Happy New Year! Hope you all had a wonderful time with your loved ones over the Holidays.

I took a little break from blogging but now it feels great to be back! I am looking forward to continuing our journey in child nutrition in 2011, but first I would like to invite you to check out these top 10 posts of 2010 in terms of page views and comments. Some of them were written in 2009 and made the list then, but continued to attract interest in 2010. Science driven, yet practical, nutrition knowledge indeed can be timeless in some ways! Thank you for interest and support over these years.

Whether you are a brand new visitor – or a regular reader of this blog – I hope you will find them interesting and useful as you try to manage your growing child’s nutrition needs. Share your own experience, offer advice, or simply ask a question in your comments below. I would love to hear from you!

	Simple Recipes – Chicken with Quinoa   This is a very easy recipe to make! Quinoa, in my opinion, is the unrecognized superfood because it is a good source of protein and low glycemic index carbs. It also provides a good mix of vitamins and minerals.
	Milk Allergy and Ear Infections   Dairy allergy can be one of the underlying causes of recurring ear infections. This article by Jasmine Jafferali, MPH, explores this issue in a simple, yet practical, Q&A format.
	Ask the Expert – Sushi and Toddlers  If you are a sushi lover and you are thinking about introducing your toddler to sushi, you have got to read this informative piece from registered dietitian Janet Helm. She writes a great blog at Nutrition Unplugged with tons of excellent information about nutrition and food trends.
	All Natural Toddler Multivitamin   My review of Floradix Kinder Love Children’s Multivitamin Liquid Extract Formula attracted a lot of attention because it is based on herbal extracts and fruit juices. It claims to be easy on the child’s digestive system while providing vitamins A, B, C, D and E. It is not a good source of minerals.
	Looking for a Multivitamin Supplement?  This is a “mini” guide to toddler vitamin supplements on the market. If you are considering a supplement for your child, you can use a simple comparison chart in this post. Centrum Kids and Flintstones Complete offer a good balance of complete vitamins and minerals. But the most important advice is to rely on a balanced diet with plenty of fruits and vegetables.
	Product Reviews – Buddy Fruits  This is a simple fruit puree and makes a healthy snack when you are on the go. When we found it in our local supermarket early last year, it wasn’t as commonly available as it is now. Can be a little messy for small children, but overall not a bad choice for a quick snack.
	Basmati Rice: It is Very Easy to Cook and You Will Love It’s Flavor and Fragrance  We love basmati rice! It is an excellent source of low glycemic index carbohydrates. Try my simple recipe to cook it as a separate side dish. You can also try some of the links in this post for other great recipes.
	Simple Recipes – Pasta with Spinach and Mushrooms  This is a simple variation of our recipe Chicken with Pasta and Vegetables. It hardly takes any time to prepare and we save it for those hectic days when we have to quickly put something together for dinner.
	Traffic Light and Food Labeling  Clearly, consumers want simple and easy to understand front of the box food labels. FDA is worried about accuracy and manipulation by the food industry. A traffic light based food labeling system is gaining popularity in UK and Australia. It is not perfect, but clearly a step in the right direction.
	Milk Choices for Toddlers   Registered dietitian Jill Castle offers an overview of several different milk choices for toddlers in case cow’s milk is a concern. Jill blogs about child nutrition at Just the Right Byte.

Web statistics are surely important, but here are a few of my personal favorites. I hope you will check them out and leave me a comment with your opinion!

1. Surprising easy solution for preventing childhood obesity
2. How worried should you be about your underweight child?
3. Do children need more vitamin D?
4. Nutrition trivia – 10 facts to know about protein
5. Resting metabolic rate and weight management

©2011 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.

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: treehouse1977

The summer is almost over and it is back to school time. Hopefully you got a chance to soak up the sun and enjoy some time off with your family. Chances are you were liberal with the sunscreen whenever you went out in the sun. That is definitely the conventional wisdom and there is nothing wrong with it. But did you know that getting some sun without the sunscreen is the best way of building up your child’s vitamin D reserves? Now I am sure you are worried about the damaging effect of too much sun on your child’s tender skin. But it does not take much to get a healthy dose of vitamin D.

