Why Feeding Your Child With A Spoon Is Better For Her Development

Written by Jesse Hackell MD

Growing up in the sixties, outer space was truly the final frontier. We greedily devoured all sorts of arcane facts about the nascent space program, from the rigors of pre-flight training to the seemingly more mundane details of how, exactly, one managed to eat and drink in the zero-gravity confines of outer space.

We knew that the astronauts drank Tang, which no self-respecting parent today would ever mistake for fresh-squeezed, locally sourced, organic and pesticide-free orange juice.

And astronaut foods were freeze-dried, and provided in pouches. When water was added to the pouches, the food was rehydrated and reconstituted, and the space explorers “ate” by sucking the resulting slurry out of the mouthpiece of the pouch.

Fast forward fifty years, and pouches aren’t just for astronauts any more. All sorts of fruits, vegetables and combinations thereof, in flavors which would certainly have thrilled early spacemen, are now seemingly the food deliver mechanism of choice for today’s on the move infants and toddlers.

No longer does feeding your baby on the go require a high chair, bib, bowl, spoon and yards of paper towels for clean-up.

Just pop off the top (don’t hand the top to the baby, although the caps are ingeniously designed to prevent choking should the little one happen to get hold of it and have it lodge in the airway), hand the pouch to your child, and–slurp–4 ounces of highest quality, organic produce goes down the hatch.

That’s progress, no? One prediction of the future made in the sixties actually coming true in the twenty-first century!

But I am not so sure that this new feeding mechanism actually represents progress for babies. They are born knowing how to suck nutrition out of a “container”–breast or bottle.

Progress in feeding, for an infant, comes not only in learning about new tastes and textures, but also in learning about new, more mature means of getting their comestibles out of the container and into their mouths.

These pouches (along with so called “sippy cups” with spouts) are really just bottles in disguise. (They are also a whole lot more expensive than either store-bought jars or homemade baby foods.) We do not generally recommend putting puréed foods in baby’s bottle, so why create a new bottle substitute?

Let me make a plea for a return to the older, admittedly messier, mealtime, with the baby sitting upright, wearing a bib, and being fed with a spoon. It will encourage the baby to learn new mouth movements and new positions for eating. And it will provide lots of opportunities for those adorable, messy face baby photographs!

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.

Is Your Child A Proud Member of The Picky Eaters Club?

Written by Melissa Arca, MD., FAAP – This post appeared originally on Dr. Arca’s blog Confessions of a Doctor Mom. Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

Having a picky eater seems to be the norm these days. I’d almost dare to say that children between the ages of 2-7 more often than not wind up in the picky eater category.

Why oh why the sharp jump in membership of The Picky Eaters Club during this time? Researchers believe it could be evolutionary. That way young “cave toddlers” wouldn’t walk around tasting every potentially dangerous thing in sight. Can you imagine? Still, there are far more factors involved here: genetics, personality, and family eating habits to name a few.

My son is no exception. He is a proud card carrying member of The Picky Eaters Club and I am a reluctant member by association, trying to sway my son in another direction.

It all began at the ripe old age of 2. Previously my baby boy would gobble anything placed before him: peas, squash, avocados, blueberries, you name it. I was proud as could be, snapping up pictures of his cherub face smothered in green bean puree.

Then at the age of 2, it was like a switch was turned off (or on, depending on how you look at it), and he was suddenly suspicious of everything that was placed before him.

Pancakes, orange juice, and chocolate milk seemed like the only foods acceptable to his new found sensitive taste buds.

This sent me in a crazy spin for awhile. I wondered what I had done. Certainly I must have caused this sudden disdain for all things considered healthy. I was convinced it was because I introduced bananas first. Or, that I failed to introduce the veggies in the proper order.

Worse yet, I figured I must be missing the magic mommy touch. You know, I didn’t have the finesse to cajole, coerce. or otherwise threaten bribe my child to eat well.

I know (now) that none of that is true. He is five now and I finally took a step back and realized there is only so much I can do. I can’t force feed the kid.

Although I admit, the thought had crossed my mind. I finally made a mental list of the things I could do and stuck to those. The rest is up to him and his discerning palate.

I continue to offer him his daily dose of veggies. All I ask is that he give them a try. It’s up to him whether or not he eats the rest. Did you know it can take up to 10-15 times of being offered a new food before a child will try it? Except, in my son’s case, it’s more like a 100 times…I’m still waiting.

He’s old enough to understand that his body requires a balanced diet. We talk to him about needing protein, fiber, and the good vitamins found in fruit and veggies.

He gets it. Hopefully one day it will sink in enough to not gag at the mere sight of broccoli.

Getting upset at him because he won’t eat the peas on his plate won’t make him want to eat those peas. He knows that he must taste them. Then, we move on. No long drawn out bribing session. We do encourage and praise his efforts though.

I have to admit I still do modify his meals somewhat. If we’re having spaghetti and meat sauce, he gets plain spaghetti with Parmesan cheese and a side of chicken. This is a kid who used to scarf down spaghetti and meat sauce at 18 months old…and yes we have a picture of that too!

Him being a picky eater has nothing to do with my mothering ability. Thankfully my daughter taught me this. At age 3, she is a much more adventurous eater and will gladly eat carrots, broccoli, edamame, and tomato soup. I can’t take credit for that either. Just the luck of the draw really.

