Toddlers Archives - Page 29 of 34

Sippy cups are not a developmental stage

At a baby’s six month old check-up I advise parents to have their child start drinking from a cup.

Some respond with surprise,” A cup? So young? How exciting! Do you mean a sippy cup?”

“No,” I explain. “A regular, open face cup.”

Then I get incredulous looks. “But how will our baby manage that?”

Just like your baby “learns” how to eat food off a spoon, she will have to practice. You will have to help her at first. Just put water in the cup. Who cares if water spills? You see how by this age she naturally puts her hands together and pulls most things to her mouth. With practice, she will learn to drink out of a cup. Just like everyone else did before sippy cups were invented.

“But when,” parents ask me, “should we introduce the sippy cup?”

The reality is, sippy cups satisfy a parent’s desire to be neat and to avoid mess. Sippy cups are not a developmental stage. Did I use sippy cups with my own kids? Yes I did, especially with my twins, because anything I could do to decrease mess in my home I welcomed with open arms. But it is perfectly okay to never introduce sippy cups to your child.

Because sippy cups are spill-proof, it is tempting to leave one out all day for your child. If the cup contains water, this practice is safe. However, many toddlers have ended up with a mouth full of cavities in their brand new baby teeth after sipping milk or juice all day long out of sippy cups. Constant sweet substances on the gums can sink in and affect baby teeth. Just as we advise parents of bottle fed babies to avoid allowing the child graze from the bottle all day and to avoid falling asleep drinking a bottle, young children should not be drinking sugar-containing drinks, including milk, all day from a sippy cup.

“But I only give my kids water mixed with a tiny bit of juice in the sippy cups,” I hear parents say. Yes, kids (and grownups) need water, but watered down juice is not the same as plain water. Watered down juice is sugar water, and it harms teeth just like straight-up juice. In addition, drinking watered down juice teaches kids that all beverages need to be sweet. Sweet drinks do not actually quench thirst; rather, they make kids feel thirstier. Remember that unlike adults, babies and toddlers have not formed unhealthy habits yet, so teach them that water and milk are for drinking. The only exceptions are electrolyte solutions that are used to prevent dehydration during vomiting and juice once a day (prune, pear, or apple) for constipated children. For nutrition, fruit is much healthier than fruit juice.

So put water in the open faced cup and allow your baby to imitate you and drink out of it. Then, around your child’s first birthday when most parents wean their children from breast milk or formula to cow milk, put the “big boy milk” or “big girl milk” into a cup. Aim for all open cups by at least two years of age. If you decide to use sippy cups, as I did, for neatness sake, do not forget practice with a regular cup. Get rid of the sippy cup whenever you are tired of washing those moldy valves and tired of rescuing them from your drain or garbage disposal. You might have a “sippy cups are for car rides” policy and use open cups at home.

What about straw cups? Well, think of it this way. Do you plan to travel around with straws in case your child becomes thirsty? Sure it’s fine to teach your child to drink out of straw. It’s healthier than a sippy cup because most of the milk will bypass most of the teeth. But again, it is easiest in the long run to teach your child to drink out of a regular cup so that in any situation you know you can offer your child a drink.

All kids are messy. The younger you practice with your child, the sooner she will be drinking out of a regular cup like a pro. Just in time for finger feeding which means self-feeding—more mealtime mess!

Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod℠

Don’t let carbon monoxide creep up on your family

This monstrosity arrived at my house last week. It’s the neighborhood snow blower my husband and several neighbors purchased together to share. As I stared at the machine, I thought about all the little arms and legs that could potentially be churned up as the monster chugs through the snow. Paranoid? Perhaps. Although, I console myself, it would be hard to ignore a snow blower coming at you.

Unfortunately, one of the biggest winter hazards is not so loud and obvious. As the temperature drops, deaths rise from this insidious poisonous gas: carbon monoxide.

According to the Centers for Disease Control, about 400 unintentional deaths occur a year from carbon monoxide poisoning. Carbon monoxide results from the incomplete combustion of fuel. The gas causes a chemical suffocation by competing with oxygen in your body. The colorless, odorless gas is impossible for human senses to detect, and unfortunately, loss of consciousness usually occurs before any symptoms appear. Those lucky enough to have warning symptoms before passing out may experience headaches, nausea or confusion.

