Like most parents of toddlers, you may find yourself wondering- is he getting enough to eat? How much is he supposed to be eating? Is my toddler getting enough nutrients? This is a time in his life of what seems to be boundless energy. He is so busy, in fact, he may not even want to stop playing to have something to eat. Following up on the Tips for Feeding your Toddler  post, here are 3 top phrases your toddler may counter mealtimes with as well as the transition from infant to toddler nutrition.

 “I Can Do It Myself”

You will find at this stage of child development, your child may have very fickle eating habits: one day she may eat like horse, while other days barely touch her food. This is ok and a normal part of being a toddler. She is asserting her independence and that usually means deciding on her own food choices and feeding herself. 

 “I’m Not Hungry”

 It is important to remember a simple rule: It is your job as the parent to provide the healthy food, and it is your child’s job to decide how much to eat.   Forcing him to eat or finish everything on his plate can set him up for unhealthy eating habits in the future and encourages eating beyond fullness. It is rare that children will let themselves starve so keep providing healthy food at regular meal and snack times and he will eat when he is hungry. Keep in mind that most toddlers eat only 1-2 “meals″ per day and tend to “pick” at their plates. Your toddler doesn’t need to eat 3 full meals a day as adults do. The American Academy of Pediatrics recommends about 40 calories per inch of height per day. Basically, if your toddler is 32 inches, he should be getting about 1,300 calories per day for adequate growth and weight gain.

“I don’t want to eat”

This phrase can be trickier to decipher as it could be a power play for independence or simply that she doesn’t want to stop what it is she’s doing to take the time to eat.  Perhaps you can explain that the game or toy can wait for a snack time but resist the temptation to battle your child over food because it is a lose - lose situation.   This does not mean you should become a short order cook either because she shouldn’t learn that if she is resistant with you, she can eat whatever she wants, whenever she wants. If you have prepared the food, set it out and if she is hungry she will come and eat.  If she doesn’t not, you can wrap it up and save it for later.

Infant vs. Toddler Nutrition

Toddler and preschool diets are very different from that of babies. Even in the older infancy stage, most nutrition comes from breast milk or formula with a gradual increase of solid foods. One monumental milestone in child nutrition is weaning your child from a bottle to a cup, usually around 12-14 months old. This means your child will start requiring more nutrients from food yet it may also be more difficult to feed them than when he was a baby.  It might seem like an overwhelming process but remember to be patient as this too shall pass and as always, talk to your health care provider if you have questions or concerns.

Having a baby prematurely is a harrowing experience for the whole family, and can often leave a baby with lifelong health struggles.  The good news is, more research has been focused on care and treatment for preemies than ever before, finding improved standards of care.  A recent report explains the new goal for upcoming research focuses on preventing premature births altogether.

Certain factors have been found to play a role in woman’s risk of giving birth prematurely such as family history, stress, and infection; but no one understands why some women give birth too soon while others do not.

Published in the New England Journal of Medicine, the report summarizes a three day symposium held in December, 2008 entitled “Preventing Prematurity: Establishing a Network for Innovation and Discovery”. The symposium was cosponsored by the March of Dimes and the Burroughs Wellcome Fund which brought together top researchers in preterm birth prevention research.

In the United States (US), more than 543,000 babies are born early and about 13 million worldwide.  Premature birth is the leading cause of infant death in the US with only half having a known cause.  Babies who survive face serious risks of lifelong health problems and chronic conditions.  There has also been a rise in induced deliveries which result in late preterm births or between 32 and 36 weeks gestation.  Preeclampsia is a serious medical condition indicated by elevated maternal blood pressure and often a reason for early induction but authors note the decision to induce must be balanced with the need to minimize infant risk.  Preeclampsia, however, does not fully explain the rise in induced labor.

Stress, genetics, inflammation, race, and family history of preterm birth all play a role in a woman’s risk.  One in three early deliveries is associated with a uterine infection, but often these infections do not present with any symptoms.  Recent studies have found that maternal genes play the greatest role in a woman’s risk of preterm birth, but the genes of the infant can also be a factor.  Scientific advancements have allowed doctors to save preemies as well as reduce the risk of complications, the authors note, but prevention is really what is needed and research will be directed towards making that possible.

