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2

222

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Your child's nutrition is important to her overall health. Proper nutrition can also prevent
many medical problems, including becoming overweight, developing weak bones, and
developing diabetes. It will also ensure that your child physically grows to her full
potential.
You can also help promote good nutrition by setting a good example. Healthy eating
habits and regular exercise should be a regular part of your family's life. It is much easier
if everyone in the house follows these guidelines, than if your child has to do it alone.
You should also buy low-calorie and low-fat meals, snacks and desserts, low fat or skim
milk and diet drinks. Avoid buying high calorie desserts or snacks, such as snack chips,
regular soft drinks or regular ice cream.

The best V

V

to keep your children healthy includes encouraging her to:

„Ê !at a 

 of foods
„Ê Ñalance the food you eat with ½   


„Ê ëhoose a diet with plenty of grain products, vegetables and fruits
„Ê ëhoose a diet low in fat, saturated fat, and cholesterol
„Ê ëhoose a diet moderate in sugars and salt
„Ê ëhoose a diet that provides enough calcium and iron to meet their growing body's
requirements.

The Food Guide Pyramid was designed by the US Dept. of Agriculture to promote
healthy nutrition in children over two years of age. It is meant to be a general guide to
daily food choices. The main emphasis of the Food Guide Pyramid is on the five major
food groups, all of which are required for good health. It also emphasizes that foods that
include a lot of fats, oils and sweets should be used very sparingly.

[



 

‰Ê The Food Guide Pyramid for young children (displayed below) was designed by
the US Dept. of Agriculture to promote healthy nutrition in children from the age
of 2 - 6 years. It is meant to be a general guide to daily food choices.
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‰Ê The main emphasis of the food pyramid is on the five major food groups, all of
which are required for good health. It also emphasizes that foods that include a lot
of fats, oils and sweets should be used very sparingly.

‰Ê After the age of two or three years, you can begin to use 2%, low fat, or skim milk
instead of whole milk.

‰Ê Your child's diet should resemble that of the rest of the families, with 3 meals and
2 nutritious snacks each day. You should limit milk and dairy products to about
16-24oz each day and juice to about 4-6oz each day and offer a variety of foods to
encourage good eating habits later.

‰Ê Feeding practices to avoid are continuing to use a bottle, giving large amounts of
sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or
candy, as they have little nutritional value.

‰Ê Also avoid giving foods that your child can choke on, such as raw carrots, peanuts,
whole grapes, tough meats, popcorn, chewing gum or hard candy.

‰Ê Your child's nutrition is important to her overall health. Proper nutrition can also
prevent many medical problems, including becoming overweight, developing
weak bones, and developing diabetes. It will also ensure that your child physically
grows to her full potential.

The best nutrition advise to keep your child healthy includes encouraging her to:

„Ê !at a 

 of foods
„Ê Ñalance the food you eat with ½   


„Ê ëhoose a diet with plenty of grain products, vegetables and fruits
„Ê ëhoose a diet low in fat, saturated fat, and cholesterol
„Ê ëhoose a diet moderate in sugars and salt
„Ê ëhoose a diet that provides enough calcium and iron to meet their growing body's
requirements.

‰Ê You can also help promote good nutrition by setting a good example. Healthy
eating habits and regular exercise should be a regular part of your family's life. It
is much easier if everyone in the house follows these guidelines, than if your child
has to do it alone. You should also buy low-calorie and low-fat meals, snacks and
desserts, low fat or skim milk and diet drinks. Avoid buying high calorie desserts
or snacks, such as snack chips, regular soft drinks or regular ice cream.
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Õ 
  V
V

V

To ensure good nutrition in your child and that they grow up healthy, they will need to
eat a large variety of foods. The amount of foods that they eat is much less important.
Remember that your child's appetite may decrease and become pickier over the next few
years as his growth rate slows. As long as they are gaining weight and have a normal
activity level, then you have little to worry about. You can still offer them a variety of
foods, but can decrease the serving sizes if they don't eat a lot.

V ½ servings include 1 slice of bread, 1/2 cup of cooked rice or pasta, 1/2 cup of
cooked cereal, and 1 ounce of ready to eat cereal. Your child should eat 6 servings from
this group.




 ½ servings include 1/2 cup of chopped or raw vegetables, or 1 cup of raw
leafy vegetables. Your child should eat 3 servings from this group.
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˜ 
 ½ servings include 1 piece of fruit or melon wedge, 3/4 cup of 100% fruit
juice, 1/2 cup of canned fruit, or 1/4 cup of dried fruit. Your child should eat 2 servings
from this group.

j  ½ servings include 1 cup of milk or yogurt or 2 ounces of cheese. Your child
should eat 2 servings from this group.

j

 ½ servings include 2 to 3 ounces of cooked lean meat, poultry or fish, 1/2 cup
of cooked dry beans. You can substitute 2 tablespoons of peanut butter or 1 egg for 1
ounce of meat. Your child should eat 2 servings from this group.

˜
 V



‰Ê 2o more than 30% of your diet should come from fats. For a 1600 calorie diet,
that would equal 53g of fat each day, with most preschool children requiring even
less. The type of fat that you eat is also important.

‰Ê 



 in foods such as meats, dairy products, coconut, palm and palm
kernal oil, raise cholesterol more than V



, which are found in olive,
peanut, and canola oils, or ½  V



 in safflower, sunflower, corn,
soybean and cottonseed oils.

‰Ê
imit saturated fats to no more than 10% of daily calories.

