Does Your Child Need a Daily Vitamin? Advice from a Pediatrician/Mom -Dr.Jen

“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.

“In most cases a daily vitamin for kids is not necessary, instead focus on healthy foods most of the time.” Dr. Jen

“In most cases a daily vitamin for kids is not necessary, instead focus on healthy foods most of the time.” Dr. Jen

Healthy Hearts-5 Important Habits for Kids

                                                                 Heart Health in Kids

 

I was inspired to write this as February is American Heart Month to remind everyone that heart health really starts in childhood to avoid cardiovascular disease, hypertension, obesity and diabetes. Kids today have developed so many bad health habits that they are facing heart attacks in their 30s. Many experts predict they will be the first generation to have a lower life expectancy than their parents.  But it doesn’t need to be this way. Parents like you have a great influence over your kid’s habits. By modeling the behaviors as well as instilling positive habits, you can make a huge different in your child’s health. It’s all about establishing good habits and breaking the bad ones early on.  Our habits from childhood continue into our adult lives and can have a huge impact on our overall health more so than just our genetics.  So let’s not wait, here are some tips to improve heart health as well as avoid other chronic diseases.

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Move it- Daily exercise is a must. For kids at least an hour a day of heart pumping movement. Childhood is a great time to try out different activities and sports, whether team or solo to find a good fit. For kids rotating activities and sports is preferable to avoid over use injuries in growing bones, joints ligaments and muscles. The idea is those kids that are active in childhood will continue to seek out physical fitness as adults. I was into dance and gymnastics as a child but now bicycling, and pilates are more my speed. It doesn’t really matter what activity you do, as long as you get your muscles fired up, strengthening, improving balance and get your heart rate up -to help combat chronic diseases like osteoporosis, heart disease and improve mood. Remember family activities like walking the dog, raking leaves, and free play at the playground all count too!

More Plants – Eating a diet that is predominately plant based (fruits, veggies, whole grains) and less emphasis on protein from meat  is a great way to keep healthy . It provides loads of vitamins, minerals, antioxidants as well as lots of fiber to keep you full and regulate your sugar levels. Parents are always concerned about kids getting enough protein but in general, kids get more than even necessary on a daily basis whether it be meat, eggs, dairy, poultry, fish)  Opt for smaller portions and instead  pile on the fruits and veggies. Make those side dishes the main event! In addition limit cured, smoked and fried foods and opt for kids getting used to steamed, baked and sautéed foods.

Ditch Desserts- A common error with kids is too start a habit that a meal ends with dessert. Forget the sweets after dinner, you should end feeling adequate and full from the food on your plate.  If hungry a few hours later, first drink a glass of water or even milk. If need be give a snack that’s healthy and avoid the highly processed, sugary laden snacks. Save those for more special occasions rather than daily treats.  Another tip is portion control. I have an ice cream loving family so trade off between frozen fruit treats and ice cream and in addition portion control is key to feeling satisfied and avoiding binge eating from deprivation.  Serve a small single cupful of ice cream rather than ordering a large 2-3 scoops. Your kids will still be happy😊

Chat with Your Child- Though it may seem like your kid tunes you out or doesn’t want to hear what you have to say, start early and keep talking about dangers and risky behaviors of smoking. Kids who’s parents talk about drugs and alcohol are 42 percent less likely to use substances than those whose parents don’t. And I know as a pediatrician its not enough to just ask about cigarette use,  you must discuss E-cigarettes which now are all the rage and extremely addictive. The most common brand is JUUL that comes in enticing fruity flavors, and each one pod contains as much nicotine as a full pack of cigarettes! I am seeing teens who are using and can’t stop- they quickly become jittery, develop headaches, anxiety and nervousness, diarrhea and difficulty concentrating.  The other chemical carcinogens as well as nicotine are dangerous to the developing brain long term. And it appears those kids that start off with e-cigarette use “just for fun” end up using regular tobacco cigarettes at a much higher rate than kids who do not vape. Let your kids learn the facts from you and help them stay healthy now and avoid heart disease and lung cancer later on.

Preventive Care Visits-  Show your kids you care about their health and your own. Make sure to schedule family annual physical exams with your physicians and stay up to date on immunizations, routine lab tests and physical examinations to ensure your health is on track. Prevention is key to avoiding chronic disease. Its also a great time to get specific advice from your doctor if you have a concern or there is a family history of a certain disease. Partnering with your family doctor or pediatrician, asking questions and being a role model will help your kids stay connected to the health system as they become young adults and in charge of their health.  Remember starting them down the right path with good health habits can make all the difference now and into their future.

 

12 Tips For a Fun Safe and Somewhat Healthy Halloween

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.

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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

Introducing Solids to Baby- When to Start and What Foods to Give Baby

This is one of the most fun and exciting milestones in the first year of life, when you start to feed solids to your baby. Its gonna be messy so be prepared , relax and have fun with it. Don't get too crazed right away about how much baby eats ( most will end up on face, bib and floor) Just as a guide, baby need only a few tablespoons to start out as a meal. Most nutrients are  still supported by either breast milk or formula.

When to start?  Baby is often ready between 4-6 months. The American Academy of Pediatrics recommends if exclusively breastfeeding can wait until 6 months then add in supplemental food.  Also baby needs to be able to sit with little support, keep head up, look interested in food, reaching out, and ability to swallow purees without tongue thrust reflex- spitting it all out. 

Rice Cereal- The biggest Dr. Jen  NO- NO  Avoid putting rice cereal in bottle!  It's unnecessary sugars, often adds on too much baby weight/ calories than necessary, interferes with long term health and no evidence it promotes sleep. Please wait to feed baby purees with a spoon unless your pediatrician tells you otherwise. And another word about that rice cereal. - I tend to tell parents to avoid it, as again its just starch/ sugar and has unfortunately a lot of Arsenic in it even if you buy organic or brown whole grain rice. If you give cereal try barley, or oatmeal . But remember cereal does not need to be your baby's first food. Read on....

What foods to offer at the start ? I recommend giving purees before going to finger foods.  Introduce fruits, veggie, as well as beans, meats and grains. In addition (unless your pediatrician says otherwise, or your baby has very bad eczema or food allergies) you then want to add in the most highly allergic foods around 6 months  (peanuts. tree nuts, fish, seafood ,eggs, wheat, soy ,milk) in small amounts  but frequently throughout a week. We now have research to back up early introduction of these foods can help reduce the risk of a food allergy in your baby. So don't be scared to start these foods- if you have more questions please speak with your baby's doctor. And remember to avoid any foods that can be choking hazards , so when moving on from purees makes very small soft pieces of  foods and avoid honey until age 1 due to risk of botulism.

The whole idea of food introduction is to give a wide array to your baby to get them used to different flavors and then soon textures as well. The bland days are gone for baby. You can add spices and seasonings just avoid adding excess salt and sugar..It's especially important to have baby start taking foods high in iron like the fortified cereals but also meats, beans, eggs, dark green veggies too. Watch my video to hear what I have to say about the best order to give new foods to baby .I think you may be surprised by my answers!! - Dr. Jen