I remind myself to look at the big picture. Instead of dissecting what he eats at each meal, I look at how he eats over the course of the week. Some days are better than others but overall, I am usually surprised to discover that he covers most of the dietary bases.

He continues to broaden his food horizons over time. It’s not overnight and I give him a multi vitamin to fill in the gaps. I hope someday he will allow a green vegetable past the obligatory “no thank you” bite. However, I am confident that his membership in The Picky Eaters Club is not lifelong.

So my fellow reluctant members of The Picky Eaters Club, take heart, it won’t last forever. I promise. One day you’ll wake up and find your formerly picky eater can’t get enough of your famous beef stew with peas and carrots.

Are you dealing with your own picky eater? Have you found ways to enjoy mealtime in spite of it?

Ten Tips to Help Prevent Childhood Obesity

Written by Dr. Jennifer Shaer MD., FAAP., IBCLC

There is a lot of attention these days on childhood obesity. How do cute chubby babies grow into unhealthy overweight children? It’s very easy. Weight management is an uphill battle for everyone. It is only successful for adults when they have the desire and determination to make a change. The problem for kids is that they want what they want, when they want it. Children cannot understand the consequences of overeating and lack of exercise. They cannot be expected to make healthy food choices on their own. It is up to parents to instill healthy eating habits in their kids. Here are a few tips.

Be a role model

Eating healthy is a family affair and children learn by example. It is unreasonable to expect one person in the family to be on a “diet”. Set the house up properly and think of healthy eating and exercise as a lifestyle change instead of a diet. Fill the cabinets and refrigerator with healthy snacks, fruits and vegetables. If the chips and junk food are not there, then they are not an option. If a child is whining that he wants the cookies, it is easy to say “no” if there are none in the house.

Watch portion sizes

There is an absolute distortion of what a portion size is these days. Read labels and measure your food just to get a sense of what a portion size is.

Recognize appetite as opposed to hunger

There is a big difference between appetite and hunger. Offer anyone an ice cream sundae and he will have an appetite. Just because your child will eat an entire plate of cookies, does not mean he is hungry.

Stop making your child clean his plate

It is really important to let your child decide how much he wants to eat. Young children have the ability to actually eat when they are hungry and stop when they are full. Your job as a parent is to choose what foods to offer and when to offer them. Your child’s hunger should determine how much of the meal he eats. If he chooses to eat very little at one meal, he will eat more at the next. Mealtime should not be stressful.

Do not use food as a reward

There are better ways to reward good behavior than giving junk food. Everyone should be allowed to eat junk food on occasion. The key is to limit unhealthy foods and limit the portions. Good behavior is an expectation aside from food.

Don’t drink your calories

An easy way to watch calorie intake is to drink more water. Kids can absorb a lot of calories by drinking juice, soda and even milk. When drinking milk, choose fat free.

Slow down. It takes time for the brain to realize that the stomach is actually full. If your child eats slower and drinks water while eating then he will get full faster. Do not allow second portions unless he is truly still hungry. Keep the serving platters off the table to make it more inconvenient to reach for a second serving.

Avoid emotional eating

If your kids are bored or happy or sad, then help them find something else to do.

Do not allow your kids to eat in front of the television or computer

Lots of calories can be eaten without even realizing it when you eat in front of the TV.

Be active as a family

Take a walk or go for a bike ride. Get off the couch and get moving.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York. Dr. Shaer is dedicated to helping nursing mothers achieve their breastfeeding goals.

Starting Solids: The Old and the New and the Myths

Written by Kristen Stuppy MD

Many parents are excited yet apprehensive to start foods with their infants. So many questions, so many fears. So much food introduction guidance has changed in recent years, that what you did with your older kids might not be current. Change takes time, so not everyone agrees on the “new” rules. Talk to your own pediatrician to see their take on it all!

The older “rules” for starting foods were so confusing… different sources will vary on these rules.

• don’t feed before 6 months is now ok to feed at 4 months if baby’s ready
• don’t give nuts, eggs, and other “allergy” foods until ____ (2/3/5 years, varying by expert) is now it is okay to give allergy foods unless there is a family history of food allergy
• don’t start more than one food every 3-5 days is now introducing multiple foods at one time is ok
• start with rice, then add vegetables, then meat., wait until last for fruit is now begin with any foods, but try to make nutritious choices, such as meat which is high in iron and protein

Variations of this were plenty, depending on the provider’s preferences. No wonder there is so much confusion!!!!

New rules are much easier. I like easier.

• Start new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.
• Don’t give honey until 1 year of age.
• Don’t give any textures your baby will choke on.

Done.

That’s it. Nothing fancy. Any foods in any order. Multiple new foods on the same day are okay. Common sense will hopefully guide types of foods. Nothing too salted. Try nutritious foods, not junk.

These minimal rules can make parents weary.

What about food allergies if foods are given too early?

Research does not support the thought that starting foods earlier lead to allergies. In fact, there is research to support that starting foods earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases. If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. Talk with your pediatrician in that case.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. ~ Back to the no textures your baby will choke on… nuts are hard and round– two no-nos, peanut butter is thick and sticky– another choking risk.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food.

Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent (not cause) allergy. In the case of nuts, since there is also a choking risk, you can try a food cooked with nuts or nut oil.

What about saving the fruit for last so they don’t get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven’t had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods. Saving fruit for last simply doesn’t seem to make a difference.

Adding fruits alone is not very nutritious though, so fruits should be added along with other more nutritious foods. The more colors on our plates, the healthier the meal probably is!

I thought they couldn’t have cow’s milk until after a year?

Cow’s milk is not a meal in itself (like breast milk or formula). It is missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. Cow’s milk may lead to allergies or eczema, including formulas made with cow’s milk.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well rounded diet as long as they don’t show any allergy risks to milk. Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first…

Rice cereal has been the first food for generations, probably because grandma said so. There has never been any research supporting giving it first. With white rice and other “white” carbohydrates under attack now, it is no wonder the “rice first” rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn’t we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed. Pureed meats (preferably from your refrigerator… baby food meats are not very palatable!) are a great source of nutrition for baby! Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we know what they’re allergic to if we start several new things at once?

First, most kids are not allergic.

Second, if they are allergic to a food, it is often days/weeks/months before the allergy is recognized. Waiting 3 days between food introduction simply doesn’t allow recognition unless it is hives or anaphylaxis, and there are a small number of foods that account for most of these reactions.

If your child has one of these reactions we can test to see what the offender was. This is recommended with severe allergies since people with one allergy might have other allergies, and identification for avoidance is important.

Allergy symptoms can be broad and often are not specific: dry skin (eczema), runny nose, hives, swelling of lips, difficulty breathing, vomiting, diarrhea, or blood in the stool. If you think your child is allergic to a food, discuss with your doctor. Severe symptoms (anaphylaxis) demand immediate attention!

How do we know when to start foods? I wanted to start to help baby sleep through the night, but I heard starting too soon increased obesity and diabetes.

When babies are able to sit with minimal support and hold their head up and when thye show interest in food by reaching for it they might be ready. They can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

In formula fed babies it has been shown to increase the risk of obesity at 3 years (6x!) if foods are started before 4 months of age. That risk is not seen in exclusively breast fed infants or those who begin foods after 4 months of age.

It is still an old wive’s tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods. As they eat more food, they will need less breast milk or formula. In general a baby who is gaining weight normally will self regulate volumes.

What’s better: baby foods bought at the store or home made foods?

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home made foods. I didn’t make baby foods when my kids were babies because I thought it would be too hard, but now I puree foods to put into recipes (my kids are like many who aren’t fans of veggies and I want to improve their nutrition). It really isn’t hard. You can take whatever you are cooking for your family and put it in a food processor or some blenders and with a little water to get it to a texture baby can eat: voila! Home made food. There are of course many baby food cook books and ideas of how to freeze meal-sized portions so you can make multiple meals at one sitting. There is help for parents who want to safely prepare baby food at home at the USDA website.

My baby only wants table foods. Is that okay? Don’t they need pureed foods first? He doesn’t have many teeth!

Pureed foods are what most babies start with due to the easy texture, but some babies quickly develop the ability to pick up small pieces of food with the pincher grasp (finger/thumb) and want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods… at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

Most babies will be able to eat table foods between 9 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Don’t put the whole meal on their tray at once… they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

How much juice should my baby drink?

In general I think babies don’t need juice at all. They can practice drinking from a cup with water. Juice adds little nutritional value and a lot of sugar. Eating fruit and drinking water is preferable. If they do drink juice, it should be 100% fruit or vegetable juice, not a fruit flavored drink! No more than 4 ounces/day of fruit juice is recommended.

What about organic?

There is not enough evidence to recommend organic food, since the nutritional components of the foods are similar regardless of how they were farmed.

Organically grown foods do have lower pesticide residues than conventionally farmed produce, but it is debated if this is significant or not to overall health. Conventionally farmed produce have the pesticide levels monitored, and they fall within levels that are felt to be safe.

Organic farming rules also dictate no food additives or added hormones, which is also an area of study for health risks and benefits, but not enough data is available to give an educated opinion yet.

Organic farming is generally felt to be better for the environment, but the sustainability of that is questioned.

Many argue that the taste of organic foods is superior.

Organic farming might increase the risk of bacterial and fungal contamination or heavy metal content, so it is very important to wash fresh fruits and vegetables well prior to cutting or eating (as you should with all fresh foods).

For more information, see the USDA site.

A backyard garden can be inexpensive, organic, and a great way for your kids to learn about growing and preparing healthy foods!

 

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

When The Joy Goes Out of Eating, Nutrition Suffers

The title of this post is a partial quote from pediatric nutritionist Ellyn Satter. Here is the entire quote:

“The secret to feeding a healthy family is to love good food, trust yourself, and share that love and trust with your child. When the joy goes out of eating, nutrition suffers.”

The quote comes from a blog post titled Constructing Snacks into Mini-Meals on Dr. Wendy Sue Swanson’s blog, seattlemamadoc.com.

I found the article very interesting. Particularly because in our house, snacking is a bit of an issue. In fact, for my kids, snacks seem to be more important than the actual meal.

