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“Should I give my child a multi vitamin?” This is one of the most common questions I get asked from moms. It’s often at a well child visit, wanting to know how to improve picky eating or also it comes up at sick visits when a child gets numerous colds and coughs and parents like you may feel their child is sick “all the time” and want to know how to “boost their immune systems” to prevent them from missing school.
As a pediatrician, kids health and well being is of utmost importance to me. Why? Not only do I want to keep children safe and care for them if they get common childhood conditions like ear infections, strep throat, eczema, and broken bones but I also want to teach parents (and kids) what they can do to control their health now and to drastically improve wellness as they got older by preventing obesity, diabetes, heart disease and so much more. A big portion of this is by instilling habits of good nutrition and healthy lifestyle choices.
Are vitamins a quick fix for most healthy kids? The short answers is no. If your child is eating a variety of foods and is not on a restricted diet, then extra vitamin supplementation is not needed. Can they hurt? A one a day multi vitamin for extra insurance won’t do harm (except the expense) but mega dosing on vitamins particularly fats soluble vitamins like ADEK that can build up in the body can cause toxicity. So more is definitely not always better. In addition, giving a vitamin supplement is not an assurance or a pass for your child to then eat unhealthy processed snacks and fast food. The biggest issues and concerns with the average kid’s diet is NOT the lack of vitamins (as even sugary cereals are fortified with vitamins) but that a typical western diet is low in fiber, fruits and vegetables and high in added sugar and unhealthy fats.
That said, here are 3 nutrients to know about that are often lacking and could use a boost in many children’s diet.
Iron – This is one of the most common deficiencies in kids of all ages particularly preemies, breast fed babies, toddlers who drink a lot of milk, growing teens and girls who menstruate. Low iron can affect neurological development. It can lead to iron deficiency anemia (a low blood hemoglobin level) this can cause a child to be pale, low energy, tired, headache and fatigue. There are many sources of foods rich in iron. Heme iron is a great source which is found in meats, turkey, chicken, liver, eggs and fish. There is also non-heme iron that’s is plant based in foods such as dark green leafy vegetables, legumes, seeds, and dried fruits. Here’s an important tip, non heme iron will be absorbed better if eaten at the same time as some vitamin C. So serve together beans with sliced tomatoes, or even broccoli and bell peppers to dip in hummus.
Vitamin D - This is a fat soluble vitamin that is needed for bone growth and development and to prevent a disease called Rickets. You may be aware that the body can make vitamin D, however sunlight is needed so depending on where you live, the amount of sun exposure, the season and even how much sunscreen your child wears they probably still need to ingest some sources of Vitamin D. Breastfed babies need additional Vitamin D as it is not as readily absorbed from breastmilk If you have questions or concerns speak with your pediatrician. For older children food sources of vitamin D include fish such as salmon, beef, liver and eggs as well as fortified foods such as many dairy products including milk and yogurt , non-dairy milk (soy, almond) and many cereals are fortified too.
Calcium – This is a mineral also important for strong bones and teeth as well as for functioning of muscles heart and the nervous system. Dairy products (cheese, yogurt and milk) as well as non-dairy milks are very good sources of calcium. Tip- when serving fortified nondairy milks, make sure to shake well as the calcium needs to be dispersed throughout before pouring otherwise it settles at the bottom of the container. Other no dairy sources include seafood, dark green leafy vegetables, tofu, legumes, almonds and dried fruit. Lastly many cereals and breads are fortified with calcium as well.
Looking at your child’s overall diet for the week rather than just each day may be a better way to assess what they are eating and the nutrient value. A food diary for a week often can help clarify and you may be pleasantly surprised that with added nutritious snacks, your child may be meeting their nutritional requirements. Reach out to your pediatrician if you still have concerns about your child’s overall diet. They can evaluate and determine with you if added supplementation is needed.
Do you feel like you’re always saying No to your child and not getting the response from them that you are looking for? Do you end up repeating yourself over and over, so frustrated you begin to yell or just given in to your toddlers demands? Unfortunately, I hear this way too often from moms so I wanted to give some tips on the art of saying No that will get your child to cooperate, understand and be safe.
To begin with, kids do much better when there are clear boundaries, routines and structure to their day. Consistency is key, not only with what you say but what you do. Your child is always watching you. The goal of discipline especially in a young toddler is to teach them to understand in order to get a desired result, it is not a punishment. So here’s my advice and strategies to making ‘NO” count.
