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

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.

There are so many handy snacks around these days. No wonder kids get hooked on them at an early age, so much that they don’t eat anything else. This week, registered dietitian and exercise physiologist  Susan Dopart advises parents to get their kids involved in shopping and cooking as they try to introduce them to vegetables and other healthy foods.

Question: My 5 1/2 yo prefers not to eat! She will “snack” on muffins, goldfish crackers if you let her, but will only eat a handful of other things, none that include vegetables. She weighs 34 lbs and is almost 6 years old; 25% percentile on weight since she was 1 or 2. What should I do?

Children will eat what you feed them.  If you offer your daughter a variety of healthy choices (and not the muffins, goldfish or other) eventually she will give up and pick one of those.

Involve her in the shopping and cooking process.  Bring her grocery shopping and have her pick out 2-3 favorite fruits and vegetables each week.  Educate her at the store about what vitamins and minerals are in each one so she knows why they are important to eat.  For example, a strawberry has vitamin C which is important for healing when you scrape your knee.

In my office I show children the list of multiple ingredients in snack or processed foods.  I then tell them it take their bodies longer to process and digest those foods rather than foods without a label, like fruits and vegetables.

Taking the snack foods out of house will eliminate temptation and keep the environment clean.  If those foods are not around or accessible, and nutritious foods are in their place it will encourage healthy eating.

There are ways to make vegetables more kid-friendly.  I have a vegetable casserole that combines vegetables with eggs and cheese in tomato sauce that kids love.

To encourage new foods have your daughter try a no thank you serving.  Since many children have aversions to vegetables due to their strong flavors, their taste buds need conditioning over time.  A “no thank you” serving is having her try a bite or two (one or two teaspoons) of something she does not like each time it is served.  Research shows a child may need to eat a new food 10 times before they start to like it and ask for it.

One of the most important aspects of feeding your child is being a healthy role model.  If a child sees you eating vegetables each day, it is one of the best ways to encourage healthy eating.

With respect to your daughter’s size that may be what is normal for her. There is not a concern about her size unless she falls below the 10% percentile for height or weight.

Good luck.

©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.

We have been getting this new snack from Gerber for the last couple of weeks. Much like the Fruit Twists, it has been a great hit with my son who enjoys it on the way back from daycare.

Here is what we like about this product -

1. Contains real fruits and made with yogurt
2. Tastes good
3. Only 80 calories per twist
4. No saturated fat or trans fat
5. No cholesterol
6. Added vitamins and minerals

Here is what we don’t like about this product -

1. No fiber although a label on the front shows made with whole grains
2. Added sugar, also contains sodium
3. It is not organic
4. High cost – a pack of 6 twists costs over 3 dollars

Overall, I think not a bad alternative if you are on-the-go and need to offer a snack. But I would not rely on it to skip real fruits!

Disclaimer – I have not received any sponsorship or free samples of product from Gerber for writing this review. For complete nutritional information and other products, visit Gerber’s website.

©2010 Littlestomaks.com

Just like thiamin, riboflavin and niacin, which I wrote about recently, Pantothenic acid is another B vitamin commonly known as the B complex. In case you have wondered what it is and why it is needed, here is some research for you in a simple Q&A format. Let me know what you think of this format and if you have any other questions that I did not cover here. I will get them answered by one of our experts and post them under Ask the Expert column.

What is Pantothenic Acid?

Pantothenic Acid is also known as vitamin B5, 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.

Pantothenic Acid, like the other B vitamins, is soluble in water. The name pantothenic acid is derived from the Greek word pantothen, which means from everywhere! Clearly, it is an essential component of all plant and animal life. Inside the living cells, it is found in the form of coenzyme A (CoA). A coenzyme is a kind of a “helper molecule” inside our cells which attaches to an enzyme involved in a variety of biochemical reactions. In some ways, living cells are like tiny factories where these biochemical reactions take place and enzymes are responsible for speeding up those reactions.

Why does my child need it?

According to the 2nd edition of the PDR for Nutritional Supplements, pantothenic acid is involved in a number of biological reaction, including the production of energy from carbohydrates, fatty acids and amino acids. It is also required for production of cholesterol, steroid hormones and neurotransmitters. Even though we hear cholesterol as a bad word and something to be avoided, there is also good cholesterol that our body needs.

