The Latest Nutrition Recommendations for Your Infant or Child

Good nutrition during the developing years of life has been correlated with improved growth, body height, IQ, educational achievement and hourly wage. Are you familiar with the current guidelines for infants, adolescents and teens?

Age 0-4 months. Breast feeding only, either directly from breast or expressed via pump. Supplement with Vitamin D 400 IU/Day (800 in winter). If mother cannot breast feed, iron-fortified infant formula is recommended. Do not offer juices, water, nonhuman milk or foods.

• If family history of allergy or atopic dermatitis, using breast milk or hypoallergenic hydrolyzed (casein or 100% whey protein) infant formulas instead of cow’s milk formulas may reduce the risk in the child.
• If infant was preterm or small for gestational age (SGA), nutrient-enriched and soy formulas are not recommended.
• Many formulas boast the addition of probiotics and long chain polyunsaturated fatty acids (LCPUFA) to their products, but there is no evidence that these are beneficial to the infant.

Age 4-6 months. Begin to introduce single grain, iron-fortified cereal (1 tbsp cereal mixed with 4tbsp breast milk, gradually increase the amount of cereal over time). Never put cereal in a bottle! Sit child upright and feed to them with a spoon.

Cues that an infant is ready for solid foods include:

• Doubled birth weight
• Ability to sit up without support with control of head and neck
• Infant shows interest in foods parents are eating

Age 6-8 months. Once all cereals have been tried, continue breast milk while gradually adding solids. Begin introducing 1-2 tbsp of both fruits and vegetables, strained, twice daily and increase to 2-3 tbsp. Try baby fruit juice in a cup and offer finely chopped or mashed fruits and cooked vegetables once all strained varieties have been tried. Introduce 1 food each week to determine which foods are poorly tolerated. Start with single ingredient baby foods before introducing mixed ones. Limit 1 serving per day of carrots, beets and spinach (may cause methemoglobinemia) and never feed them honey.

Age 8-12 months. Introduce finger foods in cups and encourage self-feeding (allow baby to get messy).  Begin to add finely chopped meats, one per week. Avoid sweetened beverages and foods that may get stuck in the throat (nuts, raw carrots, round candies, hot dogs, apple pieces, grapes and chips). Introduce no more than 4 ounces of unsweetened 100% fruit juice a day. Be sure to sit child up straight in high chair while eating, and always taste heated foods before serving. Do not restrict fat intake unless directed to do so by pediatrician.

Age 12-24 months. Add whole milk and eggs. Offer small portions. Never force toddler to eat. Continue to offer foods that have been rejected! Bedtime bottles are recommended. Transition to reduced fat (2% or fat-free) unflavored cow’s milk. Continue unsweetened 100% fruit juice and water. Limit sodium, sugar-sweetened beverages, saturated and trans fat intake. Encourage fruits, vegetables and whole grains and always offer water.

Age 2-21 years.  Primary beverage should be fat-free unflavored milk. Encourage healthy eating habits starting at age 11, stressing daily breakfast, limited fast food and eating meals as a family. Continue to limit sodium, sugar-sweetened beverages, saturated and trans fat intake. Encourage fruits, vegetables and whole grains.

• It is important not to overfeed your child. This has been associated with higher fat mass in children, insulin sensitivity (risk of diabetes) and childhood obesity.

References

Nutrition (pediatric and preventive care). In DynaMed [database online]. EBSCO Information Services. http://web.a.ebscohost.com.ezproxy.hsc.usf.edu/dynamed/detail?vid=3&sid=7ebdc599-239e-4629-b0ad-740dd1944370%40sessionmgr4005&hid=4107&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=115435.

Updated May 02, 2014. Accessed May 6, 2014.

Are Artificial Sweeteners Safe For Your Children?