‰Ê Sugars supply a large amount of calories, with little nutritional value. They include
white sugar, brown sugar, corn syrup, honey and molasses and foods like candy,
soft drinks, jams, and jellies.

Selection tips:

„Ê use lean meats and skim or low fat dairy products

„Ê use unsaturated vegetable oils and margarines that list a liquid vegetable oil as the
first ingredient on the label
„Ê read the nutrition label on foods to check for the amount and type of fat it includes
„Ê limit foods that contain a large amount of saturated fats
„Ê limit foods high in sugar and avoid adding extra sugar to your foods






2

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Serving Size 1/2 cup (114g)
Servings Per ëontainer 4

Amount per serving

ëalories 90 Fat ëal. 30

% Daily Value*

Total Fat 3g 5%

Saturated Fat 0g 0%

ëholesterol 0mg 0%

Sodium 300mg 13%

Total ëarbohydrate 4%
13mg

Dietary Fiber 3g 12%

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Sugars 3g

Protein 3g

Vitamin A 80% Vitamin ë 60%

ëalcium 4% Iron 4%

* Percent Daily Values are based on a

2,000 calorie diet. Your daily values
may be higher or lower depending on
your calorie needs.

‰Ê To learn about the new food labels, just click on the topic you are interested in.

‰Ê The new food labels are designed for children over 4 years of age and adults.
‰Ê In general, you should choose foods that are V
 V  
, V



 and  V 
, except for children under two years of age, who
should not have their fat intake restricted.


V


The serving size refers to the 


amount or ½
V
that a person eats at
one time. If the portion of the food that you eat is more or less than the serving
size, then you need to adjust the nutrient and calorie values. For example, if you
eat twice the amount listed in the serving size, then you must double the nutrient
and calorie values. ëonversely, the portion size for younger children is likely to be
less than the serving size. If your preschool age child eats a portion that is one-half
the serving size, then cut the nutrient and calorie values in half too.


V
V
V

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Refers to the number of servings in the container of food. In the above example, if
you eat the whole package or container of food, which has four servings, then you
must multiply nutrient and calorie values by four.

i  V


V

Refers to the number of nutrients and calories for each serving of food. A common
mistake that people make is to just look at the calorie and nutrient information and
not take into account how many servings are in the container. In the above
example, if you eat the whole container of food, you might think you were only
consuming 90 calories, but the whole container actually contained 4 servings,
which would equal 360 calories.

 


Refers to the number of calories for each serving of food. Again, take into account
how many servings you have had when determining how many calories you have
eaten.

 



The percent daily value for fat, cholesterol, carbohydrate, sodium, potassium and
protein are based on a 2,000 calorie diet. These values may be higher or lower
depending on the amount of calories in your diet. Your diet each day should reach
100% for total carbohydrate, dietary fiber, vitamins and minerals.
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2

V



 ˜


‰Ê Fats provide 9 calories per gram. !xcept for infants and toddlers, most children
should limit their fat intake, especially saturated fat. Foods with polyunsaturated or
monounsaturated fats (such as olive, peanut, canola, sunflower, corn or soybean oil)
are better choices. You should try and give your child a diet with no more than  
  
  V 
.

‰Ê The reference values for fat intake for children age 2-4 years is based on a diet of
1300 calories a day, with 30% of calories coming from fat, however, there are no
established guidelines for fat intake for children of this age.

 V





2-4 years over 4 years

Total Fat 40g 65g

Saturated Fat 12g 20g

 


 

ike fat, too much cholesterol can contribute to an increased risk of heart disease.
ëhildren over 4 years and adults should eat a diet low in cholesterol and should
have less than   of cholesterol in their diet each day.

 

Too much sodium or salt in your diet can contribute to high blood pressure. There
aren't clear guidelines about the daily requirements for sodium for younger
children, but in general you should provide a diet low in sodium and avoided
adding extra salt to the foods you prepare for your children.
c
 
 

 

 V





2-4 years over 4 years

Sodium ? 2400mg


  



ëarbohydrates provide 4 calories per gram. j


  
V 




 !   
   

, including sugars, starches
and fiber.

 V





2-4 years over 4 years

Total
? 300g
ëarbohydrate

Dietary Fiber ? 25g



V

Proteins provide 4 calories per gram. Most Americans consume too much protein
in their diet. Protein should make up only about " 

  
V 

#

 V





2-4 years over 4 years

Protein 16-24g 50g

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Your goal should be for your child to have 100% of each vitamin and mineral each day.
This is best accomplished by eating a variety of healthy foods.


 Vi

Milk and formula are excellent sources of Vitamin A, which is a fat soluble
vitamin. A deficiency can occur in children with fat mal-absorption or with a very
poor diet. Too much Vitamin A can also be harmful.


 V

Although many parents exceed the recommended daily requirements of Vitamin ë

to prevent colds and upper respiratory tract infections, there is little research that
supports this practice. Too little Vitamin ë can lead to scurvy, which is now
uncommon, but can occur in infants under one year of age who are exclusively fed
cow's milk.

V

Iron is another mineral that is important for your child's growth. Having a diet
with foods that are high in iron to meet daily requirements is necessary for the
development of strong muscles and production of blood. It is generally good to
choose foods high in iron. Younger children require about 10mg of iron each day,
while older children and adolescents need about 12-15mg a day.

  

ëalcium is a mineral that is mostly present in your child's bones. Having a diet
with foods that are high in calcium to meet daily requirements is necessary for the
development of strong bones. It is also an important way to prevent the
development of osteoporosis in adults. Younger children require about 800mg of
calcium each day, while older children and adolescents need about 1200-1500mg a
day.