Coenzyme A is also required for production of the neurotransmitter acetylcholine and the hormone melatonin. It also plays a role in making heme, which is a component of hemoglobin. In short, it does a lot of important things inside the body which are needed for sustaining life and healthy growth.

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

For infants, the FDA has recommended a daily amount of 3 mg. And for toddlers less than 4 years old, the recommendation is 5 mg. Pregnant and nursing women are recommended to take about 10 mg per day. Healthy adults are also advised to take about 10 mg per day.

Pantothenic acid is usually present in organ meats (liver, kidney), egg yolk, avocados, cashew nuts, peanuts, brown rice, soya, lentils, brocooli and milk.  Here are a few examples of different food sources and amount of pantothenic acid per serving (source: wikipedia and Linus Pauling Institute):

1. Avocado, 1 whole = 1.9 mg
2. Chicken, 3 oz, cooked = 0.98 mg
3. Lentils, 1/2 cup, cooked = 0.6 mg
4. Milk, 1 cup = 0.8 mg
5. Cod fish, 3 oz, cooked = 0.15 mg
6. Broccoli, 1/2 cup = 0.48 mg
7. 1 Large egg = 0.61 mg
8. Yogurt, 1 cup= 1.35 mg
9. Sweet potato, 1/2 cup = 0.88 mg
10. Whole wheat bread, 1 slice = 0.19 mg

What happens if my child does not get enough pantothenic acid?

According to the PDR for Nutritional Supplements, pantothenic deficiency is rare. The symptoms, which are seen under severe malnutrition, include numbness in the toes and painful burning in the feet.

Should I be concerned about pantothenic  acid deficiency?

The short answer is NO. As long as your child’s diet includes a variety of food sources such as meats, dairy and vegetables, you have no reason to worry. There is no need to use a supplement. Whole grains are good source of pantothenic acid and other vitamins. Eating too many refined grains is a problem not just for pantothenic acid, but for other nutrients as well. Therefore, introduce your family to whole grains for a variety of benefits. Most breakfast cereals are not fortified with pantothenic acid although they contain other B vitamins. Balance, variety and moderation in your child’s diet is the best strategy for getting essential nutrients.

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

©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

Happy Easter! It is Friday again, which means it is time for the usual Five for Fridays! Here are 5 food and nutrition related stories that caught my eye. Enjoy and let me know what you think.

New health bill will require restaurants to show calories on the menu

Chain restaurants with more than 20 outlets nationwide will be required to display nutrient content and calorie information on their menus according to Section 2572 of the recent healthcare bill. Similar rules will apply to vending machines. Menu labeling has been already in place in New York City for over an year with mixed results. Studies published last year, which I wrote about in a Five for Fridays, reported that doubts were emerging about the effectiveness of calorie labeling. What was more worrisome to me was the fact that some restaurants were actually “cheating” by posting lower calories than actually present in certain food items when tested! Clearly, this should not be allowed.

I think calorie labeling on restaurant menus is a good idea. Not only that,  there should also be other nutritional information available, particularly on salt, sugar and fat. It may take some time before consumers are fully aware of the risks of salty, sugary and fatty foods, but clearly in the long run it will help them make better decisions. The problem is that now it will require some sort of policing to ensure compliance with the law. Already there are problems with the National Organic Program (see below) due to constraints in budget and inspectors . These new requirements will undoubtedly create a new bureaucracy and another cat-and-mouse game will begin between food marketers and compliance officers. Hopefully it will become a self-policing system if consumers begin to vote with their wallets at these restaurants.

National Organic Program lacks teeth to enforce rules

You pay extra for certified organic products. You have the right to expect that they are genuine and that they do not contain pesticide residues. You do not expect non-organic products sold with the organic label. Yet, it is not an absolute guarantee! Now, wouldn’t that make you mad?

This is exactly how I felt when I read a report in the New York Times which exposed serious gaps in federal oversight of the organic food industry. Turns out that they don’t have enough inspectors to spot check organic products for pesticide residue (required by law) and that bogus organic products were allowed to be in the market for over 2 years before any action was taken. The excuse? Well, demand for organic products has grown so fast that the USDA’s National Organic Program can’t keep up with its enforcement responsibilities!

