photo credit: DesertNana aka majamom

Chances are you have not had a whole lot of opportunity to ask your family physician or pediatrician about a few rules of thumb for your child’s nutrition. After all, there is hardly any time to talk about nutrition even on a routine wellness visit. Our experience has been no different as the doctor always seems to be in such a big rush to get you out of there!

That is why, I read with great interest an article written by a physician and a registered dietitian published in the American Family Physician, which is a peer reviewed journal of the American Academy of Family Physicians. The title of this article is Nutrition in Toddlers and it contains a nice table of 7 consensus recommendations you can use to manage your child’s nutrition. I wanted to share them with you in this article.

A toddler diet should include 2-3 servings of milk or other dairy products  per day

Not a problem in most cases unless your child has a milk allergy or intolerance. Milk is a great way to meet your growing child’s calcium and vitamin D needs.

Toddlers older than 2 years old should get 30% of daily calories from fat

Not all fat is bad, even though we live in a world where low fat seems to be the golden rule. What you need to limit is saturated fat or trans fat and watch dietary cholesterol. Very easy to do if you reduce processed foods and rely more on home-cooked meals. Polyunsaturated or monounsaturated fats and fatty acids are among the healthy fats you must include in your child’s diet.

Limit fruit juices to no more than 4-6 oz per day and emphasize whole fruits and veggies

It is easy to get comfortable with the no-sugar 100% pure fruit juice label on the box, but fruit juices are no replacement for real fruit. Getting your child to love fruits and veggies takes effort and patience, but don’t give up!

Vitamin supplementation is unnecessary except in undernourished or chronically ill children

I could not agree more! It is natural to worry as a parent, and sometimes feel the pressure to start using a vitamin supplement just to be safe. There days we hear so much about vitamin D deficiency but a supplement is not needed unless your child doesn’t get enough sun exposure or if he does not or cannot drink at least 2 cups of milk. There are situations where you may consider a multivitamin for your toddler, but the general advice is to manage your child’s vitamins and minerals needs through diet and healthy lifestyle.

Good nutritional habits should be fostered by sitting at the table, turning off the television and interacting socially

Sometimes we get so focused on the what of eating, that we forget about the how of feeding! Having a family meal without the distraction of TV or video games is a very powerful way of building lifelong healthy eating habits. Dr Kathleen Cuneo of Dinner Together is an expert in this matter whose opinion I respect a lot. I really like her approach and belief that feeding is parenting. That is what matters in the long run, not the nutritional facts on the label!

Parents should offer children a variety of foods, expose them repeatedly to healthy foods and model healthy eating behaviors

Like it or not, you are a role model for your young child. And when it comes to building lifelong healthy eating habits, your attitude towards food and eating is the most important factor. Being a role model is not difficult; just be consistent and completely natural with your child.

To reassure parents and detect undernourished children, physicians should monitor growth patterns including body mass index

While it is natural to worry if your child falls below the 50th percentile on weight and height growth charts, body mass index is a better tool to assess if your child is overweight or underweight. Body mass index uses both height and weight. It is very easy and you can use an online calculator if you don’t want to wait until your next wellness check appointment.

I think these recommendations pretty much sum up the latest thinking in child nutrition. They are based on sound evidence and practical experience of doctors and dietitians. You don’t have to try to follow all of them on a daily basis. You can try to make them a part of your child’s overall eating habits in the long run. It is also a good idea to tailor your approach to your child’s individual personality without getting hung up on a certain best way to practice them.

Good luck!

©2010 Littlestomaks.com

Childhood Obesity Awareness Month Blog Carnival

This article was written for inclusion in the blog carnival hosted by Littlestomaks to promote awareness of childhood obesity as part of the National Childhood Obesity Awareness Month. Please read to the end of this article to find a list of links to the other carnival participants.

***

Talk about childhood obesity and you are sure to be inundated by all kind of alarming statistics and cries for tax on soda, banning food ads on TV and regulating school nutrition. As a parent, you hardly have any control over any of these so-called solutions. Sure you can try to limit junk foods, encourage fruits and veggies and force your kids to sit down on the dinner table each night. It is a real challenge for nearly all toddler parents and success is not guaranteed, at least in the short term. If your child is already overweight or obese, you may have even a smaller chance of success and a clinical intervention may be needed to reverse the situation.

