Transcription:
The Importance of Healthy Toddler Nutrition

Melanie Cole (Host): Starting good nutrition practices early can help children develop healthy dietary patterns that may last their whole lives. My guest today is Dr. Alisa Pierce-Kee. She's a pediatrician with BayCare Health. Dr. Pierce-Kee, why is early nutrition so important for young children?

Dr. Alisa Pierce-Kee, MD (Guest): Early nutrition is actually important for a few reasons. Primarily we think about establishing early nutrition habits that are good in order for children to grow appropriately, not only in terms of their weight, but in terms of their final height growth, as well as their brain development. And that's really sort of the primary thing that we think about. Secondary, which really truthfully is not as secondary as you might think, is that when you establish good eating habits early in childhood, it allows children to become adults who also make healthy food choices, and so really both of those things are of the utmost importance.

Melanie: Well they certainly are, so let's get into some of the questions that parents have about toddler nutrition. When can a baby start drinking cow's milk? And a lot of people feel that if they put cereal in the bottle it'll help the baby sleep longer.

Dr. Pierce-Kee: Sure. We don't recommend starting cow's milk any earlier than twelve months of age, and the reason for that is actually twofold. Cow's milk actually has a very high concentration of protein as well as salt in comparison to human milk as well as formula, and milk given too early to infants can cause electrolyte imbalances and can also cause some anemia. So really we don't recommend any cow's milk until age twelve months. Now the cow's milk based baby formulas are of course fine prior to that because the companies have appropriately adjusted the amounts of protein and salt as well as other nutrients so that it's appropriate for infancy.

The cereal in the bottle thing, that's a little bit of an old wives’ tale, and we hear it a lot in pediatrics, and the studies really have shown that it does not make babies sleep longer. Furthermore, putting cereal in the bottles can actually lead to becoming overweight and even obese because it really puts some essentially empty calories into the bottle that is not at all needed by infants, as well as it's not really developmentally appropriate for children to be drinking their cereal.

Now occasionally it's needed for things like reflux treatment, although that has fallen out of favor- esophageal reflux treatment with thickening the formula. We used to do that but it happens much less frequently now. But the important thing is that introducing cereals to babies, we really recommend offering it on a spoon mainly because we want them to learn to chew and swallow. It's absolutely essential. And so it's much better when it's age appropriate to offer it on a spoon mixed with either breast milk or formula at that time, but into the bottle is not- it's a no-no, and it really actually doesn't make them sleep longer. It's just that's just the way the story goes.

Melanie: Should a child ever have fruit juice, Doctor?

Dr. Pierce-Kee: Honestly, the short answer is no. Honestly, the only benefit to fruit juice in any circumstance in my office is as treatment for constipation. However, fruit juice itself is really just full of sugar, and people think that it's not, and unfortunately it's marketed as this very healthy beverage for children. But drinking fruit juice is essentially equivalent to giving your child soda or sports drinks, in terms of the sugar content, and can lead to cavities, and calories that are not needed, and it also deprives them of the other benefit of eating the whole fruits such as fiber and other nutrients that are not present in the juice of the fruit.

Melanie: We have so many questions, Dr. Pierce-Kee. When do we start teaching them to use utensils?

Dr. Pierce-Kee: So most babies are fairly adept at finger feeding by twelve months of age, and usually we recommend starting with allowing them to practice with utensils sometime between that point and fifteen months of age. The utensils should be small and lightweight and appropriately sized for the baby's hand. This is not usually parents' favorite time to feed their children because it makes an enormous mess, but usually what I tell people is let them do it, let them make the mess, lower your standards of household cleanliness, and just go with it.

Melanie: Well we certainly have to do that when you're a new parent, that's for sure.

Dr. Pierce-Kee: Exactly.

Melanie: Should your child be snacking?

Dr. Pierce-Kee: It's very easy to fall into the trap of allowing your small child to essentially snack throughout the day, and I do really caution parents against this mainly because we don't want this entire day of grazing because then they won't eat their meals appropriately, and this is seen quite regularly.

Now snacks are important, and typically I tell people to give their children a morning snack and an afternoon snack, just to ward off hunger and that sort of thing. But you also don't want to fall in the trap of becoming the parent who constantly has carbohydrate-filled snacks in your bag that the children eat throughout the day and then refuse their meals because of it.