I shook my head in disbelief when I read that even in sunny Florida, sub-optimal levels of vitamin D, and even deficiency of vitamin D, are quite common. On a recent discussion about vitamin D on LinkedIn, Diane Batshaw Eisman, MD FAAP wrote:

I am amazed that I find very low levels of Vit D here in Florida. I think we listen to the dermatologists and the natives avoid too much sun and then slather on the sunscreen.

There is some truth to the notion of slathering on the sunscreen because of the strong health advisory and heavy advertising by the makers of sunscreen. There is very little voice to the notion of getting your vitamin D from the sun. After all, who would want to risk advising people to stay out in the sun without sunscreen just to get vitamin D but end up getting melanomas?

Getting vitamin D from the sun appears to be a well kept secret! Experts have even developed a mathematical relationship between the amount of sun exposure and vitamin D. Holick’s rule is well known in the academic circles:

Sun exposure of 1/4 of a minimum erythemal dose (MED) over 1/4 of a body is equivalent to 1000 IU of oral vitamin D3

Minimum erythemal dose is the amount of energy required to produce the first visible sign of redness with clearly defined borders on your skin. In short, this is when you are about to get a burning sensation. The value of MED depends on the skin type – low for very fair skin and high for very dark skin. There are 6 different skin types defined based on the amount of pigment (fair vs. dark) and how easily it burns under the sun. The more popular UV Index is designed based on MED – for example, a type II skin will receive 1 MED within 20 minutes at a UV index of 10. To get a 1/4 of the MED, they would need to be in the sun for only 5 minutes, which means they can get 1000 IU of vitamin D3 in just 5 minutes with their arms and legs exposed without sunscreen! Consider this when the current recommended amount for toddlers is only 400 IU per day.

These calculations are not exact and actual exposure numbers may be different. The point is that it does not take much to get your daily quota of vitamin D3 from the sun. Of course, it is important to use good judgment and common sense not to overexpose the unprotected skin.

We live in a world where the solution to all our problems comes in a pill! For centuries, we have survived by getting this essential nutrient from the sun and diet – in fact, our skin color evolved in response to the amount of available sunlight. In the 21^st century, they now want you to believe that sunlight is too dangerous and that you should solve your vitamin D problem by popping a pill each day.

What do you think? Should the public health message about sun and sunscreen change?

©2010 Littlestomaks.com

Wall Street Journal reported last week that sales of children’s supplements in 2008 were around $1.1 billion and growing at 4-6% each year. This is the first time data is available for kids supplements, although there is little doubt that multivitamins and mineral supplements are a big business. Just look at the amount of space they occupy on the shelf at a typical supermarket!

I am sure the question has come to your mind – should you give your child a supplement?

The position of the American Dietetic Association, which I agree with completely, is that food should be the primary source of vitamins and minerals your child needs. In general, it is very unlikely that your child has a strong need for additional supplementation even if he is a picky eater or does not seem to eat enough fruits and veggies! The Wall Street Journal article cites a study of 1847 pre-schoolers in Belgium which suggested that both supplement users and those who did not take them were often meeting their nutritional needs through food alone with the exception of vitamin D.

Having said that, there are situations where you do want to discuss the subject of supplements with your pediatrician. In 5 Reasons To Consider A Multivitamin Supplement, I wrote about a few of these situations:

1. If you are exclusively breastfeeding (0-24 months)
2. If your child’s diet is primarily vegetarian (2-5  years)
3. If your child does not eat enough fruits and veggies (2-5 years)
4. If you have a picky eater (2-5 years)
5. If your child’s growth profile is slower than normal (2-5 years)

The keyword here is consider - which means you should research this option and bring it up for discussion with your pediatrician or dietitian. Some experts believe that a majority of children today need some kind of supplementation, most frequently vitamin D, probiotics and omega-3, to fully optimize their nutrient intake. That may or may not apply to your child. It is very important to look at your child’s health history and growth profile over a long period of time. Just because he has become a picky eater over the last few weeks and does not eat any fruits and veggies is not enough of a reason to jump on the supplements bandwagon!

There is another aspect to supplement use. I wrote about another study of over 10,000 children 2-17 years old which concluded that kids who really need vitamins don’t get them. The point was that children from affluent households with a fairly good health profile were the biggest consumers of supplements.