Is there a solution that can actually nip the problem of childhood obesity in the bud?

In my research, I was surprised to learn that there is indeed such a solution. Even more surprising was the fact that we don’t hear about it at all when solutions to stopping childhood obesity are discussed.

This surprising and simple solution is: Breastfeeding!

photo credit: c r z

The benefits of breastfeeding are well known. It provides all the necessary nutrients for your child’s growth and builds his immune system for a foundation of healthy growth during the toddler years and beyond. But did you know that it also significantly lowers the chances of overweight or obesity? Consider, for example, this conclusion from a CDC report which addresses the question: Does Breastfeeding Reduce the Risk of Pediatric Overweight?

In conclusion, breastfeeding is associated with a reduced odds of pediatric overweight; it also appears to have an inverse dose-response association with overweight (longer duration, less chance of overweight). While more research is needed, exclusive breastfeeding appears to have a stronger effect than combined breast and formula feeding, and the inverse association between breastfeeding and overweight appears to remain with increasing age of the child. The three meta-analyses reported in these review articles suggest a 15% to 30% reduction in odds of overweight from breastfeeding.

This conclusion was based on three different studies which analyzed data from over 50 studies between 1970 and 2004. In case you need more convincing, consider the conclusions of this German study which appeared in the British Medical Journal in 1999:

Prolonged exclusive breast feeding reduced the risk of being obese or overweight among school age children in Bavaria who were born in the early 1990s. This effect is more likely to be related to the composition of breast milk than to lifestyle factors associated with breastfeeding. Preventing childhood obesity and its conse­quences may be an important argument in the drive to encourage breast feeding in industrialized countries.

Now there are purists in the academia who say that such conclusions are not based on randomized trials, which means that it cannot be proven with enough confidence that breastfeeding alone is a cause of reduction in chances of overweight or obesity. Rightly so, because there are confounding factors present in most of these studies. Although, the conclusion about breastfeeding and a reduced risk of overweight does not change even though it becomes a little weaker. From a practical point of view, it does not matter in my opinion and breastfeeding should still be promoted as a solution to preventing childhood obesity.

Although there is considerable debate about why breastfeeding lowers the risk of overweight or obesity, these three reasons are commonly cited:

1. Breastfed babies develop better sense of when they are hungry and when they are full
2. Formula-fed babies have a higher and more prolonged insulin response which stimulates more fat and weight gain
3. Breastfed babies have a higher concentration of leptin, a hormone which regulates their appetite

If breastfeeding, and extended breastfeeding in particular, has such a protective effect on overweight or obesity in later life, why is this message not amplified in public media? How come the revised policy statement on breastfeeding by the American Academy of Pediatrics only casually mentions the benefit of breastfeeding for reducing the risk of obesity? If childhood obesity is such a huge problem, then the benefit of breastfeeding should be prominently highlighted. Why do they recommend exclusive breastfeeding for only 6 months, when extended breastfeeding to 9 or even 12 months of age show a significant risk of childhood obesity?

The rates of breastfeeding in the US are pathetically low. National average rate for exclusive breastfeeding until 6 months is only 11% (2004 data). Married women, older than 30 years with a college degree are more likely to continue breastfeeding until 12 months of age. There is clearly a need to increase the public awareness of this issue and tailor the message for different demographics of women.

During the month of September, which has been declared as the National Childhood Obesity Awareness Month, we will surely hear a lot about junk food, soda, poor quality of school nutrition, too much TV and negligent parents. There will be a lot of focus on alarming numbers and renewed cries for more Government regulation. But where is the voice of reason addressing the need to actually prevent the crisis, rather than react to finding a miracle solution? I hope you will join me in giving support to such voices wherever they are. Promoting and supporting breastfeeding seems like a simple thing to do without having to spend too much money.

