Archive for the 'Healthy Eating' Category

With Solid Foods, Earlier Isn’t Better

I saw some recent news from the American Academy of Pediatrics about parents not following expert advice when it comes to giving solid foods to babies. The recommendation is to wait until a child is four to six months of age, but many parents introduce solids earlier, for various reasons.

The findings of this study were not surprising to me. Even in our home, I wanted to have my wife wait to give our kids solids until they were six months of age. Now this may come as some surprise to many of you, but my wife doesn’t listen to everything I say, and she only held out until about four and a half months. A few years back, my mother gave me my baby record book and I noticed I was eating all sorts of things, including liver, by three months of age. It made me laugh.

The advice I give in clinic is to not introduce solids any sooner than four to six months of age. Earlier is not better. In the study that will be printed in the April issue of Pediatrics, more than 40 percent of parents introduced solids before 4 months. The reasons ranged from their baby seeming hungry to hoping it would help with sleep.

Babies don’t need solids prior to four months as their bodies are not prepared for these foods and there may be an increased risk for some chronic diseases like diabetes, obesity, and eczema. Contrary to popular myth, feeding solid foods doesn’t make babies sleep longer.

Jazzed About Veggies

I was inspired by a talk I heard recently from a guy living in South Central Los Angeles whose organization, L.A. Green Grounds, plants vegetables in parking strips and vacant lots. Ron Finley’s vision is to bring healthy foods to communities where none exist—called food deserts—and, at the same time, change the community. Ron says, “to change the community, you have to change the composition of the soil and we are the soil.” He also states at one point “If kids grow kale, they’ll eat kale.” Interestingly, last Sunday, I made homemade tomato soup with my son. He helped cut the tomatoes and simmer them in the pot. Guess what, he ate tomato soup for dinner that night.

Growing and preparing food with your kids can get them excited about healthy eating. The first day of spring has sprung and the ground is ready for planting in our region. If you can introduce your kids to digging in the dirt, planting seeds, and watching them grow into fruits or vegetables, they might be encouraged to eat foods they may not normally like coming from a can. It’s also something fun to do together that provides some exercise from the shoveling, bending, and lifting that planting a garden involves.

If you don’t have a good-sized area to build a garden and/or you don’t have time, try planting some seeds together in a container outside or even a small pot on the windowsill. And as I mentioned, cooking together can have the same positive impact for healthy eating.

Seattle has some excellent resources for gardeners of all levels. Check out:

Ron Finley’s talk at TED is here. As a caveat, the language is a little strong in places so you may want to have that in mind if you plan to watch it with your kids.

A Visit to Professor Wellbody’s Academy

I had the privilege of serving as an adviser for the new permanent exhibit at the Pacific Science Center called Professor Wellbody’s Academy of Health and Wellness. This last weekend I experienced the exhibit with my family. It was awesome to see so many children and adults interacting with this hands-on exhibit that focuses on a diet, exercise, sleep, hygiene, setting goals and making real behavior changes.

Changing behavior is a challenging thing. I gave a talk at the exhibit a few weeks back and asked the members of the audience who in the room had made New Year’s resolutions last year and who had actually achieved them. Needless to say, the real challenge is in continuing a new behavior. One of the things I like about the exhibit is that it has good evidence-based information and some tools for people of all ages to use. For example, when setting a goal, make it realistic, look for barriers in achieving the goal, and look for potential solutions to overcome the barriers.

I personally do not make a New Year’s resolutions but I do set exercise goals. I set a realistic goal and a stretch goal. In my case, it is the number of miles I want to run in a year. This goal can be broken down into monthly targets, which can further be broken down into weekly targets. This makes it easier for me to achieve, as some weeks are just busier than others and I need a countermeasure to stay on track. This last year, I shattered my goal and logged over 2000 miles.

My kids really enjoyed the exhibit. My daughter was excited about the section that looks at the nutritional content of food. She got to pick out her food items from the revolving counter and then log them into the computer for her meals. The computer analyzes the content showing how much fat, calories, and nutrients she would be getting from the meal she selected. My son really enjoyed the sneeze wall. Yes, it is as it sounds, it simulated how far a sneeze can travel.