Finally, they are making a commitment to enforce spot testing for pesticide residues. They are getting more money and more people. The bureaucracy is ballooning but don’t expect it work perfectly. It never does. Meanwhile, don’t give up on organic products; just do your research and buy from a reputable brand.

Pepsico wants to trick your tongue by “designer salt”

Don’t give up on the potato chips! At least that is what Pepsico would like you to do just in case you are having second thoughts after reading about the evil sodium in their popular snacks. Recently they announced plans to cut sodium content by 25% by 2015, saturated fat and added sugar by 15% and 25% respectively by 2020. Sounds like the responsible thing to do, especially now that there is a bright spotlight on the link between processed food and obesity.

The solution, at least for sodium? A new “designer salt” which has crystals shaped and sized so that they dissolve fast on the tongue delivering a rapid salty sensation. While an innovative idea, which Pepsico is sure to market as a “breakthrough”, I think it is still a great example of incremental thinking. The problem is not with salt folks, it is the chips that we need to cut down on.

And 25% reduction is not going to make these products “healthier”! Consider Cheetos, which contain a whopping 290 mg of sodium per 1 oz serving. A 25% reduction (in 5 years) will bring it down to about 220, which is still very high. Too little, too late? What do you think?

Spinach leaves enrich their vitamin content sitting on the store shelf

Worried about picking up that box of baby spinach close to its expiration date? Well, believe it or not, you may be actually getting more value for your money compared to a box that did not sit on the store shelves for this long!

According to researchers at the USDA, spinach leaves exposed to store lighting conditions continuously over 9 days had a higher level of folate, vitamin C, K and E compared to those kept in the dark. This fascinating research was recently published in the Journal of Agriculture and Food Chemistry. The researchers reasoned that the spinach leaves continued their photosynthesis (a process by which plants produce sugars using sunlight and carbon dioxide) under the store light, which also produces these vitamins. When the same spinach leaves were stored in the dark, photosynthesis did not happen.

This is interesting for sure, but remember that the vitamin content of vegetables also depends on how you cook them. Steaming and microwaving is good; but eating raw fresh veggies is even better.

Teaching kids to eat healthy the French way

Offer preschoolers a 5 course meal, make sure they eat at the table and keep the parents out is the French recipe for getting kids to build lifelong healthy eating habits. I was fascinated to read the Nursery School Gourmets in a recent TIME magazine, which explained how seriously the city of Paris looks at the matter of school lunches.

Clearly, it is a well-structured, heavily funded state program unlike what we have in the United States. The daily menu is planned in advance for 2 months with no repetitions. Every meal includes an hors d’oeuvre, salad, main course, cheese plate and dessert (yum!). Soda and snack machines are banned. Parents are given suggestions for what to serve at dinner based on the day’s lunch menu. Discipline is intense and kids are trained to eat at the table and keep quiet.

Should we emulate the French model to solve our childhood obesity problem? The topic of school lunch is center stage these days, and Jamie Olivers’ Food Revolution is on prime time. The French model is yet another benchmark for us to consider. What do you think?

Enjoy and let me know what is on your mind.

Photo Source: Wikimedia Commons

©2010 Littlestomaks.com

I have been keeping an eye on quinoa products lately, particularly after we found the Ancient Harvest Quinoa Pasta recently. As a grain, quinoa has exceptionally high nutritional value, but it takes a while to develop a taste for it. You can try it in a recipe like our popular chicken with quinoa, or even serve as a side dish all by itself!

Pasta made from quinoa flour certainly is a novelty in my opinion. This way, kids can get to develop a taste for quinoa in a familiar form. We found this particular quinoa from Andean Dream in our local Whole Foods Market. What invited my interest was the fact that this pasta was made from a mix of organic quinoa flour and organic rice flour, unlike the corn flour used in the Ancient Harvest Quinoa.

Here is our short review – if you try this product, let us know how you like it.

Here is what we like about this product -

1. USDA certified organic
2. Gluten free
3. No saturated fat or trans fats, no cholesterol
4. 6 g protein per serving, 3 g fiber
5. Quinoa is rich in B vitamins and iron
6. Quinoa is low in glycemic index

Here is what we don’t like about this product -

1. Does not taste like pasta, more like a rice noodle

Overall, I think it is worth a try! It may work well in oriental recipes which use rice noodles!

