Pediatric Nutrition

All of us here at Boulevard Pediatrics place a great deal of importance on your child's nutrition. During the first year of life we will guide you and your child through the introduction of solids, finger foods, and all the way to the foods we all typically eat. Then throughout the years and during each and every well child care exam, we will discuss your child's dietary habits and, if needed, look for ways to improve and maintain a healthy dietary lifestyle. We find that emphasizing healthy eating habits at a young age (as most things in life) encourages children to make smart decisions as adolescents and adults.

Breast Milk and Formula

Your newborn has arrived and congratulations are officially in order. For many of you, much thought has gone in to the decision of whether to breast or formula feed. And while we fully support and respect the researched benefits of breast milk and the entire breastfeeding experience, we also understand that in certain situations, formula feeding may be the best decision for parents of a newborn. So please know no matter the decision made, it will be respected and honored by all of us here at Boulevard Pediatrics. If you will be breastfeeding, we will share all of our tips and experience as well as point the way to a lactation consultant if one is needed. If your child will be formula feeding, we realize there are many to choose from so we will help determine which one is the best and most appropriate for your child. While ensuring your child is feeding well and gaining good weight, we certainly want to minimize any stress surrounding the newborn and infant feeding experience.

Your Baby's Weight

In the newborn/early infant period, there is often some parental concern as to whether the child is gaining enough weight. Although much reassurance will come during the well child care visits, there are a few general rules of thumb that may be of interest to many of you:

  • Most babies lose 2-3 ounces of weight in the first 24 hours. In fact, it is acceptable for a newborn to lose about 10% of his/her birthweight in the first few days of life.
  • Your newborn is typically getting enough to eat if he/she has frequent bowel movements and is content 2-3 hours after each feeding (which typically means feeding 8-12 times per day).
  • Once the breast or formula feeding is going well, a daily weight gain is typically somewhere between ½-1 ounce per day.
  • Your baby may be hungrier and wanting to eat more during growth spurts — often seen around 3, 6, and 9 weeks of age.
  • Babies typically double their birth weight by about 4-5 months of age and triple their birth weight around 12 months of age.

If there is a concern your baby is not gaining adequate weight and is breastfeeding, we will discuss ways to increase a mother's milk supply, such as drinking fenugreek tea, increasing hydration, using a breast pump to stimulate more breast milk, and/or referring to a lactation consultant to examine the breastfeeding set-up. If all avenues have been explored and your child is still not gaining, we may need to run some laboratory/stool tests to make sure no medical issue exists. If no medical issue is found, then it's simply a matter of providing more calories for the baby by adding a supplemental formula or caloric powder to breast milk.

Milk Protein and Other Food/Protein Allergies

Although not clarified in the above title, what we are referring to here is food or food protein allergies encountered during the first year of life. Although, at first, it may seem difficult to grasp the idea, there may be something in breast milk (or milk-protein based formula for that matter) that can trigger an allergic response in your baby. The reality is this occurs often enough. And how might these allergy symptoms appear? Well, typical symptoms included increased fussiness, gas, and even more spit-up (which may, at first, be difficult to determine whether reflux/GERD is an issue as well). The poops are often greenish and mucousy appearing. A specific rash may appear on the face and upper chest and back region, and even increased nasal congestion may be noted.

So which food proteins are the more common culprits here? Milk, soy, egg, nuts/peanuts, and even wheat. If an allergy exists, it may just be one of these food groups or all of the above. Typically, it takes a few weeks for an allergy to appear, so please don't avoid these foods immediately following birth. If you are breastfeeding, you may become suspicious when a few hours after eating a specific meal/food group, your child becomes extremely uncomfortable and may be demonstrating some of the other symptoms mentioned above. If you feel this may be an issue, we will often ask you to bring in a couple of your baby's stools (just seal them up and place in a zip-lock bag) and we can check for trace amounts of blood via a simple test in our office. If the test is positive, we will then create a plan to determine which food may be causing the allergy by removing certain foods from the breastfeeding mother's diet.

And the question every parent wants to know — will my child outgrow these allergies? In most instances, yes, your child will outgrow these allergies some time before the end of the first year of his/her life.

Introduction of Solid Foods

Sometime around 4-6 months of age, your baby may begin taking a particular interest in what you are eating — almost to the point where he/she may be reaching for the toast you are eating or the eyes double in size watching you finish that last spoonful of ice cream. It is at this time that solid foods may begin. But remember, there is some wiggle room here. Some babies are ready to start at four months of age while others want to wait until six months of age. You, as the parent, will know when the time is right to start solid foods.