©2010 Littlestomaks.com

***

Please take time to read the submissions by the other carnival participants:

7 Things Parents Say That Cause Eating and Weight Problems in Kids Michelle May, Physician and author of Eat What You Love Love What You Eat, highlights a few things parents say which can have unintended consequences (@EatWhatYouLove)

Childhood Obesity Kia Robertson of Today I Ate a Rainbow suggests that prevention of childhood obesity should start with education and educating parents about basics of healthy eating by breaking it into achievable parts (@eatingarainbow)

Childhood Obesity: A Reality Check Dr Susan Rubin, founder of BSF, suggests we change our approach to looking at childhood obesity (@DrSuRu)

Childhood Obesity: Prevention Starts in Infancy Nutrition expert Sarah Fennell reminds us that prevention is the best cure and offers a few tips to raise healthy eaters (@FoodFunHealth)

Giving Our Children a Chance at Health Registered dietitian Susan Dopart offers tips to parents for taking charge of their child’s health in the world of over-processed “kid foods” (@smnutritionist)

Healthy School Campaigns Works on Creating Healthy Food Environments A report on Chicago’s Healthy School Campaigns (HFC), a non profit dedicated to creating a healthy food environment in schools

How to Prevent and Manage Childhood Obesity Registered dietitian Jessica Levinson offers practical tips to prevent and manage childhood obesity (@JLevinsonRD)

Lessons I have Learned as a Mom Registered dietitian Alysa Bajenaru shares some of the lessons she has learned that have helped her develop a good understanding of what it takes to feed her kids (@InspiredRD)

Looking for a New Trend in Childhood Obesity? Registered dietitian Elizabeth Rahavi of the IFIC brings the focus back on family in the debate about childhood obesity (@FoodInsight)

Losing Weight: It Starts in Your Head Registered dietitian Cindy Williams reminds us of the power of attitude and mindset in losing weight and controlling obesity (@nutritionchic)

Making the Grade Registered dietitian Sally Kuzemchak evaluates her son’s school programs on healthy eating and physical activity (@RMNutrition)

Obesity and GERD: A Family Affair Jan Gambino, author of Reflux 101, writes about the link between overweight and GERD

Parents, Let’s Take a Positive Approach to Childhood Obesity Registered dietitian Ashley Rosales from the Dairy Council of California encourages parents to take a positive approach in helping their kids build healthy habits

Revolutionize the Way Your Kids Eat in Five Easy Steps Sociologist Dr Dina Rose suggests we shift our focus from nutrition to eating habits if we are serious about solving childhood obesity (@DrDrRose)

Surprising Easy Solution for Preventing Childhood Obesity Research shows benefits of extended breastfeeding in reducing risk of childhood obesity (@TwinToddlersDad)

The Problem Behind Childhood Obesity Ken Whitman, Publisher of Organic Connections, points out that our national priorities concerning childhood obesity are misplaced and calls for a renewed focus on the health of our nations kids.

Yoga Gets Kids Moving Registered dietitian Danielle Omar has an interesting suggestion for solving childhood obesity – get your kids into yoga! (@2eatwellRD)

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.

Nearly all toddlers are picky eaters. As if that is not enough of a challenge for parents, they also show irregular eating patterns. One day they might eat a lot, while another day it is only a few nibbles. This week, Registered Dietitian Alysa Bajenaru offers a few tips to help your little one develop regular eating habits.

Alysa Bajenaru, RD, CPT B.S. in Nutritional Sciences, University of Oklahoma Registered Dietitian, Certified Personal Trainer and Group Fitness Instructor Experience: clinical dietetics, personal training, former owner/current instructor Baby Boot Camp Expertise: Family nutrition, weight management, new mom fitness, nutrition education Contributor and instructor for Baby Boot Camp Nutrition Solutions program Mom to two toddlers (1 and 3) Website: Inspired RD Twitter: @InspiredRD Facebook: Inspired Results Contact: via email InspiredRD@gmail.com

Question: Sometimes my son won’t eat for days, except nibbles – and other days he will eat like crazy. Is this normal and healthy? Should I enforce more regular eating patterns?

Answer:

It is totally normal for a toddler’s eating habits to vary.  With that being said, here are some tips that may help bring more consistency to your toddler’s diet.

Plan Snack Times.  Many toddlers tend to “graze” all day on crackers, cereal and other snacks.  Make “snack time” an actual time when your son sits at the table and eats a quality snack.  Combining carbohydrates, protein and fat will help keep him satisfied until the next meal.  Examples are string cheese and applesauce, peanut butter and celery with raisins on top, cheese and crackers with some grapes, plain yogurt with strawberries and granola.

