Parenting Solved

Should Kids Eat Snow?

I remember as a kid in the 60’s and 70’s my grandfather would berate us for eating snow.  “You’re gonna pick up all that radioactivity from the atmosphere you know,” he’d shout into the back yard.  His concern was the fallout from nuclear testing, a concern of his generation.

I stumbled across a post at Julie’s Health Club that got me thinking about my grandfather, and my own kids.  So is snow safe for kids?  Helen Suh Macintosh, a professor of environmental health at Harvard, put together a nice summary of the snow issue last year.  She notes:

“It turns out that snow is a fairly efficient pollution collector when it is in the air. Snow is formed by water vapor that moves in clouds in cold air. As the water vapor moves in the cold air, it can stick to a tiny piece of dust and then have other water molecules attach to it, forming a crystal. Once formed, the crystal can continue to grow and can stay in the air for hours before it falls to the ground. It is during this time that the snow crystal can collect or “scavenge” pollutants that are present in the air.”  This, of course, is a bigger issue in urban areas than in rural areas. 

Macintosh goes on to suggest that white snow is probably a safe bet in small quantities.  And for the incredulous child, the impurity of snow can be demonstrated by melting some in a glass and simply looking at it.  After all, seeing is believing.

Milk: Flavored or Plain in Children?

It’s an recurring debate in parenting circles: to flavor or not to flavor a child's milk.  Those against think we’re creating the next generation of sugar-addicted chocoholics.  Those in favor of flavor think the former are a bunch of nutritionally uptight helicopter parents.

While I would never refer to any of my loving parents as nutritionally uptight helicopter types, I have to side with those who flavor.  Sorry.  So why shouldn’t we be concerned about powdered flavoring in milk?

The big argument: sugar.  Adding flavoring, of course, increases sugar consumption in milk-guzzling kids.  And a half-pint of chocolate milk provides 75 calories more than it’s plain white counterpart.  But a study published in the Journal of the American Dietetic Association found that flavored milk consumption in school-aged children was associated with less soda intake.  And from this study it appears that the sugar intake from flavored milk offsets that from soda – so as far as sugar is concerned, children don’t appear to consume more of it when drinking flavored milk.  Data from the Nutrition Health and Nutrition Examination Survey (NHANES) also found that flavored milks contributed only 2 percent of total added sugar in children's diets, compared to 50 percent or more added by soft drinks and fruit drinks.  Another study published this year also in the Journal of the American Dietetic Association found no increase in body mass index among children who drink flavored milk.  

Admittedly flavored milk adds some sugar but not to a fault.  So while I’m onboard with minimizing sugar, chocolate milk may not be the battle to pick.

If they have chocolate will they ever go back?  Tainted taste buds are a frequent preoccupation of parents.  But if they’re not keen on plain milk to begin with, you’ve got nothing to lose.  And for the picky eater, milk may be a key means of getting calcium and protein into your child.

Milk, flavored or not, delivers calcium.  An 8-ounce serving of milk provides 300 mg of calcium, about one-third to one-fourth of the daily calcium requirement for children.  And when it comes to calcium and kids we need to take it where we can get it.  The older children get the more likely they are to replace milk with soda and sports drinks – a move associated with decreased intake of riboflavin, folate, vitamins A and C, calcium and phosphorus.

Who needs milk, anway?  Finally, let me throw a big wrench in things by adding that milk in children may be highly overrated.  While we’ve all been raised to believe that we must not leave the table until we've finished our milk, this may actually be more of a cultural/parental habit.  In fact, there are no individual foods that we can’t live without.  While I love milk as a vehicle for protein and calcium, these nutrients can be found other places.  And although I exploit the fantastic qualities of milk regularly in my patients with poor diets, many kids can go without.  Call me a heretic and bring on the American Dairy Council!

Melamine in U.S. Formulas - Why I'm Not Concerned

So it’s looking like the great U.S. melamine scare of 2008 has appropriately turned out to be a big nothing.  If you missed it, the FDA reported small amounts of melamine in all three of the major formula manufacturers here in the U.S.  And if you’ve really had your head in the sand, melamine is the stuff that Chinese milk suppliers were using to create the appearance that their milk was better than it was.  The result was 50,000 babies with kidney stones and a few deaths.