I’ve come to the conclusion that the only reason my kids eat regular meals, is because otherwise, they won’t be able to have a snack or dessert. It is like they view it as a means to and end. This is what I assume goes through their heads:

“The only way I’m gonna get the snack, is if I eat my lunch. Might as well eat the lunch, so I can get to my snack.”

And apparently, my family is the not the only one with this issue. It is a growing trend in the US.

Over the past 20 years, the amount of calories consumed by children from snacks has increased by 30%. Kids eat a third more calories everyday from snacks! What kids snack on certainly can reflect how their diet is shaped and how they grow. Plain and simple: snacks make us fatter by packing in lots of calories in relatively small bits of food, the definition of “calorie dense” foods. They also discourage our eating of things like fruit and veggies because they fill us all up. One recent study found it was our over-consumption of snacks more than our under-consumption of fruits and veggies that is getting us into trouble.

Dr. Swanson says that there has a huge shift in the way children eat and get their nutrition in the US. She highlights some examples, such as:

• The introduction of processed foods in the 1970’s transformed what we eat from fresh to packaged food
• TV advertising of snacks directed at kids increases their desire for snack foods
• The challenge for busy families to find time to sit down and eat meals together
• Watching TV during meals in households
• Ubiquitous availability (they are everywhere!) and easy access to snack foods
• It is okay to be a little hungry. Dr Grow says, “Teaching kids it’s okay to get a little bit hungry (not ravenous) and work up an appetite for a regular meal” is a healthy way to learn to eat right.
• It’s our worst fear that our kids will starve. It’s almost an instinct to offer and offer and offer food all day. Our kids won’t starve, especially if we offer 3 meals and 2 healthy snacks daily.
• Red/Orange/Yellow packaging is dangerous. These colors are known to make you hungry and eat more. Advertisers know this! Think about leading fast-food chains, junk food, candy bars and soda containers. Red/Orange/Yellow is threat level alert for high-calorie foods that often have little nutritive value.

We’ve written about snacking before on Survivor Pediatrics. In the this post, Dr. Hackell ask: with the national alarm increasing about the rate of obesity in our children (and adults as well), what message are we giving our children about eating when we provide them with a continuous stream of things entering their mouth throughout the day?

Dr. Swanson does offer a possible solution. She mentions the idea of switching the snack for a mini-meal. So, anything that we would feel comfortable eating during a normal meal, but in smaller portions.

I like this idea. Except the part about preparing yet another meal, even if it is mini. Snacks in little packages are just so convenient. But I guess I’ll give it a try and see.

To read the rest of Dr. Swason’s post, click on the link.

Making Healthy Food Choices For Your Children

Written by: Joanna E. Betancourt MD., FAAP

I have many parents that come to our clinic with concerns about their children’s weight. They complain that the children only snack on unhealthy things like chips and cookies and they don’t like to drink water or milk but rather drink sugar drinks.

I often ask parents, where do they get all this junk food and drinks? And they grin or smile back with a little bit of culpability because they know where I’m going with the question. Parents are the ones buying all this stuff and putting it in the pantry. So, it isn’t a big surprise that the child prefers the junk food over the healthy foods.

You don’t have to be a doctor to know that if you give a child a choice between an apple and a chocolate chip cookie, most kids are going to prefer the cookie.

A big part of living lifestyle is making the right food choices. And the responsibility lies within the parents, not the children, because the parents are the ones that make the food buying decisions.

The HealthyChildren.org provides excellent guiding principles to keep in mind when planning and preparing meals for your family. Below are just a few:

• Vegetables: 3-5 servings per day. A serving may consist of 1 cup of raw leafy vegetables, 3/4 cup of vegetable juice, or 1/2 cup of other vegetables, chopped raw or cooked.
• Fruits: 2-4 servings per day. A serving may consist of 1/2 cup of sliced fruit, 3/4 cup of fruit juice, or a medium-size whole fruit, like an apple, banana, or pear.
• Bread, cereal, or pasta: 6-11 servings per day. Each serving should equal 1 slice of bread, 1/2 cup of rice or pasta, or 1 ounce of cereal.
• Protein foods: 2-3 servings of 2-3 ounces of cooked lean meat, poultry, or fish per day. A serving in this group may also consist of 1/2 cup of cooked dry beans, one egg, or 2 tablespoons of peanut butter for each ounce of lean meat.
• Dairy products: 2-3 servings per day of 1 cup of low-fat milk or yogurt, or l’/2 ounces of natural cheese.

Of course, the idea is not to overwhelm your children with drastic changes. However, little by little you can make a difference. For example, if your child wants chicken, it is better to “choose” baked or grilled chicken instead of a fried piece of chicken. Or when giving them a snack, consider pretzels or plain popcorn instead of potato chips.

Keep this in-mind when going to the grocery store next time. And remember, making healthy food choices is part of raising a healthy child.

Dr. Betancourt is a practicing physician. She is a mother of 3 young children (12, 8 and 5). She practices in the western suburbs of Chicago. 

Introduction to Solids – 6 Myths

Written by Natasha Burgert MD

 

At the 6-month check up, nearly all of my patient families want to talk about starting their babies on solid food. The conversations usually start like this…

“I go get all of Gerber stage 1 foods and then do all the greens, then the yellows, then the fruit. After she eats all of the stage 1 foods, then she goes on to stage 2, right?”