Watch Liquid Calories.  Offer milk (low-fat or fat-free after age 2) only at meal times.  Toddlers who drink juice or milk all day may be drinking too many calories to be hungry at meal times.  Offer water throughout the day and fresh fruit as part of meals and snacks instead of juice.

Involve your Toddler in Cooking and Meal Planning.  If you have the space to grow a garden, I highly recommend gardening with your kids.  From personal experience, my son will try anything that we have grown ourselves because he has a connection to the food.  If I brought the same item home from the grocery store, he might wrinkle his nose at it.  If you can’t plant a garden, involve your toddler in the grocery shopping by asking him to pick out fruits and vegetables that he wants to try.  Make it fun and exciting!  Invite your toddler to stand on a chair or sit on the counter while you prepare meals.  Let him help with age-appropriate tasks.  When kids are involved in the process, they feel a sense of accomplishment and are much more excited to eat.

Don’t Stress.  Toddlers are always changing.  Week to week, day by day, moment by moment.  If you are setting up healthy eating patterns for your son, there’s a good chance that he will still have days when he doesn’t eat well.  Don’t stress too much about it.  He will most likely make up for it the next day.

©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.

To find out more about Global Toddlers click here.

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

©2010 Littlestomaks.com

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.

I am so excited to be able to offer you this collection of science-based, real-life practical tips from pediatricians and dietitians! If you are like most toddler parents, you have often wondered if you are doing all you can to ensure adequate nutrition for your growing child. You want to encourage him to eat more fruits and veggies, limit sugary treats and enjoy a family meal at dinner. You wonder if you should be giving her any vitamins and supplements, especially if you are following a strict vegetarian diet. And you are often at your wits’ end to feed your picky toddler.

So many questions, so much of conflicting advice out there!

That is why this compilation of toddler nutrition questions  is a handy resource for all toddler parents. From the Foreword written by pediatrician Dr. Ayala:

There is no better time to address the issue of good nutrition than in childhood.  Childhood is the time when eating habits are formed, and what we do as parents can be a lifelong gift of healthy eating and better overall health for our kids.

This collection of tips from experts and practitioners in the field of childhood nutrition—many of them parents themselves– is a wonderful way to gain from their expertise and experience to address some frequent questions toddlers’ parents encounter.

Best of all, when you buy this eBook, you will be helping Share Our Strength fight the serious problem of childhood hunger. That is because 100% of the proceeds from the sale of this eBook will go directly to them to support their work in ending childhood hunger in America by 2015. I have supported them in the past and would like them to be the beneficiary of your generosity this holiday season. Here are a few reasons why I have selected them for this effort:

1. They are focused on childhood hunger in America. I want our dollars to solve the problem at home first
2. They have a good brand, they have the right scale and they have broad-based support
3. Their fundraising capability is impressive – they have raised over $245 million and provided support to 1000 non-profits working to end hunger
4. I believe they can be instrumental in helping our country achieve the goal of no child hungry by 2015

This 52-page eBook costs only $9.95 USD. Download a FREE 6-page excerpt, check it out and when you are ready to buy, visit the Buy eBook page or click here.

With your help, we can make childhood hunger a problem of the past!

Thank you and enjoy the Holidays.

©2009 Littlestomaks.com

Greetings! Hope you all are enjoying the beautiful days of Fall. I simply love this time of the year. We are getting ready for Trick-or-treat and pumpkin painting, and the twins are excited! They are already dreaming of collecting candy – it is going to be an uphill battle trying to keep them from eating too much. I won’t spoil the fun by telling you their costumes this year yet, but will surely post a photo after Halloween.

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

A new index to help you select affordable nutritious foods

A new food rating system called the Affordable Nutrition Index (ANI) was introduced this week at the American Dietetic Association’s Food and Nutrition Expo in Denver. The idea is to provide a score that takes into account the cost of a certain food item in addition to its nutrition value. A food item with a high score means that it is high in 9 nutrients (protein, fiber, vitamin A, C, E, calcium, iron, potassium and magnesium), low in 3 nutrients (saturated fat, added sugar and sodium) and costs less on a per serving basis. Sweet potato, broccoli, green pepper, orange and banana scored high on the index (over 100) while packaged convenience foods scored lower than 100.

