Nutrition: Some Things Old and Some Things New

     One might think there’s nothing new in the field of nutrition. We have been feeding our children for years, so what can be different now? The following bits are meant to be informative, but not comprehensive. They will give you a “taste” of the many issues, some old, some new, that you can discuss with your pediatrician.     INFANCY: Pediatricians highly endorse breast feeding through the first year of life. There is growing evidence that breastfed babies have less overweight problems in later life. They learn to control their appetite more effectively than bottle fed babies. Besides an optimum source of nutrition, breast milk has immune benefits. Breast milk contains living white blood cells and antibodies, which although not perfect, can lead to less illness in nursing babies. Only vitamin D needs to be supplemented daily using infant drops, available as Vitamin D  alone or in combination with Vitamins A and C.

     Solid foods are encouraged starting at about 5 to 6 months of life. Babies really aren’t developmentally ready to chew foods much before then. Although traditionally babies have been started with iron-fortified infant cereals as their first foods, many pediatricians are now suggesting starting with pureed meats as first foods because meats are a superior source of iron. Believe it or not, iron-deficiency anemia is still a problem in older infants and toddlers. Iron is essential for healthy brain growth and development.

     Pediatricians still advise against putting pureed foods or cereals into infant bottles or bottle-feeders, for many reasons. First, babies can’t say “no” to finishing the bottle. As a result, they can receive excessive calories. We prefer parents offer baby pureed foods by spoon. Babies can say “no” to this by turning their heads away, closing their mouths tightly, or spitting it out. Feedings from bottles are generally swallowed even if baby is full, but are often burped up later.

     Variety is the spice of life and the basis of sound nutrition. A parent’s duty is to offer a variety of cereals, fruits, veggies, meats, eggs and grains as the infant and toddler grows. Pediatricians differ in their specific dietary instructions but most follow the same general principles. Your doctor will be happy to discuss the “how to” with you.

     TODDLERS: Parents should encourage their toddlers to feed themselves. Fingers are just fine -- messy, but OK. Parents can still supplement with the occasional spoon feeding, but let your toddler hold food pieces in his/her own hands. Many parents just spread an old shower curtain under the high chair to catch what’s thrown on the floor and facilitate the clean-up.

     Making your child finish everything on the plate is no longer the goal! A parent’s duty is to put out a safe variety of finger foods, in moderate amounts (so not much is wasted if not finished), colorfully and attractively presented on the plate or tray. “No” is often not only the first word uttered by toddlers; it’s also often the body language expressed over food. When your toddler says no to a food item (taste, color or texture), just keep presenting the same food 10 to 15 times in subsequent meals. Usually it will eventually be taken and enjoyed. No lectures or explanations of health benefits to your toddlers, please! Stay calm, no bribes, keep smiling and re-offer. It’s the way of the world.

     So what’s safe food at this stage? PIECES, bite sized, soft, easily held, crushable and chewable (gummable), usually the size of your child’s thumb nail. Store bought is expensive, but convenient. Homemade is inexpensive, but a bit more work. It’s that simple. Until your child is 4 to 5 years old it would be wise not to serve chokable items, e.g. whole nuts, raw veggies or large chunks that can be aspirated into the lungs. If this sounds extreme, it isn’t. A few weeks ago, I sent a 2 ½-year-old to the emergency room because his breath sounds were uneven when I listened with my stethoscope. He saw me for some minor reason, had minimal cough and seemed happy, but I could not explain his uneven breath sounds. He seemed generally well. On further questioning, Mom and Dad said that he had just started eating almonds three days earlier. He did not choke at all! The ER docs confirmed my observation and called in the ENT (ears, nose, throat) doc to consult. At 3 a.m. our friendly pediatric sub-specialist removed three almond pieces by bronchoscopy from the child’s windpipe. He did fine thereafter.

     Pureed nuts are fine. Yep, you heard me. The effort to prevent nut allergy by delaying nuts until after 2 years of age has been a total failure. The newest information is that offering pureed nuts in small amounts weekly during the first year of life (after 6 to 7 months of age) is more likely to prevent nut allergy than withholding nuts until the child is older. Now that’s a fascinating concept and worth talking to your pediatrician about.

     More to come in future installments on nutrition in children and teenagers, and we’ll talk some about dental care too. Why not?? Any questions or comments, I’d love to hear from you.

     Dr. T/ Marc Tanenbaum, MD  www.priority-pediatrics.com