don’t characterize myself as an AP parent, but I do subscribe to their 8 principles of parenting. I read the API Speaks blog regularly. It is fun to read the experiences of Moms so passionate about the principles of attachment parenting. Not usual to find Dads writing or commenting on this blog, so I feel a little strange writing a post for the AP month 2009 blog carnival. Yet, just like my wife, the bond I feel with my twins is incredibly strong and it begins with the heart. Never before in my life, have I felt the kind of emotions I feel when I look into their eyes, enjoy their abundant smiles, feel the frustration of their tantrums. Incredible it may sound – or maybe not – this Dad is attached!

You see, Dad’s are funny creatures. Straddling the wide gulf of expectations of being tough on one side and being gentle and nurturing on the other, they try their best not to let their children and their spouse down. The heart doesn’t show itself too often in their actions, but it does beat the same way as a Mom’s and does melt at the sight of their children.

Anyway, I digress.

The theme of the AP month this year is to celebrate our growth as parents as we face the challenges of transitions in our children’s growth. Talking of transitions – our twins turned 3 this year, so we have gone through a lot in a very short period of time. So, I love this opportunity to share with you our experience and a few lessons we have learned along the way.

My son loves to go around the block with me on his tricycle. It was easy in the beginning – he would stay on the sidewalk and ride along the short circular loop around our house. Over the last few months he has grown more adventurous and curious about every small thing along the way. It is fun to watch him get off his tricycle to carefully examine the line of ants crossing the sidewalk. “Fireants! It will bite me” he shouts, remembering the time when a couple of them climbed through his sandals and bit him on the foot. He loves to climb on top of the cable boxes pretending to be on a train. Another favorite is stopping by the electrical utility boxes and trying hard to take a peek inside to see if the “electric monster” is awake! The warning label on the box shows a big electric arc in the shape of a monster hitting a child and throwing him to the ground. He knows to stay away and not climb on top of this one. “The monster will hit me and make me fall” is what he repeats to himself – not out of fear or panic, but in an attempt to register the dangers of electricity shown on the label. He is equally fascinated by the “shuttles” (airplanes) in the sky and dog poop (yikes!) on the ground! He imagines the monsters inside the wooded areas next to the sidewalk which he calls a jungle, and tries to get closer to the trees inch by inch each day.

Quite clearly, our walks around the block are not linear anymore. They are full of adventure, curiosity and story-telling. They are a stop-and-go most of the time unlike the slow, continuous riding of his early months. Sometimes he barely moves, and sometimes he pedals so fast I have to run along to stay by his side.

Although challenging, these walks have given me a chance to reflect upon a few simple parenting lessons:

Safety first – he loves to push the boundaries each day, but when it comes to safety, there is no compromise. My voice gets sharp and the tone high pitched as I command him to get back on the sidewalk when he tries to get on the road. Sometimes, I have to physically move him back on the sidewalk even if he kicks and screams. Staying calm, firm and decisive is key. Slowly he is learning that watching out for incoming cars is important, and so is getting away from the dogs even though their owners keep them on a leash!

Talk is cheap – which is why we do a lot of it on our walks! We talk constantly – he makes a statement, which I repeat in the same tone; he asks a question, which I answer not necessarily in a logical way; I ask a question which he answers definitely not in a logical way. If I were to record our conversation, it would seem at the edge of reason and bordering nonsense! He is crazy about trains, so everything boils down to engines, freight cars, signals, bridges and railroad crossings. I have been trying to talk him into writing a letter to Santa this year asking for a bag of a hundred train toys!

Be present – is probably the most important lesson. There is nothing between the two of us on these walks. No thoughts of work, meetings, deadlines; no thoughts of hanging out with friends to watch football while enjoying a beer; not even thinking about the topic of the next blog post. I do not carry my Blackberry with me; for an hour or so, there is nothing between the two of us.

Nothing is too small or ordinary – ants, dead bugs, mailboxes, cable boxes, sheriff’s parked car, sprinklers, speed bumps in the road, sound of traffic in the distance, dog poop along the road, planes in the sky and jet-skis parked in an open garage! Everything is extraordinary in my son’s imagination and he pauses for a moment to soak in the experience of everything big or small. All the senses are at their peak; being present in that moment is almost like meditation. I am learning to see the world from a child’s eye where everything is extraordinary!