Tips on Saying NO to Your Child
Say NO less often- Really?? (yup its true) Use it only when you mean it and when necessary, for example to avoid dangers such as your toddler touching a hot stove, running into the street, hitting or biting. They will quickly learn that “No” mean “No”, so don’t overuse it. Saying it all the time just dilutes its effectiveness and confuses kids as to its importance.
Distractions work – Instead of repeating “No” over and over when they want something they just can’t have, try distracting them with another item or engage them in a new activity. Be sure not to get into a battle with them (most toddlers are great at manipulation, until we lose our patience and cave in to their whining.)
Catch them Being Good- So you probably think you do this and you probably do use praise but you know what most parents don’t realize it but they tend to more often tell their child what not to do or what they are doing wrong rather than praising accepted good behavior. So I recommend accentuate the positive way more often than the negative. Give a lot of attention and praise to the good behavior and efforts. So if your child is playing nicely with his toys. Give her a shout out, that you noticed how attentive she is with her dolls. It also doesn’t haven’t to be verbal praise but just a touch or squeeze on their arm with a smile. Yes, this is called positive reinforcement and it works!
Ignore Bad Behavior – I know this seems counterintuitive but it really works. Attention around a child’s misbehavior increases the unwanted behavior. At every age kids like attention and sometimes they will even try to push your buttons to engage with them even if you’re yelling, making idle threats or seem angry. Their goal is to be heard, get their way and to pay attention to them. So how should you respond? I suggest “Planned ignoring” but it will only help to shape a child’s behavior if the child is getting positive attention most of the time. (see tip above) In addition once the undesired “bad” behavior stops, step in with the positive attention. Here is an example.
If your child is dropping food onto the floor from their high chair, instead of saying “NO don’t do that”, ignore the action, and as soon as she returns to eating appropriately, point it out and give some positive attention. With a smile say “I love the way you use your spoon” or “how clever you are to feed yourself” rather than focusing on your child throwing the food on to the floor. By doing this, you continuously shape the behaviors you want to see more of and the negative behaviors disappear.
Consistency is Key – One of the hardest things is being consistent, especially when you are a mom with 1001 things to do before the day ends. I advise to pick your battles and don’t make idle threats (follow through is very important) If you have house rule that you only want kids eating in the kitchen and not in the tv room, you need to enforce it daily not every once in a while or your little one won’t be clear on the rules. In addition be a role model for your kids because kids are always watching and your actions speak louder than words.
Parenting is hard, as a mom of three I truly get it. (and one with special needs). I know how chaotic days can often be, but try your best to keep positive. Your children will definitely make mistakes and test your limits. They will be loud at times, whine, stomp their feet and want everything their way. This is part of child development and it’s an ongoing learning process. Fill most of the day with love, affection and consistency. Shaping behaviors, just like healthy habits takes time, energy and patience, but I guarantee it does work. Good Luck Mamas! Questions? Comments? Let me know how its going. – Dr. Jen
Best Toys for Tots This Holiday Season
Holiday time is here and there is increasing advertisements and marketing directed at parents and children about what are the best toys and must haves this season. In addition, your kids will be asking and pleading for the latest or most updated tech games or apps that their friends have or want as well. There is also is a lot of pressure and guilt around this time of year to make you feel the more you spend on gifts and toys, the happier your child will be. As a pediatrician and mom, I am hear to tell you differently.
Toys are really a tool, that can be used to help bring meaningful interactions between you and your child that can foster language skills, motor skills and social-emotional development. These are very important aspects of play, more so than one gets from electronic, battery operated toys and so called “educational apps” for babies. Most of these claims are unsubstantiated, with little or no scientific evidence, particular in young infants, and may be potentially harmful if used in excess.
Here are some tips for choosing toys for your little ones
1. Think old school. Remember when you were young, you had the animal farm, or doll house that didn’t have a working doorbell or a battery operated cow that said moo. You had to act it out yourself. This pretend play helps with creativity and imagination instead of quick reinforcement from electric generated sounds.
2. Books are always beneficial. Whether you are reading to your child or they are at an age they can start reading simple books, this activity not only helps with language and vocabulary but also a great way to bond with your child.
3. Spark the imagination and creativity. Manipulatives like blocks, legos, playdoh, markers, and age appropriate crafts can grow with your child as their skills progress. Also pretend play with kitchen sets, trucks, and cars can help kids simulate actions they see around them.
4. Bored? Try a Board game. Board games are great for turn taking, following directions, and social interactions. Again, I prefer to look for non- electronic versions. This way you don’t have to worry about replacing batteries or even the real dangers of accidental ingestion of batteries.
5. Be active- Kids should not be sitting still most of the day. They don’t necessarily need organized sports at a young age, but they should be moving. Various size balls, ride on toys, pull toys, all keep kids exercising and stretching during playtime.