On food labels, the calcium content is usually represented as a percentage, such as

4%, 15% or 30%, etc. What does that percentage mean? It is the percentage of the
daily value of calcium that you would get by eating one serving of the particular
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food and it uses 1000mg as 100% daily value. So, if a food label that says that it
has 30% calcium has 30% x 1000, or 300mg.

  $
% 

V

‰Ê ëalcium is a mineral that is mostly present in your child's bones. Having a diet
with foods that are high in calcium to meet daily requirements is necessary for the
development of strong bones. It is also an important way to prevent the
development of osteoporosis in adults.

‰Ê 

"

!
% 

    
  (about 2
glasses of milk)#
‰Ê 
  V V
  
  
V
&

!
% 

 
   
 (about 3 glasses of milk)#
‰Ê  
  
  
VV

V
'
"
!
% 

"  
  
 #This higher level of calcium is especially important once they
begin puberty (about 4 glasses of milk)#
‰Ê Since milk has a lot of calcium in it, children who routinely drink milk each day
usually easily meet their daily requirements of calcium. ëhildren with milk
allergies or who just don't like milk are a little more of a challenge to meet these
requirements, but it is still easy if you learn to read food labels.
‰Ê See the table below for the calcium content of common foods and check the
nutrition label to choose foods high in calcium when you prepare your families
diet. Also choose foods that are fortified with calcium.
‰Ê The American Academy of Pediatrics has recently changed their recommendation
for Vitamin D supplements for kids, which may affect kids who do not drink much
milk. The AAP now advises that, to prevent rickets and Vitamin D deficiency,
children will need a supplement with 200 IU of Vitamin D each day if they are
exclusively breastfed or not drinking at least 500ml (17 ounces) of Vitamin D
fortified milk or infant formula. Older children and teens who do not get regular
sunlight exposure and who do not drink at least 500ml of Vitamin D fortified milk
each day will also need a supplement.

examples:

  
˜ 
V
V

V

Milk, whole or low-fat 1 cup 300 mg

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Soy or Rice Milk 1 cup 300 mg

White beans 1/2 cup 113 mg

Instant Oatmeal 1 cup 100 mg

Ñroccoli, cooked 1/2 cup 35 mg

Ñroccoli, raw 1 cup 35 mg

ëheddar cheese 1.5 oz 300 mg

Yogurt, low-fat 8 oz 300 mg

Orange juice, calcium

1 cup 350 mg
fortified

Orange, medium 1 40-50 mg

Sweet potatoes, mashed 1/2 cup 44 mg

‰Ê On food labels, the calcium content is usually represented as a percentage, such as

4%, 15% or 30%, etc. What does that percentage mean? It is the percentage of the
daily value of calcium that you would get by eating one serving of the particular
food and it uses 1000mg as 100% daily value. So, if a food label that says that it
has 30% calcium has 30% x 1000, or 300mg.
‰Ê Since younger children don't need 1000 mg, instead of adding up the percentages
of the foods they eat, add up the mg to get close to the daily requirements
described above. And keep in mind that older kids need more than 100% DV.
With a daily requirement of 1300 mg, they instead need 130% DV of calcium.

In addition to actually reading the nutrition label, you can also find foods that are good
sources of calcium by looking for the following terms on the packaging:

„Ê High in ëalcium, Rich in ëalcium or !xcellent Source of ëalcium, are found

on foods that have at least 20% daily value of calcium or 200mg (and often up to
30-35% calcium).
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„Ê ëontains ëalcium, Provides ëalcium or Good Source of ëalcium, are found
on foods that have at least 10-19% daily value of calcium or 100-190mg.

„Ê ëalcium !nriched, ëalcium-Fortified or have More ëalcium. are found on

foods that have more than 10% daily value of calcium as compared to similar
foods without as much calcium. So, if you have two type of orange juice and one
has 4% calcium and another has 15% daily value of calcium, then the one with
more calcium can say the it is calcium enriched or fortified.

So choose food products that are high in calcium to get your child the calcium he needs.
And compare food labels to choose brands or types of foods that have a higher
percentage of the daily value of calcium.

Some good choices, include:

„Ê Golden Grahams cereal - 350mg per 3/4 cup

„Ê calcium fortified soy milk - 300mg per cup
„Ê Iron Kids bread - 160mg per slice (you might look for a whole wheat bread with
calcium though)
„Ê yoo-hoo chocolate drink - 250mg per 8 oz serving (a good source of calcium, but
not a very healthy choice)
„Ê animals low fat yogurt - 150mg per cup
„Ê Honey Maid Graham ërackers (look for the ones that say '2ow a good source of
calcium) - 150mg in 2 crackers
„Ê Ouaker Fruit & Oatmeal Ñites - 200mg per serving
„Ê 2estle ëarnation Instant Ñreakfast mix - adds 250mg of calcium to a glass of milk,
boosting its calcium content to over 500mg
„Ê When looking at different brands and flavors of orange juice, you can see why
reading food labels is so important. Some will have 0% daily value of calcium,
while other flavors of juice, even of the same brand, can have up to 35% or
350mg.
„Ê What about vitamins? Many parents think that their child is getting enough
calcium if they are getting a 'complete' daily multivitamin. !xamining the label of
these 'complete' vitamins shows that they usually only have about 75-100mg of
calcium. For a school age child, that would only be about 9-12% of their daily
requirement. There are vitamins with higher calcium levels, often up to 20% daily
value of calcium or 200mg, but you will have to read the label to find them, and
they won't provide enough calcium for your child if they are your child's main
source of calcium.
„Ê There is a new calcium vitamin that has 500mg of calcium. It is the One A Day
Kids Scooby Doo ëalcium ëhews, which look and taste like a tootsie roll candy
c
 
 

 

and most kids should like taking. This vitamin does contain 'dried milk solids' and
so is not a good choice for kids with a milk allergy.
„Ê Tums and adult type calcium supplements, like Viactiv, provide 500mg of calcium
per serving, and may be good options for older kids with your Pediatrician's
approval.