Or this…

“I have gone to the farmer’s market and bought all organic produce to make his baby food. I am following the [insert name here] recipe book that I got from a friend, and their baby is such a great eater. Do you think bulgar wheat or quinoa is better?”

Or this…

“I have already given some rice porridge with scrambled egg, and some broth with root vegetables. Can I start tofu now?”

As these real-life conversations demonstrate, the plan and expectation for introducing solid food to babies is different for every family. The food items that parents first feed children is influenced more by culture and generational upbringing, than by any scientific research or product marketing plan.

And, that’s OK! In fact, it’s wonderfully liberating news for parents who are really stressed out about first foods.

So, what are my general guidelines when it comes to starting infants on solid foods?

• I encourage the families of healthy, normally-developing children* to start solids near or after 6 months of age.
• I want parents to give babies a great variety of real food, in a safe way.
• I think of pureed foods as practice and play to develop the skill of eating; nutrition is still from breast milk or formula.
• I try to challenge my families to think outside of the Gerber-defined box and give babies interesting tastes, but no raw honey until after the first birthday.
• That’s it. Go. Eat.

Wait a minute…. There has to be more. What about the rule about veggies first? Babies can’t have dairy, right? What about spicy stuff? They aren’t supposed to have strawberries or oranges, either!? My mom wanted to give her yogurt, and I told her “no.” Please don’t tell me she is right!?! And you have said nothing about rice cereal.

OK, so maybe there is a little bit more. But, likely not what you expect. When continuing the food conversation with families, some common myths creep to the surface.

It’s tIme to bust some common “starting solid food myths” … for good!

Myth #1: Rice cereal must be first.

Rice cereal has traditionally been the first food for babies in the United States for generations. But, why rice cereal? It is convenient – easy to obtain and easy to feed. Baby cereal is also fortified with iron and other nutrients. This promoted as a benefit for those infants who need some supplemental vitamins and minerals in their diet. Click here for information about iron recommendations for infants.

Giving rice cereal as a first food is under active debate. Specifically, Dr. Alan Greene is noted for starting a “White Out Now” movement. He encourages families to feed infants whole, natural first foods instead of rice cereal.

Dr. Greene discusses how the food industry has marketed and advertised to parents so heavily, the industry has created doubts in our minds regarding what is best to feed babies. We, as parents, start to believe that the healthy foods that we eat are not “good enough” for our babies.

Dr. Greene’s is also concerned that rice cereal primes infants to crave only carbohydrate-rich foods, contributing to the obesity epidemic. Other physicians have debated his theory,but I think his general concern for the quality of first foods is worth notice.

For the first few months of eating solids, an infant’s nutrition is still based upon the healthy calories given by breast milk and formula. That allows pureed foods of all forms to be first foods, as they have for centuries.

Expand beyond the rice cereal “default”. What about some pureed red meat as a first food? What about whole grain cereal, oatmeal, or a pureed fruit or veggie? Maybe, something you have in the fridge? (see #2)

Myth #2: Making baby food is hard (A.K.A. I don’t have time to make baby food.)

I hear this a lot; mainly from parents whose only experience with baby food making is observing a few moms with fancy baby-food makers, complicated recipe books, and bags of locally-sourced organic ingredients. This “all-in” approach to pureed food making can seem overwhelming and unreachable.

But, let me offer a suggestion…

In my clinical experience and personal experience, the earlier you get your baby eating the healthy meals that you provide your family (in a safe, modified way), the better they will eat as toddlers. So, I challenge all my families to try to make some first food… simply.

I do not talk about making baby food with the claims that it is of greater superiority to jarred baby food. There are some great commercial baby foods on the shelves today. But, babies have survived for many years before infant food was available in aisle 4B of the grocery store; and I think only offering what a food company can put in a jar is actually quite limiting to a baby’s early taste experiences.

To make baby food, you need soft foods (fruits, veggies, whole grains, meats), a little water, and a machine to puree. The machine could be a food mill, a blender/food processor, or a strong arm with a fork. Voila! Simple as that. I bet there is something in your kitchen right now that you could whip up for baby. Last night’s grilled chicken breast? Leftover green beans? Melon? Avocado?

As a working parent, I certainly bought prepared baby food. But, I made a lot of food for my infant, too. For me, it was easy, cheap, quick, and just part of the routine.

So, I challenge you to try to make some of your baby’s first tastes. Experiment and have fun! Decrease your family’s food cost, decrease shipping and packaging waste, and increase the palatable options for your baby to try.

Myth #3: Starting solids will help my baby sleep through the night.

Nope. It doesn’t.

Starting foods too early may actually have some negative consequence including obesity, food allergy, and decreased sleep!

Yikes!

Currently, it is recommended that first foods should be started around 6 months of age. This age is preferred for both the developmental ability of an infant to take food off a spoon, in addition to decreasing the risk of food-associated allergies and obesity.

Eating solid foods is a developmental skill, not a way to “fill baby up” to sleep longer. So don’t let this myth determine when you start solid food.

Myth #4: Greens, then yellows, then oranges.

There is no evidence to suggest that if you offer baby fruits first, she will never eat veggies. Regardless of what order food is introduced, kids (and adults!) will always prefer sweeter-tasting food items. Offer your baby foods of all colors of the rainbow, in no specific order.