You're mindful of what your child eats or drinks, but do you really know what they're putting in their bodies? Studies by NHANES over the last 40 years tracked childhood obesity as it steadily increased before plateauing at 20% in 2008. Many attribute the changes to a national focus on the importance of low-calorie, low-sugar foods. You grew up on foods that contained sucrose, the gold standard of sugar derived from cane or beets, but nowadays children are consuming foods with sugar substitutes such as aspartame and sucralose. As with any new product, there is little in the way of research on associated long-term health effects. How sure are you that these foods are safe for your developing children?

Not all sugar is created equal. Low calorie sweeteners (LCS) are not a novel concept: sugar of lead was first used by the ancient Romans, often causing lead poisoning in chronic users. The sugar substitute cyclamate, banned by FDA for it's association with bladder cancer in rats, is still used today in countries such as the UK and Russia. Today, the most commonly used sugar substitutes include the expensive natural sugar substitute Stevia (Truvia®) and those colorful packets of sugar substitutes-aspartame (Equal®), saccharin (Sweet'N Low®) and sucralose (Splenda®). 

Sucralose (Splenda®), the top-selling sugar substitute found in many sodas and foods, has been deemed safe for human consumption, from conception to old age. Since the majority of the molecule is not broken down or absorbed by the body, it is considered calorie-free. In the laboratory, studies on toxicity in rats failed to show any increased cancer risk even at the equivalent of 100 pounds of sucralose consumed daily throughout a lifetime. Long-term clinical studies have shown that human adult consumption of up to 1000 mg (~25 diet sodas) per day for up to 6 months did not lead to abnormal blood work or adverse clinical effects. Similar findings exist for the other sweeteners. 

As adults consume more of these sugar substitutes, they are making their way into the lives of children and adolescents. What research has been conducted on their behalf?

Several studies have explored the relationship between consumption of artificial sweeteners and weight changes in children, but results are conflicting. A major obstacle in these investigations involves controlling for genetic, cultural and environmental parameters. In all, they seem to suggest that when children consume sugar-free foods, many will actually GAIN weight. How could this be? Other studies explore this question, and investigators believe that children compensate for the low-calorie meals and beverages by eating more to make up for the "missing calories." This is not unreasonable, since the same phenomenon has been observed with fat-free diets in adults. 

Due to all this speculation and lack of conclusive research, and partly because artificial sweeteners tend to displace milk and 100% juice at mealtimes, the official position of the American Academy of Pediatrics is that foods and beverages containing LCS should not make up a significant part of a child's diet.

The medical community clearly needs to perform more studies on LCS consumption in children, including long-term health consequences and weight management effectiveness, as more of these mystery products find their way into your home.

• Foods and beverages containing artificial sweeteners such as aspartame, sucralose, saccharin and stevia should only be a small part of your child's diet. Substitute high-sugar drinks such as cola, chocolate milk and some fruit juices for healthier options such as milk and water whenever possible. Studies attempting to link fruit juices to obesity have been conflicting.

• Always use food labels to select lower-sugar foods and beverages, and encourage your children to do the same. Use of food labels has been associated with consuming a higher-quality diet. Consult your pediatrician, family physician or dietician with any questions.

• Communicate with your child and know what he or she is eating at school when you aren't present. Additionally, studies have shown that eating dinner as a family leads to more responsible food choices and healthier eating throughout life. 

• Avoid using sugary foods and beverages as rewards, which increases a child’s preference for that food. For more information, view our list of resources.

References

Artificial Sweetener Use Among Children: Epidemiology, Recommendations, Metabolic Outcomes, and Future Directions. Pediatrics Clinics of North America, Volume 58, Issue 6 (December 2011). W. B. Saunders Company.

Foreyt J. The use of low-calorie sweeteners by children: implications for weight management. J Nutr. 2012; 142(6): 1155S-62S. 

Grotza VL, Munrob IC. An overview of the safety of sucralose. Regulatory Toxicology and Pharmacology, Volume 55, Issue 1 (October 2009). Pages 1–5.

Update in Childhood and Adolescent Obesity. Pediatrics Clinics of North America, Volume 58, Issue 6 (December 2011). W. B. Saunders Company.