So it was true that the FDA found trace amounts of melamine in U.S. formula but at levels that are barely detectable.  To illustrate, this is the equivalent of one drop of melamine in 64 gallons of infant formula.  Or 10,000 times of that seen in the China scandal.  But there’s no scandal here.  As it turns out the miniscule levels found here were the result of a solution used to clean manufacturing equipment.  Not an excuse by any means but certainly an explanation that doesn’t suggest scandal or appreciable risk.  This is a bigger PR problem than a medical problem.

So should parents switch formulas?  As an industry-wide finding this wouldn’t appear to make any sense.  Sit tight and recognize that in the scheme of environmental exposures to lose sleep over, this ranks twenty or thirty on my list of parental worries.

Should I breast feed?  Of course you should breast feed.  But not everyone can breast feed and not everyone breastfeeds forever.  I’m not able to find any studies on Pubmed that have evaluated melamine transmission in breast milk.  Remember that when it comes to environmental substances, breast milk isn’t always the solution we wish it were.  What mom gets baby often gets.  Think bisphenol-A, unfortunately.

While the formula industry has been conspicuously silent on the issue, I haven’t.  You can see me on Houston’s Fox News Channel here.

Is High Fructose Corn Syrup Unhealthy for Children?

The Corn Refiners Association, known for bringing us high fructose corn syrup (HFCS), is on the move to buff up the image of this bastard sweetener.  Long felt to be a contributor to our growing obesity problem, HFCS has been referenced as “the crack of sweeteners.”  You can see one of the CRA’s YouTube videos here.  Propaganda?  Look at the video, read on and make your own decision.

So what’s the scoop?  Is HFCS really the evildoer that some would have us believe?  Here’s what you need to know:

Processed sugar 101.  HFCS is a processed sweetener made from corn starch and it contains a high level of fructose (found in fruits and honey) and glucose.  HCFS is made up of about 50 percent fructose and 50 percent glucose, which is about the same composition of table sugar.  While it may be from corn, HFCS’s refined composition results in remarkably quick absorption which can impact a child’s insulin levels quickly and drastically.  And this stuff is everywhere, from ketchup to twinkies.  Manufacturers love it because it’s 75% sweeter than sugar, it blends well into foods and it’s cheap.

HCFS and the obesity link.  The consumption of HFCS has increased 250% over the past 15 years which has lead some to assume that HFCS is the core thread in our obesity problem.  Further, we consume approximately 300 more calories per day than we did in 1985.  According to data cited by Michael Pollan in his book, In Defense of Food, about a quarter of this caloric increase comes from HFCS.  But another quarter come from fat and about half from grains.  So while corn syrup isn’t helping matters, it definitely isn’t operating alone.  Beyond it’s pervasive presence in just about everything our children eat and it’s propensity for quick absorption, there’s nothing specific about a HFCS calorie that puts a child at higher risk for getting fat.

Bottom line.  So while HFCS may not represent an independent threat to our children, it’s the volume of consumption and the context in which our children consume HFCS that represents a problem.  Processed foods high in calories and fat taken in quantity will put any child at risk for overweight.  If you really want to minimize HFCS, read your labels.  But be prepared to find it everywhere.  Your best general move is to minimize processed foods and offer whole foods whenever possible.

For a little fun check out A Life Less Sweet and follow one family's journey to eliminate HFCS from their world.

Photo via Wikipedia.

Boost Kid Essentials Introduced with L. reuteri

The children’s nutrition market in the U.S. is heating up with Nestle’s introduction of the probiotic Lactobacillus reuteri into their new pediatric formula, Boost Kid Essentials.  Actually the probiotic isn’t in the formula but in the straw that’s poked into the drink container.  With the first sip your child gets 100 million reuteri organisms.  Genius.  The straw isn’t new, however.  It’s been in use for years in Europe – a patented product of Biogaia AB of Sweden.  I posted on it a year and a half ago and wondered who in the States would be smart enough to pick up on it.  Now we know.