 VVjV
 

‰Ê It is estimated that a daily multivitamin is given to 25-50% of children in the

United States, although this is generally not necessary for most children with an
average diet. Some children that have a poor or restricted diet, liver disease or
other chronic medical problems, especially those that lead to fat malabsorption,
such as cystic fibrosis, may need vitamin and mineral supplements to prevent
deficiencies.

‰Ê Preterm infants and children who are exclusively breastfed may also need vitamin
supplements.
‰Ê Also, children may need fluoride supplements if they do not drink fluoridated
water.
‰Ê Although you may give your child an age appropriate multivitamin if you or your
Pediatrician feels that your child needs one, it is probably better to try and reach
his daily requirements or recommended daily allowance by providing him with a
well balanced diet. ëonsuming a diet with the minimum number of servings
suggested by the Food Guide Pyramid will provide your child with the
recommended daily allowance of most vitamins and minerals.


 Vi

Milk and infant formulas are excellent sources of Vitamin A, which is a fat soluble
vitamin. A deficiency can occur in children with fat malabsorption or with a very
poor diet. Too much Vitamin A can also be harmful.
c
 
 

 



 V

Although many parents exceed the recommended daily requirements of Vitamin ë

to prevent colds and upper respiratory tract infections, there is little research that
supports this practice. Too little Vitamin ë can lead to scurvy, which is now
uncommon, but can occur in infants under one year of age who are exclusively fed
cow's milk. Fruits and vegetables are excellant sources of Vitamin ë.

V

Iron is another mineral that is important for your child's growth. Having a diet
with foods that are high in iron to meet daily requirements is necessary for the
development of strong muscles and production of blood. It is generally good to
choose foods high in iron. Younger children require about 10mg of iron each day,
while older children and adolescents need about 12-15mg a day.

  

ëalcium is a mineral that is mostly present in your child's bones. Having a diet
with foods that are high in calcium to meet daily requirements is necessary for the
development of strong bones. It is also an important way to prevent the
development of osteoporosis in adults. Younger children require about 800mg of
calcium each day, while older children and adolescents need about 1200-1500mg a
day.


 V(

Vitamin K is a fat soluble vitamin that is necessary for proper blood clotting. It
can be deficient in some newborn babies, especially if they did not receive a
Vitamin K shot after they were born and they are being breastfed.


 V

Vitamin D is another fat soluble vitamin that can be deficient, causing Rickets, in
some infants that are exclusively breastfed, especially if they have very dark skin
or if they have limited exposure to sunlight. Vitamin D is mostly found in fortified
foods, such as milk and infant formulas.
c
 
 

 

There was once thought to be little need for supplements of Vitamin D in most
children if they have sunlight exposure, although the AAP now recommends that
all children receive Vitamin D supplements..Infants and children who drink 16-17
ounces of formula or Vitamin D fortified milk won't need a supplement, but
exclusively breastfed infants need to take 200 IU of Vitamin D each day.

˜ 


‰Ê All children need supplemental fluoride after they are ) V
 old to help
prevent cavities. For most children, they can get this fluoride from the water they
drink, if they are in an area where the city water supply has an adequate amount of
fluoride in it (greater than 0.6 ppm), and they are drinking tap water.
‰Ê Sources of water that generally don't have enough fluoride include well water and
filtered or bottled water, although some brands of bottled water (or nursery water)
do have fluoride added to it. Also, commercially prepared pre-mixed infant
formulas do not contain an adequate amount of fluoride, so consider using a
powder or concentrated formula and mixing it with tap water, supplement your
infant with extra tap water, or talk to your Pediatrician about giving fluoride
supplements.
‰Ê It is in general better to have your child drink water that is supplemented with
fluoride instead of giving extra fluoride drops or supplements. Too much fluoride
can cause  , which is permanent white to brown discoloration of the
enamel of the teeth. It is easier to get fluorosis if you are giving your child fluoride
drops and he is still getting fluoride from his diet.

*V 

Zinc is an important mineral, especially for adolescents, as it helps with growth

and sexual maturation. Infants require about 3-5mg of zinc each day, while
adolescents need about 10-15mg. Foods high in zinc include meats, seafood, dairy
products, whole grains, breads and fortified cereals, nuts and dried beans.
c
 
 

 





V



‰Ê Although many parents, and even some Pediatricians, think that it is unhealthy for
children to be on vegetarian diets, if well planned, a vegetarian diet can provide all
of the nutrients that your child needs to be healthy.

‰Ê In addition, since vegetarian diets are generally high in fiber, low in cholesterol
and low in saturated fats (all characteristics of a healthy diet), they may actually be
more healthy than most American diets and may lead to a lower risk of obesity,
heart disease, high blood pressure and Type II diabetes.
‰Ê Parents, especially if they are vegetarians, can feel reassured that they can safely
raise their kids to be vegetarians too.

½



V+

There are actually many different types of vegetarians, ranging from those that just avoid
red meat (




V) to 
V, who do not eat any foods that contain animal
products.