Leash of love – is what keeps it all together. I know it makes you think of walking a dog, but I like to think of it as flying a kite. The line needs to have the right tension depending on the winds and how high you want it to fly. Too much tension and it will break and fly away; too little and it will sink to the ground. Love lets you get to the right tension in this invisible line. It comes by trial and error, but you will know.

Enjoy the joys of parenthood. Feel free to share your thoughts in your comments below.

©2009 Littlestomaks.com

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Liz Marr offers a few tips for ensuring a complete nutrition of a 4 year old child.

Question: How much fat and protein is my 4 year old supposed to get? If he doesn’t get enough, should he be taking a vitamin?

Answer:

Despite concerns of many parents, it’s natural for preschoolers’ appetites to decline and for them to hyperfocus on specific foods to the exclusion of others (food jags). That’s because their growth rate slows compared to infancy and they are testing their independence through foods. As long as a variety of nutritious foods are presented to children and the child is otherwise healthy, most parents need not worry about whether a child is obtaining too little or too much nutrition. Following MyPyramid will help ensure that children eat appropriate amounts of protein and fat as well as balance intake of other important nutrients. Here is a quick guideline that will help you gauge your 4-year-old’s food intake compared to recommendations:

Another way to evaluate children’s longer-range nutritional status (versus day-to-day eating) is through height and weight measurements and growth charts used by pediatricians. These growth charts are very closely correlated with nutritional status. Therefore, if your child is considered within a normal range for height and weight, particularly as it tracks over time, it’s likely their nutritional intake is not compromised.
As far as vitamin and mineral supplements go, major scientific groups, such as the American Dietetic Association and the American Academy of Pediatrics, indicated that vitamin and mineral supplements are generally unnecessary for healthy children and that it’s better to emphasize healthy eating patterns.

©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 Preethi Rahul explains why it is important to know and track the general growth pattern of your toddler using growth charts.

Question: Why is it important to know the general growth pattern of toddlers?

Answer:

To understand the importance of growth pattern of toddlers it is very important to understand what growth is.

Growth is defined as increase in the size of an organism or part of an organism, usually as a result of an increase in the number of cells. Growth is a physical aspect which can be quantified. A child’s physical growth refers to the increases in height and weight and other body changes that occur as a child matures. Hair grows; teeth come in, come out, and come in again; and eventually puberty hits. It’s all part of the growth process.

How do you judge your child’s growth pattern?
There are various tools that can help parents understand their child’s growth pattern. Two most widely used ones are:

Growth charts
The National Center for Health Statistics has developed growth charts that are used to compare a child’s measurements with those of other children the same age. By plotting a child’s measurements on these charts, doctors are able to compare individual growth patterns with data collected on thousands of children. This helps to determine whether a child’s growth is normal compared with others the same age. The charts are a series of percentile curves that show the distribution of growth measurements of children from across the country.

BMI charts
Designed to measure body mass, BMI charts can help to determine whether a child’s weight is appropriate for their height. To get a quick picture of a child’s weight status, the health care professional enters the height, weight, age, and gender. The resulting number is then compared to other children of the same age to see if the child’s weight falls within the normal boundaries.

Here is a good article which tells you 5 things you need to know about growth charts.

Now why is it important to understand your child’s growth pattern?
Children are constantly growing and changing and periodic assessment of their progress allows any problems to be detected and treated early. Most children are assessed by health care professionals only when they are ill, at which time growth and development is not focus of care.

Growth measurements must be recorded at regular intervals to indicate growth patterns. Height and weight when taken only once do not lend themselves as interpretation of growth status. Children generally maintain their height and weight in the same growth channels during preschool and early childhood years, although these channels are not well established until after 2 years of age. Individual children sometimes grow at faster or slower rates; nonetheless; they should follow along their same growth channel.

Regular monitoring of growth enables trends to be identified early and intervention or education to be initiated so that long-term growth is not compromised. Weight that increases at a rapid rate and crosses growth channels suggests the development of obesity. A child who appears to be overweight may be advised to boost their physical activity a bit since overweight children have a higher risk of becoming overweight adults than their lighter peers. With early intervention, a small problem need not become a lifelong struggle.

Lack of weight gain or loss of weight over a period of months may be a result of under nutrition , an acute illness, an undiagnosed chronic disease, or significant emotional or family problems.So health care professionals and parents can work together to determine the best way to get the child back on track. Vitamin and mineral deficiencies can also be identified and if they are in the initial stages diet alone would be sufficient to bridge the gaps.
Thus as a responsible parent you need to constantly monitor your child’s growth and take necessary action as and when needed!

©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.