Why YOU May Have Gluten Sensitivity

Unless you've been living under a rock for the past year, you've noticed the words "gluten free" advertised in your local grocery store or muttered by that coworker who always boasts about her latest fad diet. You may even have peeked at a gluten-free section of the store and had to pick your jaw up off the ground in response to the exorbitant prices. What is all this nonsense? As it turns out, this nonsense is being scientifically validated, and may concern you or someone you care about. 

Our journey begins with those amber waves of grain that sway in the wind and symbolize our country. The grain is essentially grass, typically wheat, barley or rye, containing small seeds. These grain seeds are made of two key proteins called gliadin and gluten. Grinding gliadin and gluten into flour creates an extremely sticky powder that, when added to water, forms dough. 

Over 10,000 years ago, humans discovered dough, thus introducing the gluten/gliadin combination to their guts. Over time, the human gut began tolerating these foreign proteins. As many as 1 in 100 individuals, however, have not been as fortunate and instead developed gluten intolerance known as Celiac Disease (CD). Their immune systems viciously attack the gliadin in the gut as soon as it's introduced, typically between 6 and 24 months of age, causing severe abdominal pain, chronic diarrhea and vitamin malabsorption. By the 1990's, doctors had nearly deciphered this autoimmune disease, including it's association with conditions such as Down syndrome and type I diabetes, concluding that a gluten-free diet (GFD) cures over 90% of patients. 

Fast forward to the 21st century. The term "wheat belly" and the GFD are adopted by select non-celiac Americans. The feeling they get on this diet is so unmistakeable-less bloated with increased lucidity and energy-that they're willing to pay a premium for gluten-free foods. These patients are thought to be suffering from non-celiac gluten sensitivity (NCGS). NCGS is a mild disease characterized by normal small bowel biopsies (a diagnostic criteria for CD). NCGS likely affects 6-7% of the population, with some reporting incidences as high as 50%. Still, it's estimated that nearly 1/3 of the American population has tried a GFD, leading to nearly 5 billion dollars a year in profits for the gluten-free industry. Studies continue to disagree on whether this trendy diet is truly palliative or yet another case of the placebo effect. More research is needed to determine the true characteristics of gluten sensitivity.

1 in 14 people may be suffering from gluten sensitivity, and the gluten-free industry wants YOU to join the ranks... is it worth the cost?

• Recent research has revealed that the toxic effect attributed to gluten may instead be due to another substance within grain seeds called wheat germ agglutinin (WGA). Studies are reporting the toxic effects this lectin may have on human cells. Stay tuned for more on this topic.

• Implementation of a true GFD is not as simple as it sounds, considering wheat is found in many sauces, processed lunch meats, candies, pre-seasoned meats and marinades. Alternative dietary sources of carbohydrates tolerated by celiacs include rice, soybeans, potatoes and corn. Always consult your physician or dietician before significantly altering your diet.

• NCGS remains a distinct and benign condition, and is not considered a precursor for CD. Therefore, there is no elevated risk of developing cerebellar ataxia, peripheral neuropathy, seizures, dermatitis herpetiformis or cancers such as intestinal T cell lymphoma.

• For more information, visit celiac.org or one of our many trusted resources accessible from TheDailyDiagnosis.com

References

Biesiekierski, JR. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterol 2013; 145(2): 320-8.

Biesiekierski et al. Gluten Causes Gastrointestinal Symptoms in Subjects Without Celiac Disease: A Double-Blind Randomized Placebo-Controlled Trial. Amer J of Gastroent. Advance online publication, Jan. 11, 2011.

Fasano A et al. Clinical practice. Celiac disease. N Engl J Med. 2012; 367(25): 2419–26.

Pietzak, M. Celiac disease, wheat allergy, and gluten sensitivity: when gluten free is not a fad. JPEN J Parenter Enteral Nutr. 2012; 36(1 Suppl): 68S-75S.