„Ê 
½
 


V: avoids red meat only
„Ê 





V: avoids meat, seafood and poultry, but does consume milk
products and eggs
„Ê 




V: avoids meat, seafood and poultry and eggs, but does consume
milk products
„Ê 



V: avoids meat, seafood and poultry and milk products, but does
consume eggs
„Ê 
V: avoids all foods that contain animal products, including meat, seafood and
poultry, milk products and eggs

Vegetarian diets can lead to health problems in children and deficiencies of certain
vitamins and minerals if the diet is not well planned. And the more restrictive the diet, the
higher the risk of problems. It may be helpful to see a V

V
that specializes in
c
 
 

 

vegetarian diets for children, especially if your child's diet is very restrictive, such as a
macrobiotic diet.

Some areas that you should pay special attention to if your child is on a vegetarian diet
include:

„Ê !V
, 
. Vegetarian diets may have less calories than diets that include
meat and dairy products. Although it isn't necessary to count calories each day,
you should ensure that your child is receiving enough calories for their optimal
growth. In general, if your child is eating a well balanced and varied vegetarian
diet, is gaining weight and developing normally and is active, with a lot of energy,
then he is probably getting enough calories.
„Ê

 V-".. This vitamin is only absorbed from animal products, so your child
will need to take supplements or eat foods that are fortified with Vitamin Ñ12
(check nutrition labels), including fortified soy milk and some meat substitutes.
Also, nutritional yeast as a great way to get Ñ-12.
„Ê

 V. This vitamin is present in fortified milk, egg yolks, and fish. Your
body also makes Vitamin D when exposed to sunlight, so most children do not
have problems with Vitamin D deficiency. If your child is not exposed to the sun
very often, then you should consider Vitamin supplements or a soy milk that is
fortified with Vitamin D.
„Ê V. In general, the ½
V of iron from meat, chicken and fish is much
higher, around 15-30%, than other sources, which have absorption rates of only
about 5%. This means that even though some vegetables and fruits contain iron, it
is usually not absorbed as readily as the iron from meats. ëheck the nutrition label
to choose foods high in iron, choose foods that are fortified with iron (cereals,
bread, rice, and pasta) and consider a vitamin suppletment that contains iron.
„Ê   . ëalcium is a mineral that is mostly present in your child's bones. Having
a diet with foods that are high in calcium to meet daily requirements is necessary
for the development of strong bones. It is also an important way to prevent the
development of osteoporosis in adults. Many vegetables contain calcium,
especially broccoli, sweet potatoes, great northern and navy beans, and leafy
greens. You can also give your child soy milk or orange juice that is fortified with
extra calcium.
„Ê 

V. You can make sure that your child gets enough protein and amino acids
by eating a good balance of grains, legumes, nuts and seeds, vegetables and fruits.
„Ê *V . Your child will need to take supplements or eat foods that are fortified with
zinc to get enough of this important mineral, since the best sources of zinc are
meat and yogurt. Zinc is also found in whole grains, brown rice, legumes, and
spinach.
c
 
 

 


 


‰Ê Illness caused by contaminated or improperly prepared foods cause up to 81
million people to get sick each year, with almost 9000 of these illnesses leading to
death. ëhildren are among the people most at risk for serious illness from food
poisoning.

‰Ê To protect your child from germs that cause food poisoning, it is important to
practice the following food safety techniques, which include not giving your child
undercooked or poorly refrigerated poultry, meat, fish or eggs; washing your
hands, utensils and kitchen surfaces after handling uncooked poultry and meat;
thoroughly washing fruits and vegetables; not giving your child unpasteurized
dairy products or fruit juices; avoiding fish and shellfish from noncommercial
sources; not serving hamburgers rare; promptly refrigerating leftovers and not
leaving foods at room temperature for more than a few hours; defrosting foods in
the refrigerator; and keeping your refrigerator set to at least 40 degrees Fahrenheit
and your freezer to 0 degrees.

i 
   

‰Ê Almost any food can become contaminated by a virus, bacteria, or parasite and
cause food poisoning. Foods can also make you sick if they are contaminated with
pesticides or other toxins.
‰Ê The most common symptoms of food poisoning include vomiting, diarrhea,
abdominal cramps, nausea and fever and they begin a short time after eating a
contaminated food. In most people symptoms are mild and clear up quickly, but
food poisoning can lead to dehydration, kidney failure and even death.
‰Ê Foods most likely to cause illness include raw or undercooked ground beef (!.
coli), pork (bacteria and trichinella worms), chicken (Salmonella), seafood
(especially shell fish which can be contaminated with hepatitis A and other viruses
and bacteria) , and eggs (Salmonella). Fruits and vegetables can also be
contaminated with viruses such as hepatitis A and parasites. Unpasteurized milk
c
 
 

 

and fruit juices (especially apple cider) can also be contaminated with bacteria and
should be avoided.



V
V½VV
To help prevent your family from getting sick from eating contaminated foods, follow
these guidelines when buying and preparing their meals:

„Ê Keep your 


 at or below 41 degrees F and your 


 at 0 degrees.
„Ê When shopping for foods, quickly return home and 



perishable foods
and place bags that contain meats, poultry, fish and eggs separately from other
foods to avoid contamination.
„Ê Do not buy or use foods without intact ½ V.
„Ê Do not buy or use V that have been dented or that are bulging.
„Ê ëonsider using a ½ 
 

V to prepare foods, since bacteria can
become trapped in the grooves of wooden cutting boards.
„Ê Õ   V for twenty seconds with soap and warm water before preparing
foods, before you begin to prepare a new food and again before you serve the
food.
„Ê Avoid 
V
 V
V of foods by washing utensils, cutting boards, and all
kitchen surfaces that come in contact with raw meats and poultry before preparing
a new food with them. Also be careful to use a separate plate for cooked foods
then the one you used when the food was still raw.
„Ê $V
 