Disclaimer – I have not received any sponsorship or free samples of product from Andean Dream for writing this review. For complete nutritional information and other products, visit Andean Dream’s website.
©2010 Littlestomaks.com

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

What is Niacin?

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

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

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

Why does my child need it?

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

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

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

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

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

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

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

What happens if my child does not get enough niacin?

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

Should I be concerned about niacin deficiency?

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

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

©2010 Littlestomaks.com

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

What is Riboflavin?

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

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

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

Why does my child need it?

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

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

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

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

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

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

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

What happens if my child does not get enough riboflavin?

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

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

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

Should I be concerned about riboflavin deficiency?

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

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

©2010 Littlestomaks.com

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

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.

This is a very easy recipe for a quick salad! We stumbled on it in Recipes from the Heart, a cookbook we recently purchased to support the Operation STEM-ulus from the U.S. Foodservice to provide fresh fruits and vegetables to needy families. We adapted it slightly to match the ingredients at hand. We don’t normally eat avocado but this recipe turned out to be a great introduction and extremely simple to prepare. We are definitely hooked and plan to try this fruit in other recipes!

Ingredients

1. 2 avocados, peeled and diced into small cubes
2. 2-3 pears, peeled and diced
3. 1 large tomato, diced
4. 1/4 cup cilantro, finely chopped
5. 2 tbsp diced green onions
6. 1 tbsp extra virgin olive oil
7. 1 tbsp lemon juice
8. Salt and pepper to taste

Method

Combine avocado, pears, tomatoes in a salad bowl, toss together to mix well. Sprinkle cilantro and green onions. Mix olive oil and lemon juice in a small bowl and spread over the salad uniformly. Serve with baked tortilla chips or toasted bread.

About avocado

via Wikimedia

Avocado is a fruit native to the Caribbean region but now grown in many countries across the world. It is very popular in the US, which is in fact is the third largest producer in the world. 95% of the US production comes from Southern California (source: Wikipedia)

Avocado has very high dietary fiber, loads of vitamin B, C, magnesium, potassium and phosphorus. It also provides a lot of monounsaturated fats, which is one of the good fats you should aim to increase in your growing child’s diet.

©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.

Last week I wrote about the mystery of enriched flour, which on the surface appears healthy but in reality not as good as whole grain. In response, a reader wondered:

What about rice? Why is white rice called not so healthy compared to brown rice…is it because the first one is polished and the latter one is not?

We don’t normally eat brown rice because we prefer basmati rice. In fact, we eat it almost every day at dinner. It tastes great and has a low glycemic index. So, I decided to research this question to confirm if brown rice is nutritionally superior to white rice.

The short answer is YES!

Just like the process of milling wheat removes the bran and the nutrient-rich germ to leave behind carbohydrate-rich endosperm, milling rice does the same to produce white rice. During my research, I found a great website called the Cereal Knowledge Bank from the International Rice Research Institute (IRRI), which is a Philippines-based non-profit agricultural research organization. Here is a link to a great summary of modern rice milling.

After pre-cleaning the rice paddy, the husk is removed. What you get at this stage is brown rice; this is the whole grain. Which means that it contains the bran, the endosperm and the germ. Polishing removes the bran layer from the brown rice. The amount of bran removed is called the milling degree and it is usually in the range of 8 – 12%. The higher the degree of milling, the higher is the amount of vitamin and oil-rich layers removed. Finally, whole kernels are separated from large and small broken kernels and polished further to add luster.

Here is a comparison of nutrients in brown rice and white rice on a 100g cooked basis. White rice is of un-enriched variety. Source: USDA Nutrient Database.

Red is “bad”, yellow is “about the same” and green is “better” compared to brown rice.

Overall, white rice contains a much lower amount of dietary fiber, proteins, vitamins and minerals.

Brown rice is definitely better from a nutritional value point of view. The problem is that the oils from the bran layer can oxidize and turn the rice rancid in as few as 6 months. Brown rice therefore comes with an expiration date! Also, it takes longer to cook, the taste is chewy and it does not come out as fluffy as white rice.

Does it mean you should stop eating white rice and switch completely to brown rice? Definitely not! If you are eating  a lot of high glycemic index white rice (jasmine rice for example), it will be better to consider switching to brown rice at least a few times. And if you simply can’t give up white rice, try white basmati rice!