Wishing everyone a happy and great 2013

Do Kids Need Milk?

Milk (we’re talking of the cow variety right now) has long been held up as a super food for kids. It’s in the news, as new regulations from the United States Department of Agriculture are eliminating flavored milks for kids at school as reimbursable options. This ruling is part of the Healthy Hunger-Free Kids Act that aligns school meal offerings with the 2010 Dietary Guidelines for Americans. There is some controversy surrounding this choice, which, on the positive side, has clearly been made with the prevalence of childhood obesity in mind. Will the decision lead kids to drink unsweetened milks, or make sugary drinks like juices more appealing? It remains to be seen, but not likely to change, at least in my practice, are the numbers of questions I get from parents about milk in general. I thought I’d share some of these inquiries along with the answers I commonly give to parents:

How much milk do kids need, if any?
It seems that many parents worry that their children don’t drink enough milk. It’s a topic I discuss at nearly every toddler well visit. I am not sure where this worry comes from. Kids can begin drinking cow’s milk around 12 months of age, and it’s a great way to get calcium and vitamin D, but not the only way. Toddlers don’t really need more than 16 ounces of milk a day. I’m more concerned about the child who drinks too much milk than too little, as there are so many other ways to get calcium ranging from soy and tofu to cheese and yogurt not to mention green leafy vegetables, such as kale. Children need about three foods that include calcium a day. If a child drinks too much milk they are getting unnecessary calories and tend to fill up on this and eat less of other nutritious foods.

Is milk the super food it’s always made out to be?
It’s good, as mentioned, but not the be all end all. Milk does not contain enough vitamin E, iron, and essential fatty acids. It also contains too much protein, sodium, and potassium. So make sure you’re providing a wide range of healthy foods for kids including fruits and/or vegetables and lean protein. Some people choose to go with goat’s milk for their families, by the way, which may be more easily digested by the body and has a different mineral content, as an alternative.

Whole or low fat?
When it comes to whole milk or low fat, the recommendation has changed. Obesity is a big issue in this country. To combat this problem, we now recommend low-fat milk if the child is going to be consuming other foods that contain fat. Basically, children need fat in their diet but most children get more than enough from other foods. Yogurt can be started around 7-8 months.

Flavored or unflavored?
In a perfect world, children would drink unflavored milk to avoid the unnecessary calories, but as we all know, the world is not perfect. Parents need to set boundaries and limits around what is acceptable to them either way, and stick to those limits.

Obesity: A Sensitive Topic, a Challenging Problem

I loved reading the article in the winter issue of Northwest Health on kids and obesity. Many of my colleagues are passionate about this growing epidemic and contributed to the content of this article. Some things really resonated with me.

Obesity is something that I see more and more in clinic these days. American kids truly are heavier and less active than at any other time in human history. I am also beginning to see associated diseases, such as high blood pressure and glucose intolerance, more often now than I did when I started over a decade ago.

A child’s weight can be a challenging and sensitive subject to broach with families, at times. Even though it is never my intent, my words can be taken as an attack on parents’ parenting skills. Personally, there are times when I handle the conversation well and other times when I clearly wish I had the opportunity for a do over.

Ironically, on a daily basis, I will have a family come in with a child who is growing in a perfectly normal way and tracking along a consistent and stable percentile. But they still have the concern that their child is underweight. Quite often it can be the grandparents with the real concern, but unfortunately they are not the ones sitting in the room with me. I really do echo the sentiments of Dr. Nalini Gupta, in Spokane, “The problem is so pervasive that a lot of people no longer seem to know what a normal-weight child should look like.”

I fully agree with Dr. Paula Lozano when she says that the good news is, it’s not a mystery how we got this way. She goes on to say that we need to eat less and move more. Unfortunately, this is something that can be very difficult to actually deliver on. “We all try to be good parents, but in this environment, we need to be super parents.”

In fact, recently at our South Region pediatric meeting, we had one of the physicians give a talk about how to have a meaningful conversation with families during a clinic visit. For pediatrics, prevention is the key, and in the case of obesity, prevention is far easier than treatment. There are things that we primary care providers can start doing at a very early age to give parents more tools and guidance on how to feed their child. Our focus today was to get us on the same page as a group so we are all giving a more consistent message on the prevention front at a very young age.