This index has been developed by Dr Adam Drewnowski, Director of the Center for Public Health Nutrition at University of Washington in Seattle. He used the Nutrient Rich Food Index (NFR9.3) which he previously developed and a price per serving information from food prices database, Seattle area supermarkets and industry sources. This research was sponsored by the Campbell Soup Company. Not surprisingly perhaps, many of the condensed soups from Campbell ended up with a high score around 100 compared to many fresh or cooked vegetables and even fresh fruits.

I am intrigued by this idea since we all want to select foods that have high nutritional value at an affordable cost. However, I don’t think that this is the only way to make that choice. I was disappointed to see that vitamin D was not included in the 9 nutrients to promote in the NFR9.3. Plus cost per serving is probably not the right measure of what a customer pays when buying a product. Also, you can manage cost by buying seasonal fruits and vegetables from local sources. Still, I think it is a good idea and I plan to write more about it in future.

Coke’s response to the debate on obesity is lame

Coca-Cola, the icon of sugary drinks is under attack! CEO Muhtar Kent wrote an Op-Ed piece in the Wall Street Journal on October 7th defending his company against proposals of soda tax. Coke Didn’t Make America Fat is what he believes; and quite arrogantly he points the finger to his own customers saying they lead a sedentary lifestyle! Well, Coke did make America fat according to my blogger colleague Dr. Ayala who wrote an excellent piece this week in response to Mr. Kent’s lame arguments.

So far, Coke’s response to the current debate on the role of sugary drinks in our obesity problem is rather lame in my opinion. They have announced that they will add calorie information on the front of Coke cans. They have given a large amount of money to the American Academy of Family Physicians (AAFP) to develop consumer education content as part of their Consumer Alliance Program. They are also a part of the Healthy Weight Commitment Foundation (HWCF), a group of 40 organizations seemingly engaged in a collaborative effort to address obesity. And now in their latest move, Coke has announced that they will introduce a 90-calorie mini soda can so that people can limit their intake of sugary cola.

While I am no fan of the twinkie tax, I do not believe that these actions by one of America’s top brands are of the high caliber needed to solve one of America’s most challenging health problems. Coke needs to do more than just pay lip service and make lame arguments defending their products in public. They need to take a more grass-roots approach – building playgrounds in schools, sponsoring healthy lifestyle events, developing after-school programs, integrating nutrition and physical education, sponsor healthy nutritious school lunches just to name a few examples. They need to measure the effectiveness of these programs in reducing obesity and make the data public.

Coke’ 3Q financial results show that they generated $6.3 billion in cash from operations year-to-date in 2009. They spent $241 million buying back their own shares. A little more of that cash spent on real programs to solve our obesity problem will not make a dent in their profits! What do you have to say about that Mr Kent?

FDA puts the hammer down on front-of-box labeling

The Smart Choice program it seems was the last straw according to Marion Nestle who writes a blog called Food Politics! In a letter to the food industry, the FDA is openly questioning the arbitrary nutrition standards used by companies to develop these labels which end up showing their own products as healthy. FDA wants to develop a set of independent criteria which these labels will need to meet before companies can use them on their products. FDA also wants to understand how these front of the box labels affect consumer choice.

I say, it’s about time. The Nutritional Facts panel, usually at the back or the side of the box, is too complicated for most consumers to read and understand. Consumers are looking for something simple that allows them to quickly make a decision.

We are lagging behind other countries in this area. A traffic light based food labeling system developed by the industry based on government guidelines in UK seems to be working very well. Why can’t we do the same here?

Here is a good background information on different types of front of box labeling systems. What is your opinion? Have you come across a labeling system you really like?

Toddler diets a cause for concern according to the 2008 FITS data

Latest data from the 2008 Nestle Feeding Infants and Toddlers Study (FITS) confirms the sorry state of a typical toddler diet in America. Most toddlers and preschoolers are not eating fruits and vegetables. They are consuming too much saturated fat and sodium. French fries are the most popular vegetable!

Good news is that the diets of infants and older babies are much better compared to the 2002 data. Mothers are breastfeeding their children longer and consumption of sugary drinks is decreasing. There is a risk of iron deficiency in some children.