 Your toddler is now enjoying his newfound independence and skill set. Some of that independence may reveal itself at the dinner table, with strong opinions flying about his likes and dislikes. This is perfectly normal as food choice is one of the first places toddlers assert their independence.

 The first 3 years of your child’s life is an ideal time to begin lifelong healthy eating habits. Preparing fresh nutritious foods, without added salt or sugar, will have her reaching for healthy snacks when she gets older. Avoiding canned, artificially flavored, or highly processed foods will set the standard for what food is supposed to taste like. 

 Mealtime and toddler feeding tips:

•  Have faith: Trust your child’s own innate ability to listen to his hunger or fullness cues. Appetites in toddlers often decline around ages 2-3, so he may be eating less than you think he should. As long he is healthy, has energy, and is growing normally then he is just fine.
• Don’t force: Never force her to eat or “clean her plate″, this will lead to unhealthy eating habits later in her life.
• Prepare for food jags: She may be in a food rut, asking for the same foods all the time for several days. This is ok; try not to force her to eat something she doesn’t want to. Offer the food she likes, along with a few other healthy options for variety.
• Lead by example: Children learn by watching you, so set healthy mealtime habits. Turn off the TV and let your toddler enjoy meals with the family. Remember, he is more likely to eat the foods that you are eating too!
• Be consistent: Offer meals and snacks around the same time everyday in an established eating environment (e.g. TV off, at the table, etc.).
• Keep trying: Research shows that kids may need to see the same food 10-20 times before they’ll like it. If she doesn’t want it this week, try again next week.
• Keep the old, while bringing in the new: It is best to introduce a new food when served with a food he already likes.
• Let him help: Let him help you in the kitchen, he is more likely to try a food he helped prepare.
• Avoid bribing: Do not bribe her with dessert in order to get her to eat all her dinner, this could teach her to overeat. “Dessert″ should be an occasional treat no more than 1-2 times per week
• Mix it up: try offering food in different forms- he didn’t like peas? Try pea soup next time.

Offering 3 nutritious meals and 2 healthy snacks for your toddler is your job, letting her decide how much and what to eat is hers. Your toddler may prefer to graze on small bits of food throughout the day and may find playing far more interesting than eating. Keep in mind her tiny tummy fills up much faster than yours does and the rapid growth rate she experienced in infancy has slowed down quite a bit.    You may also want to set out a “nibble tray″, as highlighted on Ask Dr. Sears, with bite sized bits of nutritious foods she could stop and snack on as she makes her rounds through the house.

Once you and your baby are able to ease into a routine, there will be plenty of exciting developmental changes happening in his life to delight in:

Getting coordinated: Within the first few months, your baby will start to lift his head while lying on his tummy and although unlikely to roll over, he may be able to roll from side to back. Leg kicking and arm stretching will become more rapid, and if you offer a toy, he may even grab onto it for a few seconds.

Focusing: Your baby will start to focus clearly on your face during a feeding (about 12 inches away). Soon, more colors, sizes, shapes, and complex designs will become intriguing to her. You may even notice her studying her own hands and feet.

Responding to sound:  Expect your baby to respond to the sound of your voice. Even noises around the house such as running water, a loud bang, or footsteps may elicit a response from her in the form of a blink, facial expression, increased arm or leg movement, or a slowed sucking rhythm.

Displaying affection: One of the most exciting developments is when your baby smiles back at you for the first time. He may coo when you talk to him, mimic your facial expressions, reach for you when he needs attention, and snuggle in your arms to get comfortable.

Your bond with your baby is as important as the foods you give him as it will provide the foundation to healthy development. Have faith in your ability to provide what your baby needs. Here are a few things you can do to nurture these developmental changes:

Respond to tears: It is not possible to spoil a newborn so try to respond quickly to tears. Although the average newborn can cry for more than 2 hours on any given day, your attention to those tears with help strengthen your bond. If your baby needs a diaper change, a feeding, or some attention, your response will help build the confidence she needs to become independent.