So what solid foods are we talking about? Well, we should probably preface this by saying over the next couple of years, you may hear of some changes as to what foods should be introduced first. It is an evolving process as with most things in life. But presently, it really is quite simple with one very important guideline to follow — Introduce only one new food every 3-4 days. The reason for this is if you were to introduce four foods at one time and a reaction occurred (e.g. body rash, vomiting, diarrhea or increased fussiness), we wouldn't necessarily know which one caused the reaction.

Typically, at the 4 month well child care visit, we will discuss in great detail how we begin the solid food experience. Some insight as to what we will share with you includes starting with iron-enriched baby cereal (rice, barley or oatmeal), spending 3-4 days with each type, and emphasizing it is okay to give 1-2 times a day (mixed with either breast milk, formula or water). After this period is over, you will pick your child's favorite cereal and continue to give it 1-2 times a day and then begin the pureed veggies and fruits — stage one consistency. It is absolutely fine to make your own, but the key thing is to make sure freshly cooked food is pureed and not too chunky. It is advisable to peel root vegetables, and foods grown near the ground to avoid contamination from dirt spores and nitrite accumulation.

So after about two months, your baby should be eating a couple of meals a day — maybe a cereal with a fruit (one of a few to choose from) in the morning and a veggie (again, one of many to choose from) and another fruit sometime later in the day. And remember, this is to be a positive experience, so keep it fun. Each of us may vary in our advice as to how frequently to feed your baby, so there are no hard or fast rules here.

Advancing Solid Foods

After conquering the stage one pureed veggies and fruits, it's time to move on to the stage two and three pureed foods. Again, it's great to make your own but it might be worthwhile to buy a jar just to get a sense of what the consistency should be. At around 7-8 months, when your baby is able to rake food into his/her hand and fingers, and has lots of active jaw movement, it's okay to start finger foods — Cheerios, puffs, Gerber wheels, and soft pieces of fruit (banana, avocado). Shortly after, it is okay to start some yogurt and other pasteurized dairy (cheese and cottage cheese). Regular milk as a primary beverage, however, is not introduced until 1 year of age.

It should be noted that guidelines now encourage most foods to be introduced at an early age, as new research has found late introduction of solid foods may be associated with increased allergic sensitization to food and inhalant allergens. But rather than giving specifics as to when to introduce certain foods, we ask that you discuss this with your child's physician, as other factors may be involved with the decision, including the child's own history of allergies and even the family medical history for food allergies.

And for those looking for a feeding guide as your child gets older (2-12-year-old age range), we leave you with a link to some guidelines from the American Academy of Pediatrics.

Teen Nutrition

During the teen years, growth is very rapid and the requirements for nutrients increase to keep up with this growth spurt. This is especially true of calcium and iron, so it’s important for teens to increase their calcium intake for their lifetime bone health and to eat adequate amounts of high iron foods to prevent anemia, fatigue and weakness. Teens’ pubertal growth accounts for about 20% of their final adult height and 50% of their adult body weight.

Since eating habits are pretty well set by now, it may be challenging to change these less than desirable habits. One way to influence teen dietary changes is to inform your teen about the short-term consequences of a poor diet: which can include decrease in athletic ability, poor appearance and lack of energy, which may lead to an inability to enjoy life.

One way for teens to lead healthy lifestyles is to have regular family meal times. Although it may become more difficult as children become teenagers, it is still very important to schedule family meal times in order to avoid such problems as obesity, inadequate nutrition and eating disorders in adolescence. Even if parents are able to schedule a few family meals a week, this will go a long way in assuring that their teen’s health is optimal.

In one recent study the frequency of how many meals a week teens ate with their families was shown to have an effect on decreasing the teens’ chances of disordered eating. When teens eat meals with their families, parents are able to recognize early signs of disordered eating and take steps to work through it before it becomes a bigger problem.

Another area where nutrition is important is sports performance. Since many teenagers are involved in sports during their high school years, understanding the basics of a healthy diet is a necessity and achieving good nutrition is essential in maximizing their athletic performance.

As adolescence is the last stage before adulthood, parents have one last chance to influence their teens eating habits and contribute to a lifetime of healthy habits.

Nutrition professionals such as registered dietitians are available to assist in the nutrition care of teens.

The following links offer some basic teen nutrition information:

Diana Saikali, MS, RD, CSP, Pediatric Dietitian, [email protected], 818-908-2932