Myth #5: My baby can’t really have the food that I am eating.

I think the origin of this myth/concern stems from parents knowing the kind of diet they have. Feeding our children is often an examination of what we, as parents, feed ourselves.

If a parent’s diet consists of fast food, takeout, and late-night snacks then the thought of feeding baby exactly what you eat is ridiculous. Agreed. But, if you are not willing to feed what you eat to your baby, maybe it’s time to think about the nutrition and healthy eating choices for the entire family.

If a family eats a healthy, well-rounded diet then the concept of offering baby what you eat is not such a scary idea. Make healthy, positive food choices, include your baby, and see the long-term benefits for the whole family.

Myth #6: Oh, no.. baby can’t have that.

Currently, for healthy babies who are not in a family with significant food intolerance and allergies, the only thing babies under the age of 12 months cannot have is raw honey. Honey may contain harmful botulism spores that could make small babies very ill.

That’s it.

The research regarding introducing solid foods is actively changing. This means the foods that have been traditionally restricted until later in toddlerhood (eggs, shellfish, peanut butter) are no longer on the “Do Not Have” list. In fact, some recent data suggests that delaying the introduction of high-allergy foods (shell fish, nuts, eggs) actually increases the risk of developing a food allergy.

Other studies do not show an increase in allergic disease by starting allergenic foods early. In addition, adding dairy sources (cheeses, yogurt) and animal proteins (meat, chicken, pork, fish) can be added at any time.

Expand the box. Think about your own diet, and what you want your kids to eat. What is acceptable for your family, your culture? Don’t let Gerber or Earth’s Best or [insert baby food company here] make those definitions for you.

Your baby just might surprise you… mine certainly did. Within a very short period of time, my 8-month old son’s favorite food was my husband’s recipe for chili (pureed) – extra spicy!

Have fun!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

* Starting solid foods may be very different for children with a significant personal or family history of allergies, milk intolerance, or skin issues. It may be very different if a sibling had challenges with foods. It certainly will be unique if a child is not growing correctly. If your child has any of these issues, or you have specific concerns about your child, please ask your pediatrician for guidance.

What is the most important thing I can do to make sure my child is as healthy as possible?

Written by Nelson Branco MD

No pediatrician can answer the question: “What’s the most important thing I can do to keep my child healthy?” without listing three of four things.

I’m no different, but right now family dinners are at the top of my list. You could argue that immunizations, car seats, bike helmets, 9-1-1, sleep, or good hand washing are just as important, and I won’t disagree.

But it’s hard to overlook the overwhelming research on the positive effects of family dinners on children’s diet, social development, and sense of connection with their parents and siblings.

Family dinner means sitting down to eat with an adult, without any distracting screens, on most days of the week. It also means everyone eating the same meal. With our busy lives and overscheduled kids, this can be difficult but not impossible. Even if you can’t do it every night, it’s worth rearranging the schedule so that some nights everyone can eat together.

Benefits of the family dinner vary depending on the ages of your children. For the toddler and preschooler, the family dinner will be short. Most toddlers will sit at the table for just a few minutes before getting distracted and wanting to run off and play.

The importance of the family dinner for them is modeling good eating habits and improving their diet. Children who are fed a separate meal will eat from the “Kids Menu” more often. This usually means hot dogs, pasta, chicken nuggets, macaroni and cheese and other foods that they are quick and easy to prepare, and don’t challenge their taste buds too much.

When you serve a meal for the entire family, the toddler is forced to watch you eat all sorts of different foods. (Assuming that your diet is better than the “Kids Menu” choices.) Colorful things – green, yellow, red, and sometimes even blue. Lots of textures and tastes, and more variety than they would choose on their own. This isn’t going to be immediately popular unless you have an adventurous eater. But over time, even the pickiest eaters will try new and different foods – after watching you eat them 100 or 1000 times.

For the school-aged child, family dinners are a time to share and talk. This is where they practice telling you about school, their friends, the picture they drew that day, the insect they found in the backyard or what books they are reading.

This is a time to practice manners – I can guarantee that you will have at least one conversation about the appropriateness of potty talk at the dinner table, and if say it enough times, they may start to use a napkin to wipe their mouth instead of a sleeve.

Many families have a regular way of sharing the day’s experiences: “What was the best and worst thing that happened today?,” “Highs and Lows,” or “What are you thankful for?”

The family dinner provides opportunities for assigning chores and responsibilities. Kids should learn that being part of the family means sharing the work as well. Setting the table, pouring drinks, clearing plates and washing and putting away the dishes are all things they can do to help.

If your child is interested, they can even take part in planning meals, shopping and cooking. For the very picky eater, helping cook can get them interested in foods they would otherwise never think about eating.

As kids get older, family dinners are even more important. Teens are going through a developmental stage where they are separating from their parents and joining a peer group.

Keeping tabs on them while they make this transition is important, and family meals give you a regular time to sit and talk about what’s up. If family dinners are a regular occurrence, you’ll notice when something is bothering your teen.

Take the time to sit down and eat with your kids, even if it’s not convenient. It doesn’t have to be every night, and it doesn’t have to be both parents. Eating healthy meals with your kids is a win for everyone.