Because carbon monoxide is a by-product of incomplete combustion, sources are related to energy use. Poisoning occurs more during the winter months when fuel is used to heat closed spaces and ventilation from exhausts is poor. My sister, toxicologist and Harvard medical school instructor, Dr. Melisa Lai, tells the story of a snowplow operator a few years ago who left the house early in the morning to plow snow, only to return and find his family dead. The reason—snow blocked the exhaust pipe from the furnace and caused lethal levels of carbon monoxide to accumulate in his home.

Carbon monoxide also occurs in warm weather. To avoid carbon monoxide buildup in all climates:

–Install carbon monoxide detectors. My sister says a $20 detector such as Kidde works as well as the $150 models. Put them on every level of your home and check that the batteries work. Smoke detectors are not the same as carbon monoxide detectors. However, combination detectors are available.

–Ventilate all appliances, heating units, and your chimney adequately. Have them serviced yearly.

–Be wary of the exhaust from of any vehicle.

Parents have put their infants in running cars while they shovel snow, unaware that the car’s tailpipe is covered in snow. By the time they return to the car, the infant, who is extremely susceptible to carbon monoxide poisoning because of his size, is dead. Even opening the garage door when you run your car is not enough ventilation to prevent poisoning.

Like cars, boats also produce carbon monoxide. Since boats are less energy efficient than cars, they spew more of the gas. While your teen boogie boards behind a motor boat, the carbon monoxide can knock her tumbling unconscious into the water.

–Keep anything meant to burn fuel outdoors, OUTDOORS. Even an innocent barbeque can turn into a nightmare if you decide to grill inside your garage. Emissions from any type of grill, charcoal or gas, can send carbon monoxide levels skyrocketing. Additionally, hurricane season in the southern United States is known by toxicologists as “Carbon Monoxide Season.” During hurricanes, people buy outdoor generators and auxiliary heating units. They work so well that people then bring them indoors, trapping fumes in their homes.

My sister says she has hundreds of stories about carbon monoxide poisoning, all which end tragically. Maybe I’ll let my husband store that larger-than-life-take-up-car-space neighborhood snow blower here this winter. Then, at least I know I’ll be able to make sure no one starts up the blower in a garage.

For more details please visit http://www.cdc.gov/co/faqs.htm.

Naline Lai, MD with Julie Kardos, MD
©2010 Two Peds in a Pod℠

Tricks to stop continual treats— how to avoid Halloween candy overload

You poured out all of your two liter soda bottles, replaced all the potato chip snacks with fruit and signed all your children up for winter sports. Just when you thought your family’s activity and diet balance was perfect, along comes Halloween, that fabulous candy-filled holiday to thwart your efforts. Ways to keep the candy deluge down to a trickle:

-Let your children know Halloween (and most holidays) lasts only one day. Live it up on Halloween then dump the extra sweets into the trashcan the next day.

-Buy back the candy with toys or money. Alternatively, have the sweet tooth fairy come overnight, pick up the candy and leave a present behind.

-If you decide to keep a small bag of candy around, watch out, your children will be tempted to eat some daily. Candy becomes an ongoing “must have.” Instead, designate a day to eat candy during the week such as Sweet Saturday or Candy Friday. If the kids whine for candy on any other day of the week, you can say, ”Sorry, it’s not Sweet Saturday.”

-One parent told me she discourages her kids from eating Halloween candy by making their dental appointments on November 1—the day after Halloween.

According to an article published in the New England Journal of Medicine in 2000, the average American adult gains about a pound over the winter holidays. Unfortunately, the weight is not shed during the rest of the year.

Hope your kids don’t grow into that kind of adult. Now, that’s a scary Halloween thought.

Naline Lai, MD with Julie Kardos, MD

Organic fruit and veggies: health or hype?

Two Peds in a Pod turns today to guest blogger Dr. Alan Woolf, Director of the Pediatric Environmental Health Center at Children’s Hospital Boston and president-elect of the American Academy of Clinical Toxicology, to tackle the question, “Should you feed your kids organic fruits and vegetables?”