In other words, parents are giving supplements to their children just in case and that they do not think there is any risk. Clearly, supplement makers focus on this behavior with their marketing and product mix. The problem is that there can be a downside if you are not careful. Here are a few possibilities -

1. Risk of overdose, particularly vitamin A which can cause liver problems and lower bone density
2. Overdose of iron can be fatal
3. Zinc overdose causes copper deficiency which can cause anemia (low red blood cells)
4. Poorly balanced formulation with respect to your child’s needs
5. One product containing high amount of selenium caused vomiting and diarrhea
6. Unknown impurities, sugar, artificial colors

The fact remains that unlike pharmaceuticals, nutritional supplements are not rigorously regulated by the FDA. Some rules do exist and the FDA has the power to force product recalls, but it is only when there is a reported problem. As a result, a few bad products actually manage to slip through the cracks.

Bottom line: Treat vitamins and other supplements like drugs and use them only after consulting with your doctor. Choose a quality product with high purity ingredients (look for the USP seal).

Are you using a supplement with your child? Share your reasons and the type of supplement in comments below.

©2010 Littlestomaks.com

Greetings! It is Friday again, which means it is time for our weekly Five for Fridays where I usually highlight interesting food and nutrition articles of the week. But this week I want to highlight 5 interesting comments from readers of this blog which they wrote last year on different articles. Your comments inspire me and add so much value to my articles that it would be a shame to keep them buried in the archives! Plus, this is a good way to recognize those who take the time to leave a thoughtful comment. Many of them have blogs of their own, which I highly recommend you to visit via the links in each of the titles below.

I will be highlighting more comments in future posts; for now, enjoy these 5 insightful comments. If I did not pick your comment, just hang in there and look out for another post in future. And of course, feel free to share your opinions in a comment!

In response to my review of popular toddler multivitamins,  Tommy’s Mommy recommended paying attention to the recommended dosage

What a good guide to vitamins! My 11-yr-old has been taking Centrum Kids for years because he is my picky eater. I just tried it with my toddler because he has had a bad cold and hasn’t been eating like his normal self the last few days. A couple of observations…

I think you’ve addressed this, but parents need to make sure they check the dosage of vitamins. I cut one Centrum in half for my toddler as per instructions. Secondly, he loved the sweet, tasty vitamin so much he cried when I didn’t give him another. I don’t think I’ll give him any more when he’s eating well again.

Jenna of KidAppeal shared her enthusiasm for leeks and offered these interesting tips when she read my recipe for leeks with olive oil

I love leeks! thx for sharing this recipe. i tell the boys they are “ginormous” onions. eating super huge food is fun for kids. if your recipe doesn’t use all all your leeks, wash them, slice them and put in a zip lock back and store in freezer. take out a handful when you need them to saute and flavor sauces, soups, etc.

members of the onion family are also anti-bacterial by making the body inhospitable to bad bacteria that causes illness. eat onions/leeks to stay free from illness.

TTD-you could make a larger recipe and freeze half for a quick supper that only requires re-heating the next week!

When a reader asked about healthy superfoods for a 12 month old, registered dietitian Milton Stokes offered these additional details to his expert article about retooling your toddler’s diet effortlessly

Nothing beats breastfeeding. So good for you and your baby! Weaning may take place during the 6 – 12 month range.

For the one-year mark, it’s time for solids. At this point your child should eat during normal meal times and eat with the family where the family eats. Texture should be soft, chopped and/or easily gummed depending upon dentition. Avoid making separate, special meals just for your child. Some variation of the family’s meal is preferred. In other words, don’t create a routine of being a short-order cook.

An introduction of up to 20 times may seem excessive, but it’s not. As I said before, what a parent eats–how she models food consumption–is far superior to anything else. I discourage emphasizing certain foods as “good” or “bad,” or using food for any purpose other than nourishment. (For example, refrain from rewarding with food.)

Now, to actually answer your question: nothing is more “super” than fruits and veggies and whole grains. You may need to present them differently and call them different names. Instead of apples, call them “apple smiles” or “smiley fruit.” Or you could cook the apple in the microwave and fill the center with oats, a little brown sugar, and a sprinkle of cinnamon. Call it the “apple cave.” Additionally, you can slice bananas and call them “wheels” or “flying saucers.” Another common one is “trees” for broccoli. (Cook and/or chop tough foods to prevent choking.)

Do you have a garden. Let your daughter help you. “Help” may mean play in the dirt, but at least it’s some exposure. Little by little her diet will change/improve. Just note: her stomach only holds a tiny bit of food compared to an adult’s, so you don’t have to worry if she only eats a couple cooked carrot sticks.