 Have a chat : Describe what you see, ask questions, respond to his gurgles and coos using words that apply to his everyday life. Although he may not understand what you are saying, even the simplest conversations lay the groundwork for future language development. Keep in mind the tone of your voice can also communicate emotions.

 Babies need hugs too:  Gentle caressing, snuggling, and rocking can help your new baby feel secure, safe, and loved. 

It is important to remember that each baby reaches milestones at different times. This is perfectly normal as every baby is unique- but your instincts are important too. If you have any concerns or questions about your baby’s development, be sure to consult your physician.

Great strides have been taken in the recent years to attempt to provide an infant formula that replicates the concentrations of nutrients found in breast milk. A newer addition to infant formula is omega-3 fatty acids, a rich source of DHA, a nutrient proven in recent studies to enhance fetal brain development and future cognitive skills.  A study out this month found yet another reason for DHA enrichment and that is eye health.

 Infant formulas are a touchy subject and watchdog groups keep a keen eye on marketing strategies as some companies compare their infant formula to breast milk.  Some mothers cannot breastfeed for either health or personal reasons but that does not mean they too don’t want their babies to have the best that they can provide.

 Recently, the European Food Safety Authority (EFSA) examined and brought new regulations for DHA eye and brain health claims for infants stating that 100mg of DHA daily is appropriate for 7-24 month olds as well as 200mg per day for expecting and lactating women.  DHA, or docosohexaenoic acid, is an omega-3 fatty acid found in high levels in fish oils but nutrient analysis have also found breast milk to contain significant amounts as well.

 Published in the American Journal of Clinical Nutrition, the study examined 244 formula fed infants between 1 and 9 days of age born in Dallas and Kansas. The babies were assigned to 1 of 4 groups; one being fed a control formula without DHA as well as 3 other formulas with various amounts of DHA. At 12 months of age, the infants’ clarity of vision was measured only to find the infants fed the DHA fortified formula had better vision than the control group. 

 There was also no difference noted in the varying amounts of DHA supplemented, from .64% to .96%, and researchers note no adverse affects were seen either. With respect to long term benefits, the study authors felt more research is needed.  The EFSA recently backed these DHA related claims: “DHA intake can contribute to normal development of the eye of the fetus, infant and young children”, and “DHA intake can contribute to the visual development of the infant”. Proper maternal and infant nutrition is a serious matter and should be discussed with a healthcare provider. Please discuss any supplements with your physician before taking or giving to your child.

Long before the plastic bottle debate arose was the ongoing quandary of fluoridated toothpaste and children. Fluoride, when used topically, can help prevent tooth decay yet too much taken internally can have the opposite effecting leading to mottling or tooth discoloration. A recent study finally provides parents with a much needed fluoride usage guideline.

Brushing teeth is an excellent and necessary habit to initiate in a young child. Fluoride plays a critical role in the development of strong, healthy teeth. Being young, however, little ones do not always spit out the toothpaste properly increasing risk of fluorosis or fluoride toxicity hence the long standing debate over fluoride toothpaste. Researchers from the Cochrane Oral Health Group based out of the School of Dentistry at the University of Manchester found that fluoridated toothpaste decreased risk of tooth decay by 24% when compared with non-fluoridated products.

The recent report states parents should use a toothpaste that contains a minimum concentration of 1,000 parts per million of fluoride to prevent tooth decay in children. Preventing tooth decay ultimately can reduce the need for expensive dental treatments as well as subsequent pain and discomfort. In a second, related study the authors note the importance of parents discussing the benefits and risks with their child’s dentist particularly if a child is at high risk of tooth decay.

The study involved 73,000 children worldwide part of 79 clinical trials and examined the effects of various children’s toothpaste. Research determined that toothpastes with less than 1,000 parts per million (ppm) were similar to using a non-fluoridated toothpaste at preventing tooth decay. Currently, children’s toothpaste range in fluoride content from 100ppm to 1,4000ppm.