Nutritionists are urging parents to feed kids one and one-half cups of fruit and two and one-half cups of vegetables daily and the American Academy of Pediatrics suggests whole fruit rather than juice to meet most of the daily fruit requirements.

OK, so that’s fine, but why spend a lot more money to buy those fruits and veggies labed organic? Are they worth it? Will non-organic produce harm your kid? No easy answers here. American consumers demand a bountiful supply of blemish-free, perfect fruits and vegetables. We want unspotted shiny red apples, brightly colored large oranges and arrow-straight asparagus. Farmers want to give us just that. Since pests attack crops causing blemishes, worms, blight, and other forms of costly crop damage, farmers have been using pesticides for years to increase crop yield, profit, and visual marketability.

The US Dept of Agriculture (USDA) regulates the agricultural procedures and labeling that use the buzz word organic. Obviously every business wants to put that word on their product if it means consumers will run out and buy it. The USDA will certify farms that use organic methods. But even the USDA’s definition of organic allows a percentage of synthetic chemicals to be added to products labeled organic. Also organic does not mean that the food contains increased amounts of essential minerals and vitamins or is more nutritious for you. And remember that organic produce doesn’t necessarily come from small, cuddly, local, family-run farms. Most large, international agribusinesses are touting organic foods for sale these days.

Well over one billion pounds of pesticides, according to the Department of Agriculture, are used on American crops annually. And pesticides tend to be nasty chemicals—otherwise they wouldn’t kill bugs. In large amounts, some types can cause seizures or coma in people. However, all foods , whether organic or non-organic, must contain pesticide residues well below the standard that the government considers safe. Not every piece of non organic fruit even contains a residue; it’s hit and miss.

But what about the long-term safety of pesticides in trace amounts, the amounts barely present as micro-grams or nano-grams? The fact is that no one knows the safety for sure. The science just isn’t there yet. Some dispute the government’s definitions; arguing that children don’t eat the same market basket as adults (they eat more fruit). They reason that using adult pesticide residue standards may not protect children. Recently some scientists did a study where they measured pesticide residue in the urine of school-aged children who were fed regular, market-basket produce, and then measured again after they switched them to organic-only fruits and vegetables. Guess what—kids fed organic foods excreted less pesticide residues in their urine. There’s a powerful argument for organic.

One thing that everyone agrees with—wash all of your fruits and vegetables after you buy them and before anybody in your family eats them. And that means soap and water, not just a quick rinse. Also keep in mind that infants and children are resilient even in this modern age filled with all sorts of hazards. Kids and adults are armed with marvelous defense mechanisms that prevent chemicals from doing bodily harm. Even if a chemical does cause some injury, the body has remarkable mechanisms that repair the damage in a hurry. No need to be “chemical phobic;” you can’t keep your kids in a bubble.

That being said, you still need to be cautious. In pediatrics we often invoke the “precautionary principle.” The idea is that if you don’t exactly know what a chemical will do to a child’s health because there aren’t enough scientific studies out there, then you assume that what it is capable of is bad and so, if possible, try not to expose them, just as a precaution.

When you can, buy from local farms or stands where you can ask them their growing practices, or else just grow your own. If you decide to buy organic foods, you should eat them right away. They may not stay edible as long without preservatives. Again, no matter what type of food you buy, wash, wash, wash.

Finally, alternative “greener” farming techniques, integrated pest management (IPM), and more resistant varieties of plants have increased crop yields, in many cases without using as much pesticide. That’s good news for all of us. Breeding of genetically-engineered plants require less use of pesticides, but they may not be acceptable to most consumers. That’s a whole column in itself!

The bottom line: My wife and I will try to buy organic foods when we think of it, but we don’t obsess over it when we forget.

Alan Woolf, MD, MPH, FAACT, FAAP

Director, Pediatric Environmental Health Center, Children’s Hospital Boston

Fact or fiction? A flu vaccine quiz for all teachers, babysitters, parents, and anyone else who breathes on children

A few days ago, I spoke with the faculty of a local early childhood education center about flu vaccine myths. See how you do on the true and false quiz I gave them:

I can tell when I am getting the flu and will leave work before I infect anyone.