Looks like parents and caregivers are following the feeding guidelines for infants. So why do things go south during the toddler years? Is it because of picky behavior? Or is it because toddlers eat what their parents eat? Or a combination of the two?

Not much progress has been made in the diet of toddlers since 2002. We need to make a deliberate effort to improve this situation.  Having dinner together, being a role model and encouraging fruits and vegetables is critical to solving the problem of childhood obesity. And in case you are struggling, here are some tips for picky eating.

Let us bring the school nutrition standards to the 21^st century

Can you believe that it was 1995 when the standards for the National School Lunch Program (NSLP) and School Breakfast Program (SBP) were last revised? Yet the NSLP served lunch to over 30 million children and SBP served breakfast to over 10 million children in 2008! If we are serious about fighting the battle of childhood obesity, we need to revise these standards and bring them to the 21st century!

Well, the good news is that the Institute of Medicine (IOM) has now issued its recommendations in a report titled School Meals: Building Blocks for Healthy Children, which the US Department is going to consider as they revise these standards. Recommended meal requirements encourage more fruits & vegetables, whole grains, min and max levels of calories and limit saturated fats  and sodium.

This is good news! I hope they will begin to implement these recommendations by the time our twins start going to school. I think progress may be slow due to cost and bureaucracy, but at least it’s a good start.

Enjoy and do let me know you think. I would love to have you share your best tips in comments below.

Photo source -cambodia4kidsorg on Flickr via everystockphoto

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

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

Answer:

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

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

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

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

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

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

Here is a simple vegetarian recipe you can try:

Savoury Pongal

Ingredients:

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

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

References:

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

©2009 Littlestomaks.com. All Rights Reserved

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

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

This week, Registered Dietitian Rebecca Subbiah offers advice on how to get your little one to develop a taste for multinational ethnic foods at an early age.

Question: How can I introduce my child to ethnic foods?

Answer:

First let me introduce myself, I am Rebecca of Chow and Chatter. I am a Brit married to an Indian living in America. We have a one-year-old daughter, and as a family we love to travel and try new foods. In fact every time we visit a big city like New York we look up new cuisines to try. I am a dietitian and love picking up healthy cooking tips and recipes from around the globe.  So it would only be natural to introduce our daughter to all the amazing food from different countries and broaden her horizons.

When she was 7 months old we went on a trip to Europe, the first week we were in the UK visiting my family where she got to try Great Grandmas chocolate cake and ground Sunday roast. Then we went to France for a week where she chewed on fresh French bread, petit flors yogurts and tried small amounts of food off our plates.

Then during our last week of vacation we visited Italy where she ate pasta, I was truly amazed at how at such a young age she managed spaghetti eagerly sucking it up. She also had fresh fruits and gelato. We purchased the local baby foods from each country and I even found pastini pasta for babies in Italy. She adores pasta now maybe this early introduction and being spoilt in Italy with good food set the scene.

But you don’t have to travel to offer multinational cuisines, simply adapt the dish you are cooking to have less salt and spice and to be the correct texture depending on the age of the baby.
Here are some examples:

1. If you are making Indian dal, add the lentils, tomato, onion and garlic and a vegetable – I often use spinach – pressure cook then set aside for baby. With the remainder add the desired spices for Mom and Dad.
2. For homemade soups make your own broth or use low sodium version from the market.
3. For Chinese or Vietnamese stir-fries add onion, garlic, and a splash of soy sauce with veggies for baby then add spices for Mom and Dad.
4. If your making meat curry have a separate pan for baby with the meat, onion, garlic, and tomato. The two dishes can easily be cooked at the same time.
5. Pasta’s and polenta dishes can be the same for baby and parents.
6. Poached fish with mashed potato and vegetables are a great family meal

Don’t be afraid to offer cuisines from different countries and ask people from those places for suggestions. The more varied and adventurous your little ones diet is at a young age the better it is for life. On a final note have fun and lead by example.

©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.

Greetings! It’s Friday, which means it’s time for another Five for Fridays! Here are 5 interesting nutrition stories of the week that caught my eye. Enjoy and drop a comment to let me know what’s on your mind.