Nestle appears to have the insight to recognize the critical importance of intestinal microflora in children’s health.  More importantly, they’re pioneering products that allow reliable delivery of study-proven probiotic bugs to the intestinal tract of our youngest patients.

So how important are bugs to kids?  Perhaps the better question to ask is, “How important is reuteri to kids?” And why would a product like Boost Kid Essentials offer an advantage to kids who need caloric supplementation?  Here are some of the proven benefits of reuteri in kids (Your mileage, of course, may vary):

Fewer sick days.  In a recent study, 181 adult factory employees were assigned to receive a daily supplement containing either reuteri or a placebo.  The employees were followed over 80 days and the group taking the reuteri was found to have a 55% reduction in illness when compared with the placebo group.  While this study didn't look at kids, we may be able to extrapolate the effect to children.

Less diarrhea.  A 2005 study compared children in daycare centers supplemented with reuteri against those without.  The children supplemented with reuteri experienced fewer and shorter episodes of diarrhea.  The duration of rotavirus diarrhea in hospitalized babies has been shown to be diminished in the presence of reuteri.

Inhibits the growth of numerous nasty organisms.  L. reuteri releases a natural inhibitor of bad organisms called reuterin.  And in the test tube this has been shown to prevent the growth of salmonella, shigella, strep, E. coli and the ulcer bug, H. pylori among others.

And that’s not all.  Reuteri is one of the only probiotic organisms found to colonize nearly the entire length of the intestinal tract, not just the colon.  It’s also been identified in breast milk.  And while we would never use a product like Boost Kid Essentials in a baby, it is reuteri that was found last year to have such dramatic effects at minimizing misery in screaming babies (“colic” if you’ll pardon the term).  And subsequent studies in preemies have found dramatic effects on upper intestinal motility.  Whew!  Difficult to explain, perhaps, but nonetheless fascinating.  But it just shows that our studies in probiotic use in children are raising as many questions as they answer.

As you can tell, I love reuteri.

Stay tuned.  The pediatric probiotic market is just picking up and I wouldn’t be surprised if Nestle had a few more tricks up its sleeve. 

Vending Machine Pizza - A Sign of The Apocalypse?

And you thought keeping kids from soda vending machines was a challenge.  Try this on for size:  Tombstone Pizza has apparently begun dispensing deep dish pizza from vending machines.  According Houston Foodie, SheEats, this is a sure sign of the Apocalypse:

“And power was given unto them over the fourth part of the earth, to kill with vending machine pizza, and with high-fructose corn syrup, and with trans-fatty acids, and with all the beasts of the earth.”

Coming to a school near you...

Should Children Take Cholesterol Medication?

Hold that chicken finger. The American Academy of Pediatrics today issued a fresh policy statement on the management of high cholesterol in children. Bottom line: kids from families with a significant history of heart disease should be screened between the ages 2 and 10 years. Significant elevations in a child’s lipid profile should be managed with diet for 6-12 months and reevaluated. It is recommended that kids over age 8 years with persistent elevation in LDL cholesterol as defined by the AAP’s policy be considered for cholesterol lowering medications.

But before you get that warm, fuzzy feeling that we’ve got it all figured out, here’s what we don’t know:

Does elevated cholesterol in childhood predispose to later heart disease? There are no studies proving this to be the case although we assume what applies to us applies to our kids.

What’s the long-term safety profile of statin medications (one class of cholesterol lowering drug), for example? Short-term studies look good, long-term safety isn’t clear.

Will the long-term use of cholesterol lowering medications beginning in childhood prevent adult heart disease? We just don’t know.

While the pharmacologic management of the dangerously at-risk child is more clear cut, many kids fall into the fuzzy category. And when it comes to the long-term use of medications for what is a dietary problem in many cases, we approach what could be a very slippery slope for both parents and pediatricians.