False. According to the CDC (US Center for Disease Control), you are infectious the day before symptoms show up.

I never get the flu so it’s not necessary to get the vaccine.

False. Saying I’ve never had the flu is like saying, “I’ve never a car accident so I won’t wear my seat belt.”

I hate shots. I hear I can get a flu vaccine in a different form.

True. One flu vaccine, brand name Flu Mist, provides immunity when squirted in the nose. Non-pregnant, healthy people aged 2-49 years of age qualify for this type of vaccine.

I got the flu shot so I was healthy all year.

False. Perhaps it was the half-hour a day you added to your workout, or the surgical mask you wore to birthday parties, but your entirely healthy winter was not secondary just to the flu vaccine. The United States flu vaccine protects against several strains of flu predicted to cause illness this winter. This year’s vaccine contain both seasonal and the 2009 H1N1 strains. Your body builds up a defense (immunity) only against the strains covered in the vaccine. Immunity will not be conferred to the thousands of other viruses which exist. On the other hand, the vaccine probably did protect you from some forms of the flu, and two fewer weeks of illness feels great.

My friend got the flu shot last year, therefore, she was sick all winter.

My condolences. True, your friend was sick. But the answer is False, because the illnesses were not caused by the flu vaccine. Vaccines are not real germs, so you can’t “get” a disease from the vaccine. But to your body, vaccine proteins appear very similar to real germs and your immune system will respond by making protection against the fake vaccine germ. When the real germ comes along, pow, your body already has the protection to fend off the real disease. Please know, however, there is a chance that for a couple days after a vaccine, you will ache and have a mild fever. The reason? Your immune system is simply revving up. But no, the flu vaccine does not give you an illness.

I got the flu vaccine every year for the past decade. I will still need to get one this year.

True. Unfortunately, the flu strains change from year to year. Previous vaccines may not protect you against current germs.

I am a healthy adult and not at high risk for complications from the flu, so I will forgo the flu vaccine this year.

False. The flu vaccine is now recommended for everyone greater than 6 months of age. When supply is limited, targeted groups at risk for flu complications include all children aged 6 months–18 years, all persons aged ≥50 years, and persons with medical conditions that put them at risk for medical complications. These persons, people living in their home, their close contacts, and their CARETAKERS are the focus of vaccination.

Even if I get the flu, I’ll just wash my hands a lot to keep the germ from spreading. I have to come back to work because I don’t have much time off.

False, According to the American Academy of Pediatrics Report of the Committee on Infectious Diseases, the influenza virus can spread from an infected person for about a week after infection.

Yes, kids get sick from others kids, but as a parent who comes in contact with two children, an early childhood educator who comes in contact with ten children, an elementary school teacher who comes in contact with twenty children or a high school teacher who comes into contact with one-hundred children daily, you may end up the one who seeds your community with a potentially deadly illness. Right now, flu vaccine clinics are as plentiful as Starbucks. Hit that CVS or Walgreens on the way home, wander into your doctor’s or grab a shot while you get groceries. By protecting yourself from the flu, you protect the children you care for.

Naline Lai, MD with Julie Kardos, MD

Don’t roll your eyes at strabismus (lazy eye)

My patient looked up at me. “Do you want to see what I can do?” she asked.

Her father mockingly moaned, ”Oh, no.”

“Pleeease,” persisted the girl, “just once.”

The dad just laughed.

“Watch,” she said proudly as she suddenly rolled her eyeballs back and flipped her eyelids inside out with her fingers.

“Very impressive,” I told her, and snapped a photo.

__________________________

Voluntary eye movements like the one in the photo may be ugly to look at but are not damaging. Nor will the child’s eyes be forever stuck in that position. On the other hand, any involuntary eye movement should be investigated.

In particular, be vigilant for lazy eye (strabismus). In this condition, the eyes are do not align correctly and drift. According to the most recent edition of Nelson Textbook of Pediatrics, lazy eye affects about four percent of children under six years of age and can manifest itself in infancy.