Food industry turns sour on high sugar prices

If you ask me, more than a “fat” or “sugar” or “junk food” tax, I like the current situation better. A shift in global supply and demand of sugar, coupled with government policies that limit the import of cheap sugar in the US, domestic sugar prices are going through the roof and the food industry is crying foul! Some of the big food companies have sent a letter to Agriculture Secretary Tom Vilsack threatening price increases and worker layoffs if import quotas are not raised. Some will argue that the current quotas are against the idea of free trade. In general, I do not favor them either. But in this case, it is better to have these quotas to manage the demand for sugar rather than have a tax to control the demand for the final product. Let the companies figure out for themselves how to manage the increased cost of their raw materials. If they increase prices, demand for their product will go down. If they layoff workers, then they would need to increase their productivity to meet the current demand. Either way, it will force them to innovate.

Another front-of-box labeling system claims to be “smart”

A new front-of-the-box nutritional labeling system designed by a coalition of nutrition experts, scientists, food companies, retailers and research organizations goes live this week. It is a very simple system with a green check mark indicating the “smart choice” based on current nutrition guidelines. Also the calorie per serving and number of servings in the package are clearly shown under the check mark. There has been some criticism of this initiative, mostly because it is sponsored by food and beverage companies. Although it is not perfect, it is yet another attempt to simplify the life of most consumers who are often confused by the full nutritional facts label and the ingredients list on the back. There are many other creative versions of these front-of-the-box labeling without any standardization.  A traffic light system of food labeling is getting popular in UK and Australia. Clearly, there is a need to standardize such labeling so it does not turn into a clever marketing ploy by manufacturers. Have you come across such labels on products in store? What is your opinion of them?

Link between food stamps and obesity

A new study finds that people on food stamps are likely to be more obese compared to those of the same socioeconomic background who are not on the program. This implies that those receiving food stamps make food choices which are not very healthy. Although I think the study is interesting, its conclusions are highly speculative. The main goal seems to be influence changes to the food stamps program so that it encourages the recipients to consume nutrient-rich, low calorie foods. One idea is to force these people to attend a course in nutrition before they can get food stamps. That is quite ridiculous in my opinion! We cannot teach nutrition to kids in school – how can we expect people trying to find their next meal to learn about nutrition by sitting in a class? Still, it is something to think about. The challenge is to link food assistance with healthy foods. If only we could find them in the supermarkets at an affordable cost! What do you think?

Encourage your kids to eat veggies by these market meal ideas

Hop over to Kidappeal for some interesting ideas for a quick summer market meal, green beans, tomatoes and eggs. Very simple recipes and the pictures look great. I really liked Jenna’s tip on taking the kids to the Farmer’s market and getting them to pick their favorite fruits and veggies. And then serving a “market meal” like the one described in this post. Over the summer, we have taken the twins to a local Farmer’s market a couple of times on Fridays after we pick them up from Daycare. Have not had much luck with fresh, organic fruits and veggies – in fact, our local Whole Foods happens to have a better selection, although their prices are way too high! But we have enjoyed some local pita bread and apple-stuffed pastry from the market. Most importantly, we can get the twins on a short train ride in the nearby Mall, which really makes them happy!

5 practical ideas for becoming a positive role model

Want to encourage your toddlers to develop healthy eating habits? Check out this guilt-free guide to becoming a positive role model by Registered Dietitian Maryann Jocobsen who offers 5 simple and practical tips. My favorite one – don’t try to be perfect! Food is not just nutrition and a set of rules, but also about enjoyment. It is important to help your child build a positive relationship with food. Also remember that it does not happen in a day, or a week or even a few months. This is truly a long-term project!

What are some of your favorite tips in getting your kids to eat healthy?

Enjoy your weekend! And let me know what you think.

Photo source -baronsquirrel on Flickr via everystockphoto
©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, published author and Reflux expert Jan Gambino offers some tips for getting your picky eater to eat regular foods.

Question: I am at my wit’s end with my picky eater! Can you give some advice on how to get her to eat regular food?

Answer:

Your baby used to eagerly anticipate every scoop of pureed peas and creamed spinach. If you didn’t scoop the food fast enough, she would yelp and complain. After the jars were empty, she was content to drink an entire bottle. Now your toddler turns away when you present anything green and healthy and shrieks with anger if you dare put a new food on her plate. A “meal” consists of a few bites of chicken nuggets and a sip or two of milk from a cup before she leaps up to chase the dog or rearrange her toys. So what happened?