6. Less is more. Kids get so overwhelmed when they have too many toys to play with or to choose from. I suggest rotating toys that are in view every few weeks so an old action figure may seem novel again and a puzzle will seem exciting if they haven’t put it together for some time.
7. Be mindful of screen time. Earlier is not better when it comes to electronic media exposure. Don’t get sucked in to the hype about early infant learning with 2 dimensional screens. Babies need positive parenting and caregiver interactions to foster important brain connections for optimal learning. So limit screen time (video/ computers games/ phone apps) to less than an hour for children 2 years or older. Children younger than 5 years old (toddlers and preschoolers) make sure its developmentally appropriate and preferable with adult supervision.
Halloween is definitely a favorite holiday for kids. Children love getting dressed up in costumes, socializing with friends, trick or treating and yes, some candy too. As a pediatrician, I have seen my fair share of stomachaches, injuries and avoidable injuries. Here are some of my top safety tips as well as some healthy tips that I promise won’t put a damper on the festivities.
1. Make sure costumes fit properly. When sleeves are loose and flowing or pants drag on the floor, they are more like to get snagged or caught on objects leading to falls, scraped knees and even broken bones. Other items like long untied belts or high heeled shoes can be hazardous too. Be sure face masks fit properly, especially the eye and nose openings so as not to obscure vision or breathing.
2 Keep costumes brightly colored or use reflective tape. Bold color or placing reflective tape on your child clothing or even trick or treat bag is important especially if outside in areas that are not well lit. This will make it easier for them to be seen particularly by drivers in cars.
3 Patch test all makeup before using. Kids love face painting, but many of the makeup kits for Halloween don’t use high quality ingredients and may have chemicals that react on skin causing rashes like hives, bumps, redness and itching. Be sure to test on a small area of arm before applying to face.
4 Avoid imported inexpensive costume jewelry for young children. Please be wary and if purchasing please supervise if your young child is wearing accessories that have small parts that can potentially break off causing choking ,be put up their nose or in their ears. In addition young children may put these accessories in their mouth to chew on, causing the paint to come off and be swallowed. Imported painted costume jewelry items have been known to contain metals like lead and cadmium which are toxic if ingested so if you have a little teether avoid altogether.
5 Do not buy decorative contact lenses. Non prescription contacts can give you the appearance of bright colored eyes( magenta , neon green or Dracula eyes) however because they are not fitted properly, there is potential for severe damage to eyes such as corneal scratches, infections and in some cases even visual loss. It is not worth the risks.
6 Darkness can mean more dangers outside. Supervision is needed by adults or even responsible teenagers while out and about going house to house. It’s a great idea to have a designated route ahead of time. In addition carry flashlights as many neighborhoods may not have sidewalks or even street lamps. I encourage all homeowners on Halloween to keep their outdoor house lights on as well as to make sure walkways are clear of wet slippery leaves to make the whole neighborhood brighter and safer.
7 Avoid candles in Jack-O -Lanterns. Kids move fast and not always paying attention to their surroundings. Candles can cause burns and unexpected fires, so instead use a battery operated flameless light or even a flashlight to illuminate your pumpkins.
8 Restrain pets or keep in another room when trick or treaters come to the door. Even the most docile and friendly dogs can get over excited by all the kids and crowds. Children who fear animals may cry or be frightened, others may try petting the tail or animals face causing an unexpected reaction or even get bitten. To avoid any problems keep your pets away from the front door.
9 Eat a good meal before going out trick or treating. Starting out on a full stomach can help discourage kids from wanting to eat the candy and goodies throughout the night and it will help to cut down on binge/ overeating. Yes Halloween stomachaches are a real thing.
10 Walk to the farthest point you are traveling and then trick or treat on the way back home. By doing this, you and your kids are getting a bit more exercise and physical activity, because eventually you have to walk all the way back home.
11 Sort and inspect candy before eating. Even though it is rare for tampering of candy on Halloween, especially if you stick to neigbors that you know, its important to check the candy and home baked goodies, as well as remove any items that may be potential allergens to your child.
12 Share Share Share. Most kids have so much fun on Halloween, but it’s a great time to remind them that not all children may be able to participate in the holiday events. Let your child pick out their favorite items and then have them share and give away the rest to the local hospital, child care centers or even a favorite charity.
Remember, Halloween comes but once a year, besides the trick or treating, there are other fun activities to participate in such as drawing on pumpkins, roasting pumpkin seeds and drawing Halloween cards and posters. I wish and your child a spooktacular and safe holiday. – Dr. Jen