By two months old, your child’s eyes should be able to fix on your face and move together as she watches you. If you notice her eyes cross beyond this age, take her to her doctor. Lazy eyes tend to run in families. The child pictured immediately here has several relatives with lazy eyes.

The cause of most lazy eye is unclear; however some cases are due to a defect in the pathways of the brain and nerves which control eye movement. Occasionally, some types are associated with other medical problems.

Detection of a lazy eye is important because a “lazy” eye can lose vision (amblyopia) from underuse. Treatment for most kids involves covering the good eye and forcing the lazy eye to “do more work” in order to prevent amblyopia. Ophthalmologists (eye surgeons) use techniques such as covering an eye with a patch, prescribing special glasses, or using eye drops to encourage the use of the lazy eye. For some, surgery is needed to fully align the eyes. The earlier treatment starts, the more rapid the response. Unfortunately, after a child is eight years old, treatment is much less effective.

Shortly after the girl showed me her eye rolling talent, a boy in the office showed me another intriguing trick. By inhaling deeply, the boy sucked in one nostril until it flattened without pulling in the other one.

Didn’t take a picture of that one.

Naline Lai, MD with Julie Kardos, MD

Evaluating Vaccine Sites on the Internet

A concerned parent wrote to us:

Can you please read this and comment?www.thinktwice. com.
I’m terrified to vaccinate due to sites like these. There seems to be many horrifying stories out there to what happens to kids after getting vaccines. If the chance of them getting these diseases is small, is it worth taking the risk of them suffering these near death or death experiences?

Here is our response:

Dear Concerned,

We looked at the web site you sent to us. When evaluating the merit of information that you read on the internet, it is important to know the source of the information. The thinktwice site has an easy to read disclaimer. To highlight: the founders of the site explain that they are NOT medical professionals and that they do NOT give medical advice. They refer their readers to “licensed medical professionals” for medical advice. In addition, they acknowledge that their site is NOT endorsed by the American Academy of Pediatrics (AAP), the Food and Drug Administration (FDA), or the US Center for Disease Control (CDC). In fact, they refer their readers to these organizations for vaccine information and advice. They post “information” that will certainly cause a stir on the internet but actually defer to well established medical experts at the AAP, the CDC, and the FDA for definitive advice about vaccines. If you investigate those sites, you would find that all of the organizations actually endorse the use of vaccines.

It makes sense to consult experts in the field for any problem that you have. When researching a health care issue, actresses, political figures, and web site sponsors, while experts in knowing their own children, are not medical professionals. If, for example, we had a car problem, we would consult a mechanic. We would not read testimonials of car owners on the internet to figure out how to fix a car. If we did not trust our mechanic’s recommendation, we would get a second opinion from another car expert.

Doctors are trained to evaluate evidence. We are medical professionals who read all the medical textbooks for you. Pediatricians go to school and train for nearly a quarter of a century before they even begin practicing on their own. We base our medical advice on the pediatric standards set forth by the American Academy of Pediatrics. These standards represent consensus of thousands of pediatricians who dedicate their lives to improving the well being of children. We would never support a practice that causes more harm than good.

If you are moved by testimonials, then you should also read testimonials of parents whose children were not vaccinated and then died or suffered disability from vaccine preventable diseases: http://vaccinateyourbaby.org/why/victims.cfm, http://vaccine.chop.edu. In addition, we encourage you to read our own vaccine posts: How Vaccines Work and Do Vaccines Cause Autism? Please visit the websites we provide in these articles for more information about vaccines.

Experts in pediatrics have evaluated data based on millions of vaccine doses given to millions of children. The evidence shows that the benefits of vaccines outweigh risk of harm. Think of seat belts. You may imagine that your child’s neck may get caught in a seat belt, but you would never let your child go without a seatbelt. The reason is that rather than trust a “feeling” that theoretically the seat belt could cause harm, we know from evidence, data, and experience that seatbelts save lives.