Using fluoride toothpaste to brush a child’s teeth under the age of 12 months may increase risk for fluorosis. Up until age 6, when teeth are fully developed, there is still risk of fluorosis if children swallow large amounts of toothpaste. Using a small amount under a parent’s watchful can help reduce these risks. Study authors note the confusion this particular matter can cause for parents which is only exacerbated by the varying amounts of fluoride in children’s toothpaste. The risk of tooth decay and its consequences, authors note, outweigh the small risk of fluorosis as children would have to swallow large amounts over a long period of time but recommend parents discuss this with their dentist.

Finding yummy gluten free snacks for kids is not easy especially ones that aren’t too unhealthy so most moms take matters into their own hands and make their own.  This month’s gluten free recipe adds to the snack recipe artillery with chewy granola bars, a treat kids love.  The recipe is also dairy free, and allows for lots of variations for family food preference or other food allergies or intolerances.  It is of course, also suitable for celiacs.

The granola bars call for gluten free oats, so when shopping make sure oats are specifically labeled as gluten free.  Although oats by nature do not contain gluten, a lot of cross-contamination with other gluten containing grains often occurs and can happen anywhere from the growing field to the processing room. 

This gluten free recipe is from Living Without, a magazine for people with food allergies and sensitivities and is a great resource for recipes as well as other tips for managing food intolerances.  The original recipe calls for butter, which does contain casein so those avoiding should use a poly or monounsaturated oil based margarine.

Chewy Granola Bars

These granola bars make a great breakfast on the go, afterschool snack, or brown bag lunch treat and have been tested and tried by Mum Mum’s dietitian.

½ cup margarine or butter, melted

½ cup vegetable oil

½ cup brown or date sugar

¼ cup sugar

2 tablespoons pure maple syrup (or honey for children over 2)

2 cups of gluten free oats

2 cups of quinoa flakes (or rice)

1 cup shredded coconut

1 cup shopped almonds or pumpkin seeds (optional)

1 cup raisins, chopped dates, or other dried fruit

Preheat oven to 350◦, lightly oil and line a 9 x12 jelly roll pan (cookie sheet with sides) with parchment paper.  In a large mixing bowl, combine butter, sugars, and syrup then stir in remaining ingredients until mixed.  Spoon mixture onto pan; spread evenly through pan pressing down to create a smooth surface.  Bake for 30 minutes, allow to cool slightly then cut into 2 inch bars.

Prep time: 45 minutes

Yield: 3 dozen bars

By Colleen Hurley, RD, Certified Kid’s Nutrition Specialist

Mum Mum’s recently reported that the UK sent researchers out to discover why breastfeeding rates and duration lengths remain low in that country, particularly when current research touts numerous health benefits to both mother and baby. Although many women initiate breastfeeding, the duration of breastfeeding remains lower than health experts would like to see of a minimum of 6 months. A recent study found that there is further reason to encourage longer breastfeeding duration as it may improve a baby’s mental health.

MSNBC reported the Australian study which discovered children who are breastfed longer than 6 months could be at a lower risk for mental health issues later in life. Researchers theorize that breastfeeding may help a child cope better with stress as well as solidify a stronger mother-child bond which benefits the child into adolescence.

The study, conducted by Dr. Wendy H. Oddy and colleagues of the Telethon Institute for Child Health Research in West Perth, examined 2, 366 children enrolled in the Western Australia Pregnancy Cohort Study. The children underwent mental health assessments at 2, 5, 8, 10, and 14 years of age.

Of the children in the study, 11% were not breastfed, 38% were breastfed for less than 6 months, and approximately half were breastfed for 6 months or longer. Data from the mothers was also collected noting that the mothers who nursed for 6 months or less were poorer, less educated, and with greater stress levels than the mothers who breastfed longer. These same mothers also had a higher likelihood of post partum depression and their babies were more likely to have growth problems.

