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

Should Kids Be Snacking? Nutrition Tips From A Pediatrician

Tips on Healthy Snacking for Kids

Parents often ask me about snacks for their children once they are eating table food. Should they even give them snacks? If so, what kinds are good for them, and how often? In general, after age one I recommend 3 kids size meals and 1-2 snacks to help the get their daily nutritional requirements. Try not to stress or obsess at each feeding about them eating all that you serve.  Your job is to provide the food, your child’s is to decide how much to eat. Instead look at the nutrition content your child eats for the week rather than just on a daily basis. Here are some more tips to get the most health benefit out of your child’s snacks.

Cut out the juice and instead serve whole fruit- Juice is high in concentrated sugar, low in fiber, as well as causes big fluctuations in glucose and insulin levels.  Making whole fruit more accessible by cutting it up and even leaving it in containers or grab and go bags will increase the likelihood it will be gobbled up. A little fruit and veggie preparation for the week can make a huge difference in the amount eaten. Some suggestions: melon balls, tangerine slices, a fruit kebab skewer, even a glass of berries with a dollop of yogurt on top. Eating the whole foods instead of juicing will ensure your child feels full and satisfied until it’s time for the next meal.

Snacking is an activity. Be mindful, present and enjoy your snack completely. Don’t snack on the go or even in front of the television. This type of mindless/distracted eating often results in excess processed junk foods high in fat and sugar, low in fiber and important nutrients.  In addition, studies show eating while watching tv results in consuming more empty calories and still feeling hungry. I suggest, if you are having a snack, savor it by chewing slowly, paying attention, sitting at table and if possible don’t multitask.

Think outside the conventional snack bag I tell parents to think of a snack as a small meal. A snack is just another way to get the added fruits/veggies and nutrients kids need. So instead of assuming ‘snack’ means a bag of chips or chocolate bar, you can serve hard boiled eggs, peanut butter and crackers, turkey rolled up, waffle with fruit spread, a simple homemade mix of whole grain cereal, nuts, craisins and dark choc chips. In addition, kids love to “dip” using dressing, salsa, hummus or yogurt with their sliced raw peppers, carrots and cucumbers. If in a rush, and no time to spare, a glass of milk can be a snack too, Milk is high in protein, calcium, vitamin D as well as potassium and B vitamins.

Don’t confuse boredom for hunger. Often kids say they are hungry when in reality they are bored or don’t know what to do or play. If you child just ate and is whining to eat again, offer some water and then try to coax them in to an activity. Surprisingly, if you initiate play with them for a few minutes, for example coloring, or building blocks, they will become engaged and you can fade yourself out as they continue to play independently. By not over snacking and eating out of boredom, your child will have a healthy appetite at the next mealtime.

Daily snacks are different than “desserts’. A dessert or treat is usually thought of as an after meal food that may not be so healthy or nutritious. Desserts/ treats are inevitable and my advice, it’s totally ok to indulge on an intermittent basis. I tell my patients that total avoidance of cakes, cookies, and ice cream is not necessary, in fact I see it backfire all the time. Children who never eat any kind of junk food or a less than healthy treat often overindulge whenever the opportunity arises. So instead, embrace the moment and allow your child to enjoy the dessert. I also advise against labeling foods good or bad. Indulge in the birthday cake on occasion and savor the deliciousness.  But just remember portion size is key and you can control that amount (rarely are seconds necessary) when serving to the family . In addition if most of the time, you eat healthfully, provide a wide variety of high nutrient snacks, then your child overtime will develop a healthy relationship with food.

Happy snacking! What are your child;s favorite snacks? Let me know:)

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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