Vaccines are a gift of protection against childhood disease. As moms, both of us vaccinated our own children on time according to the standard schedule. Tragically, the more parents don’t vaccinate, the easier it will be for all of our children to contract these preventable and often deadly disease. Proof of this is California’s current whooping cough epidemic which has killed six infants so far. Most of the illness is breaking out in areas where parents stopped vaccinating their children.

If you are wondering about the merits of a web site, try to cross reference the information with organizations which set medical standards such as The American Academy of Pediatrics, the Centers for Disease Control, and your local Children’s Hospital. And of course, you can always ask your pediatrician.

By asking questions you are being a responsible parent.

Keep on asking.

Rotten News: A Salmonella Story

Eeew! Pictured is the raw chicken I left sitting out in a pot for a day (inadvertently, of course). The putrid mess was teaming with germs and amongst them was probably salmonella. This bacteria is in the news because of the thousands of eggs recently recalled for contamination (Centers for Disease Control , New York Times, National Public Radio.)

Non-typhoidal Salmonella usually causes fever and crampy diarrhea. This stomach bug mainly lurks in raw poultry, raw eggs, raw beef, and unpasturized dairy products. Luckily, salmonella does not jump up and attack humans. People are safe from disease as long as they do not eat salmonella-infested food.

In the case of my pot of rotten chicken, the obvious stench warned me that it was inedible. However, salmonella often hides in food and it is difficult to tell what is or is not contaminated. A perfectly fine looking egg may harbor the germ. Even before this outbreak, the Centers for Disease Control estimates in the United States as many as 1 in 50 people are exposed to a contaminated egg each year.

Luckily salmonella is killed by heat and bleach. Even if an egg has salmonella, adequate cooking will destroy the bacteria. Gone are the days when parents can feed kids soft boiled eggs in a silver cup, have kids wipe up with toast the yolk from a sunny-side up egg, or add a raw egg to a milkshake. Instead, cook your hardboiled eggs until the yolks are green and crumble, and tolerate a little crispness to your scrambled eggs. Wash all utensils well. The disinfecting solution used in childcare centers of ¼ cup bleach to 1 gallon water works well to sanitize counters. Do not keep perishable food, even if it is cooked, out at room temperature for more than two hours.

A mom once called me frantic because her child had just happily eaten a half-cooked chicken nugget. What if this happens to your child? Don’t panic. Watch for symptoms — the onset of diarrhea from salmonella is usually between 12 to 36 hours after exposure but can occur up to three days later. The diarrhea can last up to 5-7 days. If symptoms occur, the general recommendation is to ride it out. Prevent dehydration by giving plenty of fluids. My simple rule to prevent dehydration is that more must go in than comes out.

According to the American Academy of Pediatric’s 2009 infectious diseases report, antibiotic treatment may be considered for unusually severe symptoms or if your child is at risk for overwhelming infection. People at high risk for overwhelming disease include infants younger than three months old and those with abnormal immune systems (cancer, HIV, Sickle Cell disease, kids taking daily steroids for other illnesses). Using antibiotics in a typical case of salmonella not only promotes general antibiotic resistance, but in fact does not shorten the time frame for the illness. Also, the medication can prolong how long your child carries the germ in his stool.

I ended up tying the chicken up, pot and all, in a plastic grocery bag and throwing out the whole mess. Don’t tell my husband, he is the kind of guy who gets annoyed because I throw out germy sponges on a frequent basis. If he knew, he’d probably want me to at least keep the pot. Yuck.

Naline Lai, MD with Julie Kardos, MD

Packing your child’s school lunch: Beware of junk food disguised as healthy food

Need ideas on what to pack in your child’s lunch bag? Beware of junk food masquerading as healthy food. Dr. Roxanne Sukol, an internist who writes the popular nutrition blog Your Health is on Your Plate , mom of three children, and friend of Dr. Kardos’s from medical school, shares her insights…

What should we pack in our children’s lunch bags? The key to retraining our children to eat real food is to restore historical patterns of food consumption. My great-grandparents didn’t eat potato chips, corn chips, sun chips, or moon chips. They ate a slice of whole-grain rye bread with a generous smear of butter or cream cheese. They didn’t eat fruit roll-ups. They ate apricots, peaches, plums, and grapes. Fresh or dried. Depending on where your family originated, you might have eaten a thick slice of Mexican white cheese (queso blanco), or a generous wedge of cheddar cheese, or brie. Sunflower seeds, dried apples, roasted almonds. Peanut butter or almond butter. Small containers of yogurt. Slices of cucumbers, pickles, or peppers. All of these make good snacks or meals. My mom is proud to have given me slices of Swiss cheese when I was a hungry toddler out for a stroll with my baby brother. Maybe that’s how I ended up where I am today.