At each of the assessment points, researchers found the children who breastfed for shorter periods of time had worse behavior. The unfavorable behavior predominately exhibited in the children was directing negative behavior inwards, or internalizing, such as depression or outward acts like aggression. For each additional month a child was breastfed, behaviors improved.

After economic, social, physiological factors, and early life events were adjusted for; breastfeeding 6 months or longer was positively associated with the mental health and well-being of children and adolescents. In conclusion, researchers noted: “Interventions aimed at increasing breastfeeding duration could be of long-term benefit for child and adolescent mental health.”

Breast is milk is best when it comes to feeding baby, yet many mothers opt to bottle feed instead. The amount of research supporting the positive health benefits of breastfeeding for both mother and baby is astounding and the studies don’t seem to be slowing down any time soon. Deciding whether or not breastfeed is a big decision, so what exactly determines that choice? UK researchers decided to find out.

The breastfeeding rates in the UK have been one of the lowest in the world and the country has put forth a great deal of effort over the past several years in an attempt to increase breastfeeding rates. The UK government recommends, along with health experts of countries all over the globe including the World Health Organization (WHO), exclusive breastfeeding for the 6 months of life. It was the WHO report of global breastfeeding rates that ranked the UK second to lowest in 2000, as only 21% of mothers were still breastfeeding at 6 months.

The University of Manchester along with Lancashire Primary Care Trust examined the effects of maternal obstetric factors, maternal socio-demographic factors, and hospital feeding practices on breastfeeding rates. The most important factors, according to the study, were ethnicity, hospital feeding practices, and mothers who had previously given birth.

Interestingly, the study did not find a significant correlation between breastfeeding duration and mothers in a peer-support program, marital status, time of delivery, length of time to initiate breastfeeding after giving birth, or socioeconomic status – all factors previously believed to play a critical role. About 50% of the breastfeeding mothers with peer support continued to breastfeed past 27 weeks. White mothers were 69% more likely to cease nursing than non-White mothers and also breastfed for shorter durations.

The study findings reveal mixed emotions. Researchers note that the association between feeding practices and ethnicity along with previous births can be much more difficult to influence through peer support programs. Yet, knowing what the study suggests, peer support programs can now focus on identifying the needs of their various clients to support them appropriately.

It is not just parents that feel baffled by infant formula ingredients these days.  From keeping harmful chemicals out to attempting the addition of nutrients shown in recent research to boost baby’s development, infant formula makers are finally seeking outside advice.  A recent report explains industry views are being sought on infant formula ingredients.

The feedback being solicited pertains to the new standards being proposed for inclusion in the Food Chemical Codex (FCC), aiming to ensure quality as well as enhance safety of key ingredients commonly used in infant formulas. 

 Published by the US Pharmacopeia Convention (USP), the FCC standards are internationally acknowledged voluntary industry standards.  These standards provide quality assurance for both the consumer and food manufacturers who purchase the ingredient for use in their products.  The proposed standards include 3 nucleotides present in breast milk as well as omega-3 fatty acids; all of which are now being added to many infant formulas.

 The USP explains that new “functional foods” being added in addition to the concern over infant formula contamination warrants a stringent level of quality assurance.  The new standards will bolster consumer confidence that the product purchases will be free of contaminants, not diluted with water or tampered with using substituted or less expensive ingredients, and will be consistent from batch to batch.  To ensure these confidences, the FCC standards also include validated test methods providing repeatable means of measuring ingredients as well as corresponding reference materials.

Comments from the industry will be reviewed by the USP’s Food Ingredient Expert Committee, a group of scientific experts that oversee FCC standards and will publish final standards in August of this year.  Baby Milk Action, a group that promotes breastfeeding and making infant formula safer, explains that not enough has been done in the past to ensure the safety of infant formula.  Even the World Health Organization (WHO) weighed in by stating that while breastfeeding is the ideal way to provide a baby nutrients, it is also important to ensure an ample supply of safe infant formula to meet babies’ needs.