The cliff notes version of what we discussed at the meeting is that as parents, when it comes to food, we are in charge of what our child gets to eat, where they eat, and when they eat.  The child gets to be in charge of deciding if they are hungry or not for a given meal or snack. This helps a child learn to follow their own hunger cues. If they aren’t hungry then they should never be forced to eat. My own daughter chooses not to have dinner at least once a week and we are perfectly fine with this.

In clinic, I will occasionally ask a parent about their own eating habits. Who knows better than they do whether they are hungry or not? Why would it be any different with their child? The light bulb often goes on at this point. Our job as parents is to provide healthy and nutritious food. To prevent grazing, we should dictate when it is mealtime and when it is snack time. We also need to set the expectation, and model the behavior, that all meals and snacks are eaten at the table and with the television turned off. There’s also so much to be said for gathering the family whenever possible for family dinners, which not only helps kids eat better, but helps strengthen their emotional health, as well.


Happy Thanksgiving, Mashed Potatoes and All

Last Sunday, I had what I thought was a great idea, a pre-Thanksgiving dinner at home with my family. We always go to my brother’s house for a family get-together on the actual day. The event there is so over the top, it puts Martha Stewart to shame, so we wanted to celebrate with our smaller family unit in advance. I roasted a turkey that came out perfectly, the beans were nice and crisp, and the mashed potatoes to die for. Some background for those that do not know me well, I am the chef of our family and I love to cook. I view recipes as guides that are meant to be broken.

The table was set by my 8-year-old daughter, the candles were lit, and the food was set out on the table. We started to say a brief prayer when everything fell apart. My daughter went running off upstairs, crying all the way, and my son followed suit, just to get some sympathy. My wife and I were left sitting across from each other, perplexed. “Happy Thanksgiving,” I said to her, with a sigh. Ultimately, we were re joined by our little munchkins, and the evening finished out fairly well.

I thought I would share a recipe from that day: the famous mashed potatoes. Again, I do not write anything down and do it from memory, tasting as I go.

Boiled peeled potatoes
Butter (we used yogurt spread)
Sour Cream (lite)
Chopped up cooked bacon (about ½ a pound)
Chopped chives to taste
Grated Parmesan cheese
Salt and pepper

Mix everything together with either a stand-up or hand-held mixer. Place in a glass Pyrex baking dish, sprinkle the top with more grated Parmesan cheese and put into the oven at 325°F until warm and ready to eat.

Happy Thanksgiving.

Breastfeeding Doesn’t Always Come Naturally

I follow the American Academy of Pediatrics (AAP) guidance when it comes to feeding infants. I believe breast milk is best for babies, ideally for the first year of life. Mom’s milk is naturally matched to an infant’s nutritional needs and digestive system. The AAP cites many other advantages of breastfeeding for children including immunologic, health, developmental, and psychological benefits. For moms, breastfeeding speeds contraction of the uterus and causes bleeding to end more quickly following delivery.

While I always advise families about these benefits and encourage breastfeeding, I also see many new mothers in my practice who struggle with the practice to varying degrees. For some moms and babies, breastfeeding seems to click right away. For others, it can be a real challenge for many different reasons, which can include the amount of knowledge the mom had going in to childbirth, the mother’s anatomy, the state of the baby’s health upon arrival, sore nipples, and low milk supply. I’ve seen that many moms are able to work through their challenges on their own or with the help of lactation consultants to arrive at a place where nursing is a comfortable and even wonderful experience. I am proud of the support our Group Health lactation consultants offer at both Central Hospital on the Capitol Hill Campus and the Bellevue Medical Center.

For a new mom, feeding her infant is the most fundamental need she fulfills for her child, and for this reason, the topic carries a a lot of emotional weight. Many new moms put a great amount of pressure on themselves to make breastfeeding work, or they feel pressure from their families or the parenting community. They can carry guilt and sadness if breastfeeding isn’t going the way they hoped it would, which can contribute to postpartum depression. They worry that they won’t be able to provide the health benefits of breast milk if they choose to go with formula or that they won’t experience the same closeness with their child. Some moms simply can’t maintain breastfeeding if they’re unable to pump their milk when they’re away from their babies for longer periods of time.