Kayris offered this simple recipe for a greek-style salad with quinoa when she read my review article quinoa – the unrecognized superfood

We love quinoa, and it IS so eay to prepare.

My favorite way to make it is in this Greek-style salad:
One cup quinoa, cooked as directed (or you can sub any other grain, I have made this with bulgur and also with couscous)
1 cucumber, chopped (peel it if you like)
1 large tomato, chopped
1 can chickpeas, rinsed and drained
Italian or Greek salad dressing until saturated (I usually use homemade Italian dressing)

Alina shared her success with herb tea instead of sugary drinks in response to shaking off a sweet addiction

I introduced herbal teas to my daughter who is now 16 months old. I wanted to offer her something different than just water and milk. And I didn’t want to go with juice which is so sweet, even when diluted. So I have offered her some basic, caffeine-free herbal teas such as chamomile. You can add ice as a refreshing cool drink or serve warm or at room temperature.

Like any new foods, I had to offer it to her many many times before she actually drank it. I think that’s where some parents go wrong with juice — it’s sweet so the child will drink it right away. But I have found my toddlers will eat non-sweet foods (or drinks), it just may take longer for them to like the taste. Also it really helps when they can see you drinking the same thing. And with tea, there is the fun part of preparing the tea…. adding the tea bag, waiting for it to steep, adding some ice, etc!

To any parents who would like to try offering tea in a sippy cup, make sure to read the label carefully because some herbal teas do contain caffeine or other “odd” ingredients.

Enjoy and let me know what is on your mind.

Photo Source: Just chaos on Flickr via everystockphoto

©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

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.

Getting enough vitamin A through diet (preferably) or supplements (carefully) is very important for growing children. In response to a reader comment to last week’s post 5 Things to Know About Vitamin A, I decided to write a follow up post on risks of vitamin A overdose and what you can do to protect yourself or your child.

Risks of vitamin A overdose

According to the 2nd edition of the PDR for Nutritional Supplements, overdose of vitamin A can be very serious in infants or children, and even adults:

• A single dose of 25000 IU per kilogram of body weight causes acute toxicity – vomiting, high pressure in the brain and death may occur (recommended daily dose for children less than 4 years old is 2500 IU)
• High amounts of vitamin A causes chronic toxicity – early signs are dry rough skin, cracked lips, sparse coarse hair and hair loss of the eyebrows. Late signs are irritability, headache, high level of liver enzyme in blood and liver disease.
• Supplemental daily doses of 10,000 IU or more taken by pregnant women have been reported to increase the risk of birth defects.
• Too much vitamin A can increase the risk of osteoporosis.

Clearly, you have to be careful not to exceed the recommended dosage and frequency if you are using a vitamin A supplement.

This is another reason why you should mainly rely on getting this nutrient from dietary sources such as carrots, sweet potato, cantaloupe, dairy products, eggs, green vegetables (spinach, collard greens), cod liver oil etc. Except cod liver oil, where it may be possible to get a lot of vitamin A at one time, all of these sources contain moderate amounts of provitamin A. There is no way you can get an overdose by consuming these sources.

Factors affecting vitamin A levels in the body

The amount of  vitamin A finally delivered into your body from provitamin A depends on the type of provitamin A (beta carotene, alpha carotene or beta-cryptoxanthin). Carrots, sweet potato, spinach and collard greens are good sources of beta-carotene, which is the more effective form of provitamin A. For example, 1 IU is equal to 0.6 micrograms of beta-carotene and 1.2 micrograms of other mixed provitamin A. Here is a nice table showing amount per serving of vitamin A from different foods. 5 servings of a variety of fruits and vegetables will provide about 3 – 6 mg of beta-carotene a day, enough for maintaining healthy levels of vitamin A in the long run.

Another factor affecting the vitamin A level is the amount absorbed in the small intestine after eating these foods. Efficiency of absorption can range from 9 – 22%. That is, out of the 3-6 mg daily beta-carotene, only about a tenth or a fifth will be absorbed. You can improve it by cooking the food and adding a little fat to the recipe. Absorption can be severely affected by certain medical conditions such as cystic fibrosis (pancreas), Whipple’s disease (small intestine), Crohn’s disease (intestines), ulcerative colitis (large intestine) and chronic liver disease.