When my own children were toddlers, I gave them tiny cubes of frozen tofu to grasp and eat. I packed school lunches with variations on the following theme: 1) a sandwich made with whole grain bread, 2) a container of fruit (usually apple slices, orange slices, kiwi slices, berries, or slices of pear), and 3) a small bag of homemade trail mix (usually peanuts + raisins). The sandwich was usually turkey, mayo and lettuce; or sliced Jarlsberg cheese, sliced tomato, and cream cheese; or tuna; or peanut butter, sometimes with thin slices of banana. On Fridays I often included a treat, like a few small chocolates.

Homemade trail mix is one terrific snack. It can be made with any combination of nuts, seeds, and/or dried fruit, plus bits of dark chocolate if desired. Remember that dark chocolate is good for you (in small amounts). Dried apple slices, apricots, kiwi or banana chips, raisins, and currants are nutritious and delicious, and so are pumpkin seeds and sunflower seeds, especially of course in homes with nut allergies. Trail mix can be simple or involved. Fill and secure baggies with ¼ cup servings, and refrigerate them in a closed container until it’s time to make more. I would include grains, like rolled oats, only for children who are active and slender.

If possible (and I do know it’s a big “if”), the best way to get kids interested in increasing the amount of real food they eat is to involve them in its preparation. That might mean smearing their own peanut butter on celery sticks before popping them into the bag. It might mean taking slices of the very veggies they helped carry at the weekly farmer’s market. Kids are more likely to eat the berries in their lunch bag if they picked them themselves. There’s a much greater chance they’ll eat kohlrabi if they helped you peel it, slice it, or squeeze a fresh lemon over it. That’s the key to healthy eating.

What do I consider junk food? Chips of all kinds, as well as those “100 calorie packs,” which are invariably filled with 100 calories of refined carbohydrate (white flour and sugar) in the form of crackers (®Ritz), cereal (®Chex), or cookies (®Chips Ahoy).

You can even find junk food snacks for babies and toddlers now: The main ingredients in popular ®Gerber Puffs are refined flour and sugar. Reviewers tout: “You just peel off the top and pour when you need some pieces of food, then replace the cap and wait for the next feeding opportunity.” [Are we at the zoo?] “He would eat them all day long if I let him.” [This is not a benefit. It means that the product is not nutritious enough to satisfy the child’s hunger.]

Beware not only of drinks that contain minimal amounts of juice, but also of juice itself. Even 100% fruit juice is simply a concentrated sugar-delivery system. A much better approach is to teach children to drink water when they are thirsty, (See my post entitled One Step at a Time) and to snack on fresh fruit when they are hungry. Milk works, too, especially if they are both hungry and thirsty!

TeachMed, LLC

http://yourhealthisonyourplate.com

Reprinted with permission in edited form for Two Peds in a Pod

Roxanne B. Sukol, MD is a 1995 graduate of Case Western Reserve School of Medicine. She is board-certified in Internal Medicine and practices in suburban Cleveland, Ohio. With special interests in the prevention and management of diabetes and obesity, Dr. Sukol writes the blog Your Health is on Your Plate . Because her patients (the grown-ups) are the ones packing the school lunches for our patients, we thank her for this post.

Julie Kardos, MD and Naline Lai, MD

The Ins and Outs of Baby Proofing

A mom once told me about a time when she left their toddler in the care of her husband who worked from home.

“Are you sure you can concentrate on your work and watch him?” she asked quizzically.

“No problem,” he said reassuringly.