Photo source: Photoxpress
©2009 Littletomaks.com

Greetings! Fall is in the air and I really love this time of the year. There is a cool, crisp freshness in the air, especially in the morning and just before the sunset. We are having a lot of fun with the twins playing outdoors in the yard or going around the block with them on their tricycles. Hopefully you all are having fun too. And yes, the Holidays are not that far off either!

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.

Maximize your child’s nutrition at every stage

Registered Dietitian Maryann Jacobsen has written a very nice and comprehensive guide to help you maximize your child’s nutrition at every stage, from birth to school years. What I liked about her post is that she describes very clearly the recommended levels of different nutrients and offers great feeding tips at every age. For preschoolers, it is important to build healthy eating habits early on by striking a balance between their desire for sugary, fatty and high energy snacks and balanced homemade meals. Eating as a family is highly recommended, although it is no easy feat to accomplish!

For school-age children, watch out for deficiencies in vitamin E, D, calcium, magnesium, potassium and fiber. Get them to eat with you as a family and encourage them to eat more fruits and vegetables.

Most of all, don’t give up, keep trying and fight the battle by being a role model.

Too much marketing hype behind probiotics

There is a lot of buzz around probiotics these days! People have been eating yogurt for a long time, but it is only recently that food marketers have realized they can make it sexier by using the immunity claim on the package. This kind of advertising is hard to resist, especially when it comes to products for kids. Even we fell for the DanActive Immunity Probiotic Drink, which claimed to have a new more absorbable yogurt culture but it contained a lot of sugar and it was super expensive. All kinds of claims are being made to pull customers. I was surprised to lean that Dannon recently settled a class-action lawsuit Activia yogurts and DanActive yogurt drinks.

When it comes to probiotics, not every strain of the bacteria is equally effective. Consumers should be informed about the specific probiotic strain in the product and its scientifically proven benefits. The L. Casei Immunitas^TM strain in DanActive drinks has been shown to reduce illness in children attending daycare. But there is very little evidence of general immunity or resistance to disease from these probiotics. In my opinion, these new products are not worth the extra money and you should watch out for added sugar. In the meantime, plain yogurt with home-made fruit puree is a very decent affordable option!

Schools start cooking fresh food for a healthier lunch

Yes there are a lot of regulations for school kitchens, there is little or no equipment and there aren’t any skilled cooks on the staff. Plus it is simply easier to serve straight out of a package after a quick reheat. No wonder over 80% of the school districts in the country cook less than half of their entrees from scratch according to a 2009 survey by the School Nutrition Association. School lunches have neither appealing nor appetizing for kids!

I was happy to read about one middle school in New York which is trying to do things differently to encourage kids to eat better at lunch. Mostly due to the efforts of its principal and the cafeteria manager, a few new ideas are being implemented. A curry chicken recipe is one such idea especially popular among the students. The bread is whole wheat, pasta is whole grain and milk is low fat. There are salad bars and deli bars. More importantly, these leaders believe that “the children need a little flair in the food, it is good for their brains”. Amen to that!

Omega-3 cheese may soon become available

A new study shows the promise of formulating cheese with fish-derived omega-3 without the fishy smell. Scientists have developed a technique to add omega-3 as an emulsion to the cheese to make it stable and mask the fishy smell. It is still at the research stage but I am sure there will soon be a commercial product given the huge consumer interest in omega-3 fatty acids. I think it is a good innovation even though only a small amount of omega-3 can be added to cheese by this technique.

Omega-3 fatty acids are called essential fatty acids because the human body cannot make them. They are good for growing children because they help in visual and brain function development. Diet and supplements are the only source of these nutrients. Cheese is popular among children, therefore omega-3 fortification of cheese makes sense. When it becomes available, watch out for saturated fats and trans fats before tossing it in your shopping cart!

A fun way to learn about nutrition

Cathy of A Life Less Sweet provided a link to Nourish Interactive, a website which is trying to educate parents and kids about nutrition by using online games. It looks very interesting, and best of all, membership is free. Parents and kids can learn together by trying out these games, puzzles and challenges. You will need to create an account for your child to play free. There are many useful interactive tools such as a healthy meal planner which helps you calculate the daily calories for different foods based on your child’s age. I plan to check it out in detail. If you do try it, let me know what you think.

Enjoy your weekend!

Photo source -chefranden on Flickr via everystockphoto
©2009 Littlestomaks.com