V



 before serving or eating.
„Ê   and V

foods in the refrigerator, instead of leaving them out at room
temperature.
„Ê Õ  
 in hot water after using them to clean up after raw meats and
poultry.
„Ê Keep ½

 away from all areas where you prepare foods.
„Ê Thoroughly cook foods to kill germs and consider using a



 


to
ensure proper cooking temperatures. $


 should be cooked to an interior
temperature of 160 degrees F and make sure the inside is brown or gray to make
sure it is fully cooked. Hamburgers especially should not be served rare. 

should be cooked to an interior temperature of 180 degrees F and until the juices
run clear.
„Ê $






 and do not leave foods out at room temperature for more
than two hours.
„Ê Throw away partially eaten foods and beverages.
„Ê Thoroughly 





 before eating.
„Ê Do not eat raw
.
c
 
 

 

„Ê Do not drink V½


 milk or fruit juices (especially apple cider that is not
pasteurized or heat treated).
„Ê Do not use foods or beverages that taste, look or smell unusual.
„Ê If you are unsure if a food is still good, be safe and throw it out.

[



Do your kids eat breakfast?

Ñy many reports, 40% of kids don't.

Ñut everyone knows that breakfast is the most important meal of the day, right?

Here is some proof:

„Ê Study showed that 'students who ate breakfasts before starting school had a
general increase in math grades and reading scores, increased student attention,
reduced nurse visits, and improved student behaviors'

„Ê ëhildren who eat a healthy breakfast 'meet their daily nutritional needs, keep their
weight under control, have lower blood cholesterol levels, attend school more
frequently, and make fewer trips to the school nurses office complaining of tummy
aches.'*

„Ê Kids 'who eat breakfast are more likely than children who skip breakfast to
consume foods with adequate levels of minerals, such as calcium, phosphorus,
magnesium, and vitamins, such as riboflavin, vitamins A, ë, and Ñ12, and folate.'*

„Ê Kids 'who skip breakfast do not make up for the missed calories at other meals.'*
c
 
 

 

So why aren't your kids eating breakfast each day?

Most likely it is because your family is already rushed in the morning and you don't feel
like you have time to provide a nutritious breakfast. Ñut remember that breakfast doesn't
have to mean home-made waffles or french toast every day. There are many quick and
easy breakfasts that you can give your kids that are also nutritious.

According to the American Dietetic Association, these can include:

„Ê ready-to-eat cereal with fruit and milk

„Ê toasted bagel with cheese
„Ê fruit-filled breakfast bar and yogurt
„Ê toasted waffle topped with fruit and yogurt
„Ê fruit smoothie (fruit and milk whirled in a blender)
„Ê peanut butter on whole-wheat toast

If you can't provide a healthy breakfast for your child at home, you might also look at
breakfasts offered at your child's school or daycare.

 

The nonprofit group ëenter for Science in the Public Interest has released a list of
unhealthy snacks that are commonly served in vending machines in schools, which are
often 'filled with soda, candy bars, cookies, chips and other low-nutrition foods,' plus a
list of more healthy choices.

Another big problem is that many kids use these vending machines and 'snacks' as an
alternative for lunch.

Among the 'Õ


VV½
V' are:

„Ê ëhips Ahoy!, Oreo and other fatty cookies

c
 
 

 

„Ê ëhocolate whole or 2% milk
„Ê ëoca-ëola, Pepsi and other soda
„Ê Fruitopia, FruitWorks, and other ³fruit´ drinks
„Ê Hostess HOHOs and other snack cakes
„Ê Keebler ëlub & ëheddar Sandwich ërackers
„Ê Kit Kat Ñig Kat, Snickers and other candy bars
„Ê Starburst Fruit ëhews and other sugary candies

Are there better options for snacks at school?

Sure. The ëSPI offers these '-



VV½
V':

„Ê Applesauce cups (unsweetened)

„Ê Ñottled water
„Ê ëhex Mix, Traditional
„Ê Dole or Del Monte fruit cups
„Ê
ow-fat or fat-free milk
„Ê 2ature Valley ërunchy Granola Ñars, Oats µ2 Honey
„Ê Orange juice (100%)
„Ê Raisins and unsweetened dried fruit

And these healthy snack choices aren't just for school vending machines.

They can help guide your choices of snacks that you offer your kids at home.

   

‰Ê
Parents often ask how many calories their children need, but for the average child
who is growing and developing normally and has a normal activity level, counting
calories is usually not necessary.
c
 
 

 

‰Ê In general though, knowing how many calories your child needs each day can help
you plan your child's nutrition and make sure he is eating a healthy diet.
‰Ê Ñeing familiar with calorie requirements can also be helpful in evaluating children
with failure to thrive, who are gaining weight well, and for children who are
overweight.
‰Ê For younger children, calorie recommendations and average energy needs depend
on their age. Remember that these are just averages though, some children will
require more calories and some will require less. The amount of calories that
allows your child to grow normally is likely what is 'enough' for him.

i

 
2


i

! 
0-5 months 650
5-12
850
months
1-3 years 1300
4-6 years 1800
7-10 years 2000

In addition to age, for older children, calorie requirements are also determined by their
sex, with boys, in general, requiring more calories than girls. Other factors include a
child's size, body composition and level of activity. A very active teen at the top of the
growth charts will likely need many more calories than a smaller and/or less active child.

