Transcription:
Pediatric Nutrition

Melanie Cole, MS (Host): There’s no handbook for your child’s heath, but we do have a podcast featuring world class clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kid’s Health Cast by Weill Cornell Medicine. Our topic today is feeding our little kiddos from birth through toddlerhood. My guest is Dr. Chloe Rowe. She’s an assistant professor of clinic pediatrics at Weill Cornell Medicine and an assistant attending pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Rowe, I love this topic. Welcome to the show. I'm so glad you could join us today. Let’s just talk about complimentary foods that can be started with our infant, and what foods are best to start with. When do we do this and what do we start with?

Chloe Rowe M.D. (Guest): Sure. Well, I'm happy to be here today. I usually recommend starting infants on complimentary foods between the ages of four and six months. So there's a little leeway in that age range, and I often talk it over with parents. It’s a decision in terms of is your baby ready and are you ready. So in terms of the baby’s readiness, we like to see that the infant can sit up, has good head and trunk control, and would be able to sit in the highchair to accept the spoon feedings. I often ask them to watch for the infant signs of readiness and interest in solid foods. Are they looking at you while you're eating? Are they reaching for your spoon or your food? Are they opening their mouth when they see you eating? So often one of the first things I’ll do at the four month visit is ask the parents to first get a highchair. Set it up, practice having the infant sit in the highchair. Do they look comfortable? Can they hold their head and trunk up for a short period of time? Bring the child to the table with them. Let the child watch them eat. Let them be a part of that family meal just to assess the infant’s level of interest in foods.

Host:  Wow. That was a great explanation. So useable. So then once we’ve assessed their readiness, and our own of course because time goes so fast, what about first foods? Do we try avocado mixed with a little breastmilk or formula? Do we smash up a banana or a pear? What do you think are some great first foods?

Dr. Rowe:  Sure. Well, traditionally we start with our infant cereals which are fortified with iron. The reason being, iron is a very important nutrients for babies, especially for their neurologic development. So iron is an important first food to introduce or an iron rich food is important to introduce. Typical way we give an iron rich food is through those infant cereals. We recommend oatmeal cereal more so than the old fashioned rice cereal because of some of the concerns about arsenic in rice cereal. So recently the AAP has also been concerned with that so recommended other cereals other than the rice to start with. So we can start something like avocado or banana. I typically recommend the first food be something smooth and pureed. Kind a little bit soupier at first because the instant has only been exposed to milk. So they're used to that texture.

Once they get the sense of the spoon feedings and try those tastes for a little while then we can start to make it a little thicker and change the consistency of it. You can start with banana pureed, avocado pureed, but you do want to keep in mind having some source of iron in your infant’s diet. Iron is especially important for breastfed babies, less so important for formula fed babies due to the fact that the formula does contain iron.

Host:  So as long as we’re on the subject of breast milk and formula, when can a baby start drinking milk besides breast milk? Or whole milk or soymilk or almond milk or any of these other milks that are out there.

Dr. Rowe:  So we recommend breastmilk or formula through the first year of life. So once the child is hitting their first birthday, we can transition onto typically whole cow’s milk. Prior to one year, it is okay to introduce cow’s milk products such as yogurts and cheeses and cottage cheese, but we don’t recommend whole cow’s milk until one year.

Host:  Dr. Rowe, this is such great information. How long do we wait between introducing new foods to a child as we’re feeding them foods for the first time?

Dr. Rowe:  Traditionally we've recommended introducing one new food every three to five days. Probably practically speaking that’s not necessary. If you introduced chicken today and carrots tomorrow and sweet potatoes the next day it would be fine. Most of the time we’re going to get better results by giving our children a variety of foods and flavors and just reintroducing those or exposing the children to those foods repeatedly to develop their taste and their palate. I would more cautiously introduce highly allergic foods. So something like peanut or egg or fish. I would probably still recommend that if we’re going to do that food, that be the only food we five the child for a couple of days in a row. We do that in the morning at home versus at a restaurant or at daycare and observe the child for any adverse reaction after one of those highly allergic foods.

Host:  That’s great advice. So now, fruit juice as we’re starting to think about giving them other things to drink. The AAP recently put out new guidelines for healthy drinks. Should children even have fruit juice? What about smoothies with vegetables and fruits as they get to be toddlers and two and three years old? Can we give them those things?