Say "No" to Lactose-Free Formula

Let’s put an end to lactose-free formula. Babies just don’t need it

Here are the facts: babies go through a very transient period where their production of lactase (the bowel enzyme necessary for digestion of lactose) is subpar. Beyond this very early and temporary period, babies tolerate lactose just fine. There are a handful of babies in recorded medical history who have been born without lactase. And unless you’ve birthed one of these half-dozen babies, your baby shouldn’t need a lactose-free formula. One exception: viruses may injure the lining of the small bowel to the point where lactase can be temporarily lost. While some pediatricians will recommend going lactose-free during this time period, there’s little evidence that it actually improves a baby’s course of diarrhea. And soy formulas for generations have covered the waterfront just fine – they’re lactose-free.

And while there will always be those who claim that lactose-free formula “saved their baby’s life”, there will also be those who suggest that switching from Similac to Enfamil had the same impact. Infant formula urban legends are complicated and what some parents report is truly hard to reconcile. I can say this as a father and a pediatrician.

As someone who makes a living caring for babies with fragile tummies, I can attest to the fact that presence of lactose-free formula on grocery store shelves serves to confuse parents. And in some cases this confusion fuels the game of formula roulette. While I won’t go so far as to call the marketing of lactose-free formula irresponsible, I will suggest that it should go the way of low-iron formula. It represents a market-driven product that doesn’t serve the needs of its customer, the baby. Further, its empty promise of soothing “colic” serves only to bamboozle desperate parents who think that it might make a difference.

Let’s put an end to lactose-free formula. Babies just don’t need it.

5 Things You Should Never Do With Infant Formula

Overheat it. Excessive heat will damage vitamins and protein (ditto freezing). Heat in warm water for 10 minutes or so and remember that cold formula has yet to kill a baby. And while everyone’s done it from time to time, avoid the microwave.

Make your own recipes. Don’t think you’re smarter than Mead Johnson or Abbott, prepare formula as instructed. Adding less water, for example, to help your baby gain weight should only be done under the direction of a professional. The wrong mixture can lead to dangerous levels of minerals.

Let it sit. Prepared or opened infant formula should never be allowed to sit at room temperature for more than two hours. Sugar and warmth = growth of the weird and wonderful. In the fridge, formula is good for about 24 hours. When in doubt, throw it out.

Play roulette. Unless your baby has clear signs of milk protein allergy, there’s likely little to be gained from formula roulette. Gamble at will, but remember: Babies have symptoms for a reason and formula change is rarely the answer.

Dump it at the airline security gate. According to TSA breast milk and formula in quantities exceeding 3 ounces may be brought onboard and airplane so long as it is declared at the security checkpoint. And no, you don’t have to taste it in front of the TSA agent.

6 Great Sources of Fiber for Your Child

As a pediatric gastroenterologist I struggle with children who suffer the complications of a miserable diet. Digestive health is tightly linked to what we put into our mouths. And this is never more evident than in those children who lack adequate fiber in their diet.

So how much fiber does a child need? While there aren’t well-established fiber requirements in children a good rule-of-thumb is to add 5 to a child’s age to establish a daily fiber target. A four-year-old, for example, would optimally receive 9 grams of fiber each day. After age 15 we can look at our children as adults and put their requirement somewhere between 20-25 grams per day.

Meeting fiber requirements can be easier said than done, however. The big trick is finding sources of fiber that a child will actually take. Since we can’t control what our children eat we have to find “fiber opportunities” for our children through meals and snacks. Fiber missed through refused beans at lunch, for example, may be met in the mid-afternoon with a snack limited to sliced pears and whole grain crackers.

Here are 6 great sources of fiber that you might want to consider integrating into your child’s diet:

1. Baked beans. 4.5 gm in a quarter-cup
2. Dried apricot. 2.5 gm/in a quarter-cup
3. Grapes. 2.6 gm/10 grapes
4. Pear. 2 gm in a half pear with skin
5. Raisins. 2.2 gram per box
6. Chickpea dip (hummus). 3.5 gm per ¼ cup.

Remember: As you eat, so shall they eat. Set an example and do as you would have your child do. And habits change hard – take small, consistent steps towards dietary change.