i

 
2


-
! 
11-14
2500
years
15-18
3000
years

i

 
2


 
! 
11-14 2200
c
 
 

 

years
15-18
2200
years

-
V 



A Pediatric nutritionist can suggest ways that you can provide your child with more
calories by offering    



  V½

V
 
V

V
,
especially since he will need additional calories to help him catch-up with his growth,
including (disclaimer: only use these suggestions for increasing the calories that you are
giving your child under the guidance of your Pediatrician or a Pediatric nutritionist):

„Ê avoid junk foods, such as candy, which may have calories, but are usually low in
protein.
„Ê for younger children, under the direction of your Pediatrician or a nutritionist, your
infant's   V
 V
V


 to provide more than the regular 20
calories/ounce.
„Ê for older children, over 12 months of age, instead of milk, you can offer

 
, which has 30 calories/ounce (vs 20 calories/ounce for whole milk) 2-3
times a day.
„Ê or mix whole milk with a packet of V
V


½
 (adds 130 calories)
or   ½
 (adds 33 calories per tablespoon) to increase calories.
„Ê when baking and cooking, substitute whole milk, half and half, evaporated milk or
condensed milk mixed with dry milk powder for water or milk.
„Ê for high calorie snacks, offer    
 made with a cup of whole milk, a
packet of instant breakfast powder and a cup of ice cream blended together (can
provide over 400 calories).
„Ê ½ V can also provide a lot of calories if you add 1/2 cup of dry milk powder
to the milk and instant pudding mix.
„Ê add


as a topping for sandwiches, vegetables, etc.
c
 
 

 

„Ê use ½
V



 (about 100 calories/tablespoon) as a snack and as a topping for
vegetables, crackers, and fruits or blended with milk, ice cream or yogurt
„Ê make a high calorie  
V  using fruits canned in heavy syrup, add sugar or
yogurt to fresh fruit or add a packet of instant breakfast powder to strained fruits.
„Ê make high calorie -
 by substituting fruit juice for water in its preparation
„Ê serve meats and breads with added butter, margarine, gravy or sauces
„Ê serve 
, such as fish and chicken and add breading or flour before
cooking

V$
% 

V

‰Ê Iron is another mineral that is important for your child's growth. Having a diet
with foods that are high in iron to meet daily requirements is necessary for the
development of strong muscles and production of blood.

‰Ê i

V

% 

". 
!
" 

! V
 #
‰Ê J V
  
V
% 

"  V
 #
‰Ê See the table below for the iron content of common foods and check the nutrition
label to choose foods high in iron when you prepare your families diet. Also
choose foods that are fortified with iron (cereals, bread, rice, and pasta).

‰Ê In general, the ½
V of iron from meat, chicken and fish (heme iron) is
much higher, around 15-30%, than other sources (non heme iron), which have
absorption rates of only about 5%. This means that even though one serving of
meat and one serving of baked beans both have 3 mg or iron, your child will get
much more iron into his body by eating the meat serving. However, eating both of
these foods at the same time will increase the absorption of iron, as will eating
foods high in Vitamin ë.
‰Ê The following tables suggest dietary sources of heme and nonheme iron. As the
table indicates, meat, poultry, fish and seafood are good sources of heme iron and
beans are good sources of nonheme iron. In addition, many foods are fortified with
iron. Some foods, such as cereals, may be fortified with 100% of the Daily Value
(DV)* for iron.
‰Ê Remember that heme iron is absorbed very efficiently by your body, and that
nonheme iron is not as well absorbed as heme iron, and that meat proteins and
vitamin ë will improve the absorption of nonheme iron though. Also, calcium,
like from cow's milk, can decrease the absorption of iron,which is one of the
reasons that drinking too much milk can contribute to a child developing iron
deficiency.
c
 
 

 

˜$ V/

V
˜ j   


ëhicken liver, cooked, 3 ounces 7.0 40

Oysters, breaded and fried, 6 4.5 25

Ñeef, chuck, braised, 3 ounces 3.2 20

ëlams, breaded, fried, 3/4 cup 3.0 15

Ñeef, tenderloin, roasted, 3 ounces 3.0 15

Turkey, dark meat, roasted, 3 ounces 2.0 10

Ñeef, eye of round, roasted, 3 ounces 1.7 10

Turkey, light meat, roasted, 3 ounces 1.2 6

Tuna, fresh bluefin, cooked, dry heat, 3 ounces 1.1 6

ëhicken, leg, meat only, roasted, 3 ounces 1.1 6

ërab, blue crab, flaked & pieces, cooked, moist heat,

1.1 6
1 cup

ëhicken, breast, roasted, 3 ounces 1.0 5

Halibut, cooked, dry heat, 3 ounces 0.9 5

Pork, loin, meat only, broiled, 3 ounces 0.8 4

Tuna, white, canned in water, 3 ounces 0.8 4

ërab, blue crab, cooked, moist heat, 3 ounces 0.8 4

c
 
 

 

Shrimp, mixed species, cooked, moist heat, 4 large 0.7 4

* DV = Daily Value. DVs are reference numbers based on the Recommended

Dietary Allowance (RDA). They were developed to help consumers determine
if a food contains a lot or a little of a specific nutrient. The DV for iron is 18
milligrams (mg). The percent DV (%DV) listed on the nutrition facts panel of
food labels tells adults what percentage of the DV is provided in one serving.
Percent DVs are based on a 2,000 calorie diet. Your Daily Values may be
higher or lower depending on your calorie needs. Foods that provide lower
percentages of the DV also contribute to a healthful diet.