Hours later, the mom was delighted to come home to a quiet house. She found her husband busy working at his desk. Everything seemed calm. That is, until the mom glanced in the dining room and saw her toddler. Somehow he had scampered to the top of the table and now dangled from the chandelier.

A kid hanging from the chandelier is a parent’s baby proofing nightmare. Out there are an overwhelming number of baby proofing checklists and catalogs of safety devices. But you don’t need to read reams on how to baby proof or spend a fortune on equipment. To baby proof, just roll back to 5^th grade and remember your prepositions… those little placement words such as “IN, OUT, ON and OVER.” Remember those words? Then you are ready to baby proof. Let’s go.

Drop DOWN on your hands and knees and look at your home from your child’s perspective. Start when your child is about six months old, before he can crawl. Because baby proofing is time consuming and it’s tough to take time out of your sleep deprived life, you need to start early, or you may not be done before your child is ready for high school.

Clear play areas of anything which may go IN your baby’s mouth and choke or poison him. Anything small enough to fit inside of a toilet paper tube is a potential choking hazard. Don’t leave loose change lying around on a counter top. Lock caustic and poisonous substances UP and OUT of reach. Have the Poison Control Center’s phone number BY the phone in case of accidental ingestion (United States 1-800-222-1222). The clinicians at the Center will instruct you whether or not to go to the emergency room. Do not induce vomiting because the emergency room has more effective ways to detoxify your child and if the ingested substance is caustic, vomit will cause a chemical burn both going DOWN and coming back UP.

Brain death can occur within five minutes of oxygen deprivation, so anything a child can pull OVER or AROUND his airway passages is hazardous. Dangling drapery cords, plastic bags, crib bumpers, and loose crib sheets fall into this category. To avoid neck strangulation, bars ON cribs and on banisters should be less than 2 3/8 inches apart (the width of a soda can) to prevent a child from trapping his head between them. Do not allow more than two fingerbreadths between the crib frame and the mattress.

All standing water is a potential drowning hazard. Even a large ice bucket at a party poses a risk. Several years ago, one of my neighbor’s children toddled up to an ice bucket at a party and right UNDER my nose flipped head first INTO the icy water.

What goes UP must come DOWN. An unsteady kid who climbs UP the stairs may come tumbling DOWN. Gate the top and the bottom of the stairs. Make sure to bolt the top gate into the wall. An angry toddler can break THROUGH any pressure secured gate. Walkers are also associated with an increased injury from falls DOWN steps. Since walkers do not actually teach your baby to walk any sooner than he would have anyway, just avoid them altogether.

Look also INSIDE his crib. Too much soft bedding (crib bumpers and large blankets) are not only suffocation risks but older babies can use the material as a step ladder and climb out. Also ensure that your five month old cannot reach UP and pull the mobile OVER the crib down ON himself.

Outside the crib, your child can still fall DOWN, so cushion and move sharp edges (end tables) out of the way. Not just children fall. Furniture which is UP may tumble DOWN ONTO a child’s head. Make sure your excited child reaching for a dancing dinosaur does not pull the television DOWN.

Don’t allow children to get their hands ON a burn hazard. Secure electrical outlets and cords. Set the temperature of hot water to no more than 120 degrees and protect children from the stove and open heating units.

Beware of other people’s homes and hotels. Grandparents tend to leave pills within reach of little hands ON end tables or NEAR bathroom sinks. Once when my family stayed AT a hotel, one of my children proudly showed me a pill she found ON the floor. “Look mommy at what I found,” she said and handed me a pill of Viagra!

Sooner or later children will need to identify potential hazards on their own. Help them understand what is safe. For instance, watch and teach your two year old to “bite then chew” a grape. Practice going UP and DOWN a few steps at a time and have her always hold the rail.

Of course, nothing is a substitute for adult supervision. But not everything can be anticipated. Sometimes you just have to cross your fingers. When my oldest was 15 months old, my husband was eating an open faced toasted bagel. My daughter toddled up, looked at daddy and scraped her forehead on the hard edge of the bagel.

Maybe we should just cushion children WITH pillows and keep helmets ON their heads until they go AWAY from home.

Naline Lai, MD with Julie Kardos, MD