Melanie: Dr. Pierce-Kee, what about picky eaters? We're trying to get our kids to eat healthy, and they're two or three years old, and we're giving them steamed carrots, and sweet potato pieces, and maybe they don't like those kinds of things. Give us some tips for picky eaters to help a child try new foods.

Dr. Pierce-Kee: Sure. Usually what I recommend is that try multiple different preparations of foods. Don't just offer them steamed, unflavored vegetables. Offer- prepare your foods as you prepare for your family, as long as it's not too spicy or a choking hazard, and allow them to eat those things. The other thing that's really important for parents is for parents to model healthy eating to their toddlers. They really need to see their parents enjoying these healthy foods, and they will follow along over time. And it's really important to continue. Even if your child has refused a food multiple times in the past, it's important to keep offering it.

The studies have shown that a child really needs to refuse a food ten times before you can really officially say, "No, they don't like broccoli," or whatever the food is. And so I try to tell people just stick with it. Keep giving a good healthy variety of things, well-seasoned, well-prepared to do it. And the other thing that I recommend is once they're about three or sometimes four years old, institute what we call a 'no thank you' bite. So nobody wants to eat a giant bowl of food that they don't like, but you can convince most children who are at least three years old to take one bite of it, and if they don't like it, fine but thank you for trying it, and we'll try again another day.

Melanie: That's a great bit of advice, Doctor. And when we're talking about these vegetables and better ways to cook them, what foods are considered choking hazards? What should they be avoiding and what should we be cutting up into tiny little pieces?

Dr. Pierce-Kee: Sure. The things that you must be extremely careful to cut are really hot dogs and whole grapes. Both of those things must be cut lengthwise, and the reason for that is that a child's airway in the back of their throat is actually the size of about a drinking straw, and so it's extremely easy for small, small bits of food to get stuck there, and hot dogs and grapes are two of the main culprits, and you must cut them lengthwise so that they are essentially a half circle instead of being that tubular shape. Those are really the most important things to cut.

Now in terms of other foods that would be choking hazards, you must be careful with things like nuts and seeds, as well as popcorn. Now popcorn people don't always know about, and it seems like a relatively reasonable healthy snack for children, but it's actually the kernel, the brown part which is inside the white puffed part of the popcorn, that can impact their breathing. And so you should not give toddlers popcorn. Other things that are troublesome as well would be hard candy, chewing gum, large sort of globs of peanut butter, and raw vegetables can also do it because they're very hard.

Melanie: Do we try and hide nutritious foods in foods kids like more? Are you a fan of that?

Dr. Pierce-Kee: I would say it's acceptable in moderation. What you don't want, is you don't want a toddler who ends up getting their sole vegetable source from zucchini bread, but doing that occasionally is fine, but it's very important that children start to develop a taste for vegetables as they are, but you can try a few tricky things. In my house, we mix steamed spinach into our spaghetti sauce, and things like that, but it isn't what you want to do primarily.

Melanie: Dr. Pierce-Kee, as we wrap up, how important is eating together to foster that love of a variety of foods and healthy eating and for the little ones to see their parents and older siblings eating all these great healthy foods?

Dr. Pierce-Kee: It's actually essential, and in nowadays with everyone's busy lives, we're quick to have to be on the go, and different children have different activities, and that sort of thing, but it is important not only to teach children so that they will enjoy nutritionally balanced foods, but also to help them avoid obesity. Studies have clearly shown that families who eat most dinners together have a lower incidence of obesity and children will eat a larger variety of foods.

Melanie: Your best advice now on toddler nutrition and what you as a pediatrician want the listeners to know about starting to feed those children that healthy food so it will last their whole lives.

Dr. Pierce-Kee: Don't be afraid to offer your toddlers interesting foods. They need to learn to eat what the family is eating, so make nutritious foods for your entire family to eat, and as long as they are not a choking hazard, allow your toddler to eat with the family.

Melanie: It's great advice. Thank you so much for helping parents to work on those picky eaters, and to know what choking hazards are. It's so important and it's something that parents go through every single day. Thank you again for joining us. You're listening to BayCare Health Chat. For more information, please visit www.BayCare.org. That's www.BayCare.org. This is Melanie Cole, thanks so much for listening.