While I believe that formula will never be a better substitute for breast milk, and that any breast milk is better than none, I also believe that at some point, a mom’s sanity becomes the paramount consideration. If a mom is struggling with anxiety, stress, or depression over breastfeeding, the negatives can begin to outweigh the positives. The mom’s physical health, emotional well being, and relationship with her new baby, are also highly important to the overall health of the child. I have done this long enough to have encountered many situations where despite phenomenal lactation support, the parents come to a breaking point. I always tell parents that I stand behind them and their children, no matter what they decide.

I have seen thousands of children in my 13-year career who were fed as babies in different ways:  by being solely breast fed for varying ranges of time, solely formula fed, or fed with some combination of both. In the long run, the vast majority of kids I see have happy, healthy lives and good relationships with their parents, regardless of how they were fed as babies. When it comes to great health, there are no guarantees. As parents and caregivers, we are all just doing the best we can to care for these kids we love so much.

Group Health has resources:

Group Health has many informational resources for moms, both pre and postpartum, when it comes to feeding their babies. It’s especially important for moms to be prepared for breastfeeding before they deliver their children if they plan to breastfeed. See:

Defending Your Family against Foodborne Invaders

washing veggiesAs you probably know if you’ve been within range of the Internet, a TV, or newspaper in the past couple of weeks, the latest food-safety scare is Listeria in cantaloupes originating from a specific grower in Colorado. I saw the signs up at the grocery store this weekend. As with many bacterial invaders, this pathogen can be especially serious for pregnant women, infants, the elderly, and those with compromised immune systems. Sadly, there have been reports of up to 16 deaths from this pathogen, which can take several weeks to cause illness after it’s been ingested.

It’s hard to know if foodborne illness is really on the rise Continue reading ‘Defending Your Family against Foodborne Invaders’

Veggies: Fighting the Fear Factor

turnipsWhat is it about vegetables that makes many children protest at the sight of them and refuse to even take a nibble? I have a few patients who are so afraid of the color green, their aversion includes green fruits such as grapes or apples. I always wonder how much of this fear and disgust is real, and how much is  due to kids trying to gain some control as their parents attempt to encourage healthy eating. But this is one battle worth fighting. The benefits are great, and if you get creative, the struggle may not be as hard as you think.

In our household, my kids’ vegetable consumption tends to wax and wane like the moon, with some weeks being better than others. Our household rule is that you either need to eat lots of different fruits or lots of different vegetables.  Raw seems to go over better as well. From a child’s perspective, it seems that the more you cook something, the more it tastes like vegetables.

I would love to say that we grow our own produce, which is an excellent idea to get the kids involved and increase the chances of them eating their greens (reds and purples too),  but we went the vegetable-box route with a local company. Every other week we get our veggie box and try to unpack it together so our kids can see the huge variety. Questions always arise when there’s something new. Buying from the farm has also gotten us to try new things that typically we would never think to grab at the grocery store. It can make healthy eating fun and exciting for my kids.

Many families grow their own produce. This is such a wonderful way to get the children involved and teach them about gardening. Kids may be more interested in eating the vegetables they plant themselves or see sprouting close to home. They can participate in the full growing cycle that begins with preparation of the soil and planting of the seeds and ends with the harvesting of the crops. Home gardening can also lead to conversations on the important role insects can play in our environment.

Perhaps what may be most worthwhile, gardening allows families to get outdoors and engage in an activity together, which can only help the family grow closer.

Families that Eat Together are Healthier Together

Life just seems busier these days, especially as our children get older. I would love to say that we all sit down as a family for dinner every night, but that just wouldn’t be the truth. I love to cook, and we rarely eat out, yet it seems like we only manage to eat together two or three meals a week.

Even so, on the nights when we may not necessarily eat with our children, we do try to make an effort to sit down at the table with them and talk. I always enjoy this time and find us discussing what’s going on in our lives or upcoming vacations. Our children also seem to bask in this togetherness and feel more connected to the family. There has been a lot of research on the topic of the family meal and the health benefits are real. Positives include:

Like all behavior changes in life, taking time for family dinners requires some effort and motivation to act. This is one area where the benefits are well worth it.