Many processed  foods are fortified with vitamin A, that is they contain added vitamin A mostly in the form of retinyl palmitate and retinyl acetate. The efficiency of their absorption is much higher, typically around 60-90%.

A third factor that affects the amount of vitamin A levels is the amount stored in the body in the first place. Vitamin A is fat soluble and your body typically stores excess vitamin A in the liver. The half life of vitamin A is about six months, which means that it takes about 6 months for its level to fall down to half of the original levels. That is why it takes a long time of poor nutrition for vitamin A deficiency to show up.

5 actions you can take to be safe

Bottom line: vitamin A is vital for your child’s growth, but there are serious risks of accidental overdose or sustained high levels of vitamin A supplementation. Here are a few things you can do to be safe:

1. Rely on fruits, vegetables and dairy products to meet your growing child’s vitamin A needs. Check out these simple vitamin A rich recipes.
2. Reduce or limit processed foods, they are artificially fortified with vitamins (including vitamin A). While one serving of a particular food item may not have a lot of vitamin A, when you add all the processed food together, you can end up consuming a lot of them.
3. Check the nutrition facts label on your child’s multivitamin if you are using one. Vitamin gummy bears are very popular!
4. Talk to you doctor about a suitable vitamin A supplement if your child has a medical condition. Do not make this decision yourself and do not pick up any random over the counter supplement yourself.
5. Get an annual eye exam for both you and your child to catch early eye health problems

Are you using a vitamin supplement for your child? Have you checked the label? Share your thoughts and concerns in a comment below.

©2010 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

There is something ironic about freezing cold weather in Florida! I know, I should not be complaining because rest of the country seems to be under a really bitter cold, but I can’t help myself. It is not supposed to be that cold here. I would not mind it so much if it got cold enough to get some snow and everything shut down for a day or so. That way, we could go out and play in the snow with kids. That would be fun, but this bitter cold with the sun shining on us at the same time is simply miserable!

Anyway, enough of complaining about the cold. I hope you all had a wonderful Holiday season. I am just now getting in the groove with blogging again in the new year after a short break. Therefore, for this week’s 5 for Fridays, I am going to pick my personal favorite nutrition stories of 2009 I wrote about in this weekly column. So, here they are; let me know what you think about them.

Even Top Chefs Have Picky Kids (published Feb 20, 2009)

I have not seen the otherwise popular show “Top Chef”, but I really liked this interview with Chef Tom Colicchio in the New York Times. Despite his celebrity status, he appears to be quite modest and down-to-earth. Like most parents, he too struggles with his teenage son’s eating habits. I liked his ideas about wholesome food made from fresh ingredients and setting an example by eating healthy food at home. According to him, the choice of food is not between unhealthy and healthy, it is between good and bad! Although he acknowledges that people are busy, it is not really that hard and time consuming to make a healthy recipe (if you know what you are doing of course!). He proves that by giving an example of a 20-minute pasta dish with a yummy clams sauce.

Which vitamin is better – tablet or liquid? (published Mar 27, 2009)

There is an interesting debate going on in one of the LinkedIn groups on Nutrition. Does a tablet form of vitamin work better inside the body or the liquid form? Absorption of vitamins and minerals from a multivitamin supplement is not very well understood. In the absence of scientific data, all kinds of claims are made about liquid vitamins that they are better and they are absorbed quickly. In response to these claims, those who believe in tablets and capsules tend to make their own counter claims. It is all very confusing to everybody.

In response to my poll on multivitamins, most of those who used these supplements for their toddlers preferred the gummies or tablet variety. Very few favored the liquid form. Could be that liquid form of vitamins is not very common and tends to be more expensive.

I have been thinking about this topic lately and I intend to do some research before writing a post. In the meantime, feel free to share your opinion.

The sweet nothingness of artificial sweeteners (published May 29, 2009)

There are so many different types of artificial sweeteners available these days. And now there is all this buzz about Stevia, the real “natural” no-calorie sweetener. How do you decide which one of the white, blue, yellow and pink packets to go for as you try to grab your morning coffee? They are zero calories all right, but should you worry about possible adverse health effects, including the possibility of cancer, from some of these chemicals? And what about the fact that consuming zero calories sugary beverages does nothing to control your appetite and you might actually end up eating more even as you try to cut down on calories? Check out this very detailed article on artificial sweeteners which basically says that most artificial sweeteners are safe in moderate amounts. So go for the one that tastes the best to you. Overall, you will be better off going for just water instead of the sweet beverage and following a nutrient-rich diet including fruits and vegetables. Zero means zero after all!