 

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

Eating healthy meals with your kids is a win for everyone.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

Is Providing Food Snacks To Children Contributing To Obesity?

Written by Dr. Jesse Hackell

I recently had a call from a local child psychologist, one to whom I regularly refer patients. After the usual pleasantries, and her report on her findings about, and treatment plan for, the most recent patient, she hit me with a question that I had never been asked before. “Why,” she inquired, “do so many patients seem to think that my waiting room is a picnic area?” When I inquired about what she meant, she went on to describe a recent family who brought a child in for an appointment, and while sitting in the waiting room, proceeded to spread out a cloth on the floor, and actually start giving the three year old child a variety of snacks. This was not, she was careful to inform me, at a normal lunch hour.

I had no good answer, but it did set me to observing my own office. I quickly came to realize that not a day goes by that the exam rooms and waiting area are not littered with candy wrappers, discarded juice boxes, raisins and crumbs of all descriptions. And while I have not found chewing gum stuck to the underside of the exam tables (yet!), many surfaces in the office end the day with unidentifiable sticky patches on them. But maybe worst of all is asking a child to open his or her mouth and finding the mushy remains of a chocolate cookie, pretzel or bagel coating the tissues one is trying to assess.

We do a pretty good job of running on time most days, getting patients out of the office within a half-hour or so of their arrival (see Dr. Lessin’s recent post), so most of the time patients are not sitting around waiting for more than a few minutes, either in the waiting room or the exam room. Are our children so nutritionally deprived that they cannot go thirty or even sixty minutes without some sort of food or drink, lest they starve?

But it goes further than the crumbs underfoot in the exam rooms (where we do expect our patients to be barefoot during some examinations) or the sticky patches on the waiting room chairs. Children in pre-school and all the way through elementary school seem to have snack time, sometimes twice a day, with cookies and juice provided two hours after breakfast and two hours after lunch.

With the national alarm increasing about the rate of obesity in our children (and adults as well), what message are we giving our children about eating when we provide them with a continuous stream of things entering their mouth throughout the day? We know that eating habits and relationships with food which are developed and reinforced in childhood will persist readily into adolescence and adult life. I fear that we may be creating problems for a whole new generation of people when we make food and snacks available at every waking moment of a young child’s day.

Signs in the office requesting patients and family members to refrain from eating and drinking have some effect, at least on our office cleaning bills. But I think we need to carefully think about the messages we give to parents about feeding their children. Breast feeding, even on demand, is fine, but even feeding an infant too frequently can develop a “snacking” habit, where the baby never learns to take a full feeding which will last a few hours until the next feeding time. But once the child moves on to beikost (German for foods other than milk or formula), we need to help parents develop a schedule where times for meals are separate and distinct from times where food and drink is not offered.

There are a whole host of potential benefits to this pattern, not the least of which might be less of a focus on food and drink as a continuous feast, and, just possibly, a reduction in a child’s total daily calorie intake. But teaching our children that the times when we eat are discreet and separate moments might also go some way to returning eating to a social, and not just refueling, activity.

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.

Things Your Mother Told You That Were Wrong

by Herschel Lessin MD

My first appointment of the day is a visit I enjoy immensely: the first well baby visit for a new mother and her newborn infant. At this visit, new mothers and very often new fathers, will have their first interaction with the Pediatrician. They usually come loaded with questions. After all, babies don’t come with an instruction manual. Despite the many books on the market that try to serve as one, there is nothing like a dose of reality to make the entire process seem nothing short of overwhelming.

EVERYONE IS AN EXPERT

If you’ve ever been pregnant or had children, you’ve undoubtedly noticed an odd phenomenon. People who normally wouldn’t even consider giving unsolicited advice about your personal life seem suddenly unable to suppress their desire to tell you all the secrets of delivering and raising a healthy and happy child.

Most of the advice is very good and will work very, very well. A lot of it, however, falls into the category of “Old Wives’ Tales”.

TO WHOM DO YOU TURN?

One does not have to be an old wife to pass along an old wives’ tale. In fact, a lot of what people call “common sense” is not really very sensible. As a parent, you must make decisions that affect your children’s lives, and yours as well. It is one of your many jobs as a parent to filter through the enormous amount of well meaning advice you receive and decide which of it is useful and effective.

Your Pediatrician ought to be of some help here. A large part of pediatric practice is the giving of advice that helps parents cope with the thousands of small day to day challenges that this new young person in their lives will bring. Your doctor should be ready, willing and able not only to dispense such advice, but to comment on advice given by others and found in the media (including the Internet). My job as the Pediatrician is to give you a convincing reason why my advice might be better than your mother’s.

OLD WIVES TALES ABOUT FOOD

The care and feeding of children is a fertile area for unsolicited advice. Feeding a child has an emotional impact that is often way out of proportion to the problems involved. This is easily understood, since if we can’t even feed our children, what kind of parents are we? The wonderful truth is that our kids seem to survive and thrive no matter how we try to feed them. Now I am not talking about families in which poverty prevents children from getting enough to eat. I am talking about middle class families where this is not an issue. Here are a few pieces of advice you ought to ignore:

If you don’t force a child to eat, he’ll starve. NOT TRUE.