Dr. Rowe:  So I would say fruit juice is not necessary for a healthy diet and we do not recommend that for infants or children. The reason being is fruit juice is mostly sugar. So I tell parent’s it’s squeezing out the sugary part of the fruit and giving that to the child and leaving out all the other good fiber and nutrients that comes with eating the whole fruit. So probably better to offer your child whole fruits or pureed chopped finger food type fruits versus giving them fruit juices. We’ve seen over time that fruit juices can lead to obesity with the high sugar content and can also lead to cavities and tooth decay. So typically we do not recommend fruit juices for children. I typically, in my practice, reserve giving some prune juice or pear juice maybe in the case where a child might be constipated.

Host:  Now every parent’s biggest fear when they're feeding their children is choking. I mean as a mother, I sat there watching my kids so closely. What foods are considered choking hazards for our little ones? What would you like us to avoid or ways that we can arrange the food, prepare the food so that it’s not so dangerous.

Dr. Rowe:  Right. So I think choking hazards are a very important topic. Foods that are most commonly choked on in children would be things that are firm and hard and round. A whole grape would be dangerous. A whole nut, a piece of popcorn, a hot dog, a piece of raw carrot, a piece firm apple, firm cheese. So when children are infants and starting those finger foods about eight/nine months, we usually recommend that everything is soft and squishy. Kind of bite sized, about half inch or the size of your pinky nail. I describe for parent’s it’s just something that you can squish between your thumb and your first finger. So like a soft piece of banana is usually safe. A steamed or well cooked carrot, a cooked pea, a piece of ripe pear, a piece of ripe avocado, little bit of meat or fish would all be safe. But we wouldn’t want to give some of those firmer, rounder, larger pieces of food. Even through the toddler years those can be dangerous foods for choking risk.

Host:  Now onto our toddlers for a brief moment and picky eaters. What if we’re trying steamed carrots or we’re trying these things and kids are pushing them away or making a face? What do we do if they're picky eaters from little guy hood and we want them to foster a love of healthy foods and a variety of foods? What do we do?

Dr. Rowe:  So that’s a good question, and it’s always a very frustrating situation for a lot of parents when they're dealing with a picky eater. A couple of things that I like to remind people of is one, just the repeated exposure. So I try carrots and my child doesn’t like it, it doesn’t mean I never offer it to them again. You have to try it over and over and over, upwards of 10/15/20 times before a child might accept a new food. So continue to offer those foods to the child. Try them in different ways and different formats. You can try raw broccoli; you can try roaster broccoli. You can try broccoli with a dip or something to make it different or fun or exciting. So repeated exposures are very, very important.

Another tip I give parents is just modeling good eating behaviors. So if your child sees you eating carrots or broccoli, over time they're going to want to imitate you. We see that with a lot of children and other behaviors of the parents, but same goes for foods. So you have to show them that you eat healthy foods, you have to model good eating behaviors. You have to eat with the child, so they see you eating the healthy foods and the good variety. You have to kind of play it up. Take a bite, make good facial expressions, say, “Mm, this is delicious. I love broccoli.” Be very positive about the healthy foods. I think over tie with some patience and persistence then children do accept some of these healthy foods and new foods.

Host:  I couldn’t agree more with you about that. So as we wrap up, how important is eating together—you just mentioned it—to foster that love of a variety of foods and healthy eating and good parent role modeling when it comes to healthy food and a love of all different kinds of food.

Dr. Rowe:  I think it is important. We do in pediatrics in with the AAP support family meals. Not only is it important for nutrition, I think it’s also important to stay connected to your children especially as they mature and grow older. From the infant/toddler perspective as we were talking about, we’re eating together. We’re seeing our parents eat healthy foods and a variety of foods. We’re not staring at the child and force feeding them with the spoon while we’re sitting there doing something else. We’re all eating. It’s enjoyable. We’re talking. We’re interacting. We’re stimulating the child both with foods but also that social aspect of a meal. Then as we get older, as we said it’s a time to bring the family together. To talk to the child about their day, understand what’s going on in their lives socially, academically, and just stay connected as a family as the children mature.

Host:  Do you have any final thoughts you’d like to leave parents with when it comes to feeding our children?

Dr. Rowe:  I think it’s a great topic. I love to council families on nutrition, and I think it’s an important topic for a lot of families. It brings a lot of joy as well as a lot of stress. I’ve learned a little quote that I often share with families in terms of toddler, which is often the most challenging time for eating, is that toddlers often eat one meal, play one meal, and totally refuse the third meal. That’s pretty typical for toddlers. I try to encourage parents not to get too frustrated, but to keep a positive attitude around feeding and nutrition and hopefully over time to teach our children healthy habits.

Host:  So well said. Thank you so much, Dr. Rowe, for joining us. What a great segment. So much usable information for parents and thank you to our listeners. This concludes today’s episode of Kid’s Health Cast. Please remember to subscribe, rate, and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs, please follow us on Facebook and Twitter. I'm Melanie Cole.

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