30 states have 30% or higher childhood obesity rates (published Jul 3, 3009)

Scary statistics, and nothing to be proud of in my opinion. This data comes from a new report called F as in Fat – How Obesity Policies are Failing in America 2009 published by the Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF). Mississippi got the top honor for its 44% childhood obesity rate – that is nearly 1 in 2 children 10-17 years old is either overweight or obese. 8 of the 10 states with highest rates of childhood obesity are in the South. Another study of children 2-5 years old in low income families shows that nearly 15% of these children are obese compared to about 12% nationwide. It is not that we don’t know the reason for this trend – children eat junk food, they spend too much time watching TV or in front of a computer, they don’t exercise, and schools are not up to standard when it comes to providing healthy meals. Still, nothing is being done about it, and seems like we have no control over the expanding waistlines of our children. Clearly, childhood obesity is a problem we need to confront with all our creativity and resources since it has terrible implications for the long term health of our nation.

Watch out, eating hamburgers can paralyze you (published Oct 9, 2009)

I was shocked beyond belief to read the unfortunate story of 22 years old Stephanie Smith, who got really sick after eating a hamburger contaminated with E. coli. She was so sick that doctors had to put her in a coma for nine weeks, after which she could no longer walk because she was paralyzed from the waist down. A very heavy price to pay for a cheap hamburger all of us assume safe for eating without much thought.

Turns out there are serious gaps in the food inspection system which is supposed to test packaged meat for E. coli contamination. Ground beef is produced by processors from beef trimmings and other parts which they buy from many different suppliers. Not all of these incoming supplies are tested for contamination before grinding. The result is that contaminated cow parts can sometime enter the ground beef supply undetected. Does not happen very frequently, but it does happen often enough to make the news. 8000 people have become sick from 16 E. coli outbreaks in the last 3 years.

No matter how many regulations and inspections are put in place, there is no way to be 100% safe because of the way meat is processed in modern plants. My advice – cut down on beef in the first place – it has been shown to increase the risk of various types of cancer. And if you do want to enjoy a burger, make sure you follow the safe handling procedures and cook it thoroughly so that the inside of the hamburger reaches 165 °F.

Photo source: dylinindustries on Flickr via everystockphoto
©2010 Littlestomaks.com

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

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

Enjoy and let me know what is on your mind!

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

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

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

©2009 Littlestomaks.com

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, Family Physician and Registered Dietitian Dr. Shelley Meyer explains the recommended levels of vitamin D and A for a toddler.

Question: What is a safe level of vitamins D and A to give a 31 month child that weighs about 40 pounds?

Answer:

Vitamins A and D are fat-soluble vitamins, quite essential to children’s diets.  Vitamin D has been a particularly hot topic in the news lately, due to recent findings that a lot of Americans are deficient, including toddlers and children.  Vitamin D is needed for healthy bones, and a deficiency can cause soft, weakened bones known as rickets, and even lead to osteoporosis.  The recommended daily intake of Vitamin D for infants, toddlers and children has recently been increased from 200 IU to 400 IU.  Sunshine is needed to make Vitamin D into its active form, and little ones tend to be covered in sunscreen to protect their delicate skin, therefore explaining how potential deficiencies can occur.  However, only 10-15 minutes per day is needed to activate this essential vitamin.

It is important to remember that food sources are always better absorbed by the body than supplements.   However, if your child is a picky eater and does not drink Vitamin D fortified milk or eat foods rich in Vitamin D, such as fish and egg yolks, then it can be difficult to meet the daily requirements.  In this case, a simple daily dose of a multivitamin or a 400 IU Vitamin D supplement will suffice.

Vitamin A is generally found in abundance, as long as your child or toddler will eat fruits and vegetables.  Vitamin A is essential for healthy eyes, skin, teeth and bones.  Good sources of Vitamin A are eggs, milk, dairy, carrots, sweet potatoes, cantaloupe and dark green vegetables .   Vitamin A can be toxic in excessive amounts so it is important not to exceed the amount found in a multivitamin, generally 2500 retinol equivalent.

©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.