Young children generally eat when they are hungry, rarely overeat, and refuse food only when it they honestly don’t want it, or if it upsets their parents enough to be fun. Never fight with a child over food. You will lose.

Early introduction of solids will make a young infant sleep through the night. NOT TRUE

Infants generally do not want or need solids prior to around 4 months of age. They will sleep through the night when they are good and ready. Giving them a few spoons of cereal at bedtime which contains perhaps 20 calories will not put them out for the night.

You shouldn’t give a child with a cold, milk because it causes phlegm.

Unless your child is one of the few that are actually allergic to milk, there is no truth to this one. If your child with a cold wants milk, give it to him. No harm done.

OLD WIVES TALES ABOUT FEVER

Fever and illness is another fertile area for bad advice.

“Feed a cold, starve a fever…” or is it “Starve a cold and feed a fever?” It really doesn’t matter, since both are wrong. Good nutrition is important to all children, especially sick ones. One should maintain the best nutrition possible, regardless of colds or fever. If a child has a stomach bug, some degree of dietary restriction is often suggested, but a quick return to good nutrition is always the goal.

A high fever is dangerous.

While the disease that causes the fever may indeed be dangerous, the fever itself is not. A fever in a child that is acting well is rarely a cause for alarm. The only exception to this is in the case of heat stroke, where the body’s sweating mechanism is not working. Then body temperature can rise to 107 or higher which is a danger all by itself. In the absence of heat stroke, the temperature will not rise more than 106, which while very scary, will not, in itself cause harm. A high fever can be an indication of a serious underlying illness, so high fevers should always be discussed with your Pediatrician.

Parents are constantly asking me if it is OK to give their feverish child a bath. It is OK. A lukewarm bath may help lower the temperature and may make the child look and feel better. So bathe away — it’s not a problem. Just don’t let the child get so cold as to shiver. That will raise his internal temperature and make him feel worse.

You must keep a head injured child awake. Not Always

If your child has a head injury that is severe enough to cause loss of consciousness, it is severe enough to seek immediate medical attention. If your child has a minor head injury, it is often normal to be sleepy, but not unconscious. Trying to keep such a sleepy child awake will only make him feel worse. One should check such a child frequently to make sure he is arousable, and always call your doctor for further instructions after any significant head injury.

OLD WIVES TALES THAN CAN CAUSE HARM

While most old wives tales cause only anxiety, a few can cause harm. The most common one is the advice to put something greasy like butter on a burn. This is dangerous. Grease will hold the heat inside the skin, deepening the burn and making it more severe. If your child is burned, the first thing to do is to get something cool, but not freezing, on it. This will reduce the heat and minimize the damage.

Poison ivy is dangerous if it involves the eyes.

Old wives’ tales also wrongly tell us that some very mild things are dangerous. Poison ivy on the face may cause swelling of the eyelids, but while this is very uncomfortable, it will cause no lasting harm. Oh, and by the way, poison ivy is caused by oil found on the plant. Once it is washed off, you cannot spread poison ivy by touching the affected areas.

Another worry is that one should not let a child cry because that will cause him harm or he’ll choke. This is not true. The only one harmed by prolonged crying is the parent listening to it.

COLICS

There are few things in life as miserable to live through as the first 3 months of life with an infant who has colic. The old wives will tell you that there is something that you are doing to cause the colic or that there is a real medical problem. Once a good physical examination has ruled out organic illness, you should realize that not only is it NOT your fault, no one has any idea what causes colic. It is extremely common, and that there is very little anyone can do to make it better. It will, however, magically go away after the baby is 3 months old, if you live that long.

A FEW MORE PIECES OF QUESTIONABLE ADVICE

Over the years, I have heard of more complaints and illnesses attributed to teething than almost any other cause. Some facts about teething. First of all, it rarely is severe enough to wake a child up at night out of a sound sleep. If your child is up at night and has a cold, think ear infection, not teeth. Teething does NOT cause fever. It does not cause congestion or mucus and it does not cause diarrhea. It can make an awake child irritable and is best dealt with by either occasional use of rub on anesthetics or by giving a dose of acetaminophen by mouth.

Another thing new parents are often told is: “Don’t pick the baby up all the time, you’ll spoil him!” This is absolutely wrong. Young infants need to be picked up a lot in order to have normal psychological development. As they get older, they can be spoiled, but rarely by paying attention to their legitimate needs.

I am also amazed at how important it is for people to have their children be “regular.” Perhaps it’s the influence of all those laxative commercials. Being regular is of no importance to young children. Most children will find their own pattern and timing of bowel movements, from once a day to once a week for some infants. Going once a day is not special.

I’ll finish up with feet. I’ve never understood why so many grandparents feel that if you let a young infant stand up, he’ll get bow legs. He won’t. And believe it or not, buying an infant an expensive pair of shoes will not prevent flat feet. Aside from the fact that all infants have flat feet, this is rarely, if ever, a problem at any age as long as the foot is flexible. In any case, shoes make absolutely no difference.

CONCLUSION

Bringing a new baby into your lives is an exhilarating and exhausting experience. It can provoke a great deal of anxiety. I encourage new parents to seek out advice from any source of support that you can find. Just be sure that the advice is good advice, so you don’t fall victim to old wives’ tales.

Dr. Lessin has been practicing Pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children’s Medical Group