Along the way, your baby has turned into an independent, opinionated little person called a toddler! She has learned to control her world in such grand ways-from crawling to walking and then climbing, offering new ways to challenge herself. Communication has taught her the power of words with “no” being the one that really tickles her! She is finding that she has the ability to make decisions and communicate her wants and needs.

She is beginning to get longer and leaner too. The rapid growth of the first year is slowing down and her body is changing. So are her eating habits. It makes sense that she will use her new skills to explore new ways of eating.

Toddlers are often labeled as picky eaters. A picky eater is a child who eats only a few foods from a few food groups. For instance, a child may eat 5 foods over and over again. Typically a picky eater will crave carbohydrates and omit fruits and vegetables. I call this the “White Diet” or “Prison Diet”. During the toddler years, my daughter was on the White Diet and would only eat chicken nuggets, mashed potatoes, crackers and dry cereal. I was worried that she was missing vital vitamins and nutrients from her limited eating. The pediatrician assured me that this was very common and somehow, most children continue to grow and thrive despite such a limited diet.

Top Tips for Coping with a Picky Eater:

1. Leave your emotions at the Kitchen Door: Remember, picky eating is normal and she will most likely emerge from this stage and expand her diet. Try not to show your anger or disappointment about her picky eating. Do not negotiate, offer bribes or withhold dessert. This just fuels the fire.
2. Routines: Try to eat at least one meal per day as a family. Little ones model our behavior whether we want them to or not. Maybe if she sees you eating fruits and vegetables over and over again, she will eventually decide to try some.
3. Kitchen Helper: An older toddler can “help” you in the kitchen. My daughter loved ripping the lettuce and making a salad each night. We told her how delicious the salad was and she beamed with pride. It was a full year before she decided to take a nibble of her handiwork!
4. Vitamins and Minerals: A picky eater may benefit from a multivitamin with minerals. Check with your doctor.
5. Nutrition Drinks: Some picky eaters may benefit from a nutrition drink made for children ages 1-12 years. It can be served as a substitute for a meal, added to a shake or smoothie or used in cooking instead of milk (i.e.: pudding pancakes).
6. Hide the Oreos: I kept my emergency chocolate supply on a high shelf. The “snack drawer” was full of healthy snacks within her reach: crackers, pretzels, raisins, nuts. That way, she was not tempted by unhealthy food choices.
7. Little Stomachs/Little Meals: Make sure you are offering small portions to your toddler. In the morning, she ate breakfast followed by her “fruit snack”. My picky eater ate half her lunch at noon and then in the afternoon, her “snack” consisted of the other half of her lunch. After dinner, if she was still hungry, it was time for her “yogurt snack”.
8. Play with your food: Make sure mealtime is enjoyable and playful. Bring out the special silverware and plates (with your child’s favorite character on it of course); invite a friend to join you. Eat in a new place: on a big rock, on the top of the jungle gym or in a kid friendly restaurant.

Remember, your picky eater will be a teenager before you know it and will surely eat you out of house and home! Good luck and happy eating!

©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.

To find out more about Global Toddlers click here.

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

©2009 Littlestomaks.com

To find out more about Global Toddlers click here.

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

©2009 Littlestomaks.com

To find out more about Global Toddlers click here.

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

©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 practical tips for feeding a very active child.

Question: Can you give a few suggestions on feeding a very active child?

Answer:

Many parents of busy toddlers wonder if their child will sit still long enough to actually eat anything substantial. And I know from first-hand experience that can be a particular challenge with very active toddlers. Several points to keep in mind: Children will eat when they are hungry and it may not always be at a prescribed mealtime. Keep in mind, if a child doesn’t want to eat, he or she is probably not hungry. If you are presenting a variety of nutritious foods, try not to worry too much. One way young children express their independence through food, so allow them to make choices. Serve smaller, more frequent meals and snacks for active toddlers, if you know they won’t sit still. Or try letting them eat their meal in stages, if it seems they need an activity break. Allow flexibility to reduce stress at feeding time. In the long run, you’re helping your child develop a healthy relationship with food, which means not responding to prescribed external rules, like eating everything on the plate and specific meal times, but rather creating a solid connection with internal hunger cues and fueling the for health.

©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.