˜$ V2V/

V
˜ j   


Ready-to-eat cereal, 100% fortified, 3/4 cup 18.0 100

Ready-to-eat cereal, 50% fortified, 3/4 cup 9.0 50

Soybeans, mature, cooked, boiled, 1 cup 8 50

entils, cooked, boiled, 1 cup. 6 35

Grits, white, enriched, instant, 1 packet prepared 5.4 30

Oatmeal, instant, fortified, 1/2 cup 4.1 25

Kidney beans, cooked, boiled, 1 cup 5.2 25

Pinto beans, cooked, boiled, 1 cup 4.6 25

ima beans, cooked, boiled, 1 cup 4.2 25

2avy beans, cooked, boiled, 1 cup 3.8 20

Ñlack beans, cooked, boiled, 1 cup 3.6 20

c
 
 

 

Spinach, cooked, boiled, drained, 1/2 cup 3.2 20

Spinach, canned, drained solids 1/2 cup 2.5 10

Tofu, firm, 1/2 cup 1.8 10

Ñlack-eyed-peas, cooked, boiled, 1 cup 1.8 10

Spinach, frozen, cooked, boiled 1/2 cup 1.4 8

Whole wheat bread, 1 slice 0.9 5

Molasses, 1 Tablespoon 0.9 5

White bread, enriched, 1 slice 0.8 4

Raisins, seedless, 50 0.5 2

* DV = Daily Value. DVs are reference numbers based on the Recommended

Dietary Allowance (RDA). They were developed to help consumers determine
if a food contains a lot or a little of a specific nutrient. The DV for iron is 18
milligrams (mg). The percent DV (%DV) listed on the nutrition facts panel of
food labels tells adults what percentage of the DV is provided in one serving.
Percent DVs are based on a 2,000 calorie diet. Your Daily Values may be
higher or lower depending on your calorie needs. Foods that provide lower
percentages of the DV also contribute to a healthful diet.

other examples:

˜ 
V VV

V

Hamburger 3 oz 2.7 mg

ean Steak 3 oz 3 mg
c
 
 

 

Pork ëhop 3 oz 3.3 mg

ëhicken (dark meat) 3 oz 2 mg

ëhicken (white meat) 3 oz 1 mg

Fish 3 oz 1 mg

Peanut butter 4 tbsp 1.2 mg

Green peas, lima beans 1/2 cup 2.1 mg

Ñaked beans 1/2 cup 3 mg

Whole grain bread 2 slices 1.4 mg

Raisins 1/2 cup 2.1 mg

$V

V  
V

‰Ê A 
V does not eat any foods that contain animal products. This means no beef,
chicken, fish, pork or veal; no milk, cheese, butter, eggs, sour cream, or cottage
cheese. Instead a vegan eats fruits, vegetables, nuts, grains
and legumes.
‰Ê Is a vegan diet healthy for an active, growing child?
Absolutely. ëhildren raised on a vegan diet eat more fruits and vegetables than
their meat-eating counterparts. They are sick less often, and don't have as many
food allergies. !ven vegan junk food is healthier than regular junk food,
c
 
 

 

containing fruit juice instead of sugar, and whole wheat flour instead of white
flour. Family and friends may worry that your child will be ostracized at school if
he brings tofu and sprouts. So send your child to school with a peanut butter and
jelly sandwich, apple, carrots, and fruit-sweetened cookies and no one will know
your child is eating a special diet. At birthday parties, find out what the host is
serving and drop your child off with the vegan equivalent of those items.

V

V-


The 

  of vegan women is refreshingly void of many toxins and pesticides that
are found in the breast milk of meat-eating women. This affords a vegan baby an even
better chance for short and long term health.

V

VVV


The first foods any child eats are usually mashed fruits, soft veggies, and iron fortified
rice cereals. All of these items are vegan so nothing special needs to be said for starting
solids. Avoiding cow's milk and eggs are probably good advice for the first year of any
child's life anyway. After that, simply give your vegan child samples of food from your
own plate and see what she likes.

V

V  
V

As your child gets older you can incorporate the things most kids enjoy eating. Ñelow are
some suggestions for things most vegan children will enjoy and will ensure that he has a
well balanced and varied diet:

„Ê Spaghetti with tomato sauce

„Ê Peanut butter and jelly sandwiches
„Ê ëhicken-Free nuggets (soy protein nuggets that taste just like breaded chicken)
„Ê Ñaked french fries with ketchup
„Ê Ñurgers, hot dogs and sandwich slices made of tofu and other meat substitutes
„Ê Whole wheat 
 (3-4 slices each day)
„Ê Grilled soy cheese sandwiches
c
 
 

 

„Ê Mashed potatoes
„Ê Veggie pizzas with soy cheese
„Ê Oatmeal with apples and cinnamon
„Ê Pancakes with pure maple syrup
„Ê Waffles with fruit
„Ê Ñarley and vegetable soup
„Ê Romaine lettuce salad
„Ê




, including green leafy and deep yellow vegetables
„Ê Ñaked potato with broccoli and tofu sour cream (non dairy)
„Ê Rice and beans
„Ê Vegetable stew
„Ê Spinach lasagna
„Ê ëalcium-fortified orange juice
„Ê ëalcium-fortified    (3 cups each day).
„Ê Iron-fortified cereal with calcium-fortified soy milk
„Ê supplements: a vegan

 V to provide Vitamin Ñ12 and zinc, and extra
iron and calcium

Snacks:

„Ê ˜ 
, cut up into bite sized pieces for children under 4 (4-5 1/2 cup servings with
at least 2 servings of citrus fruit or juice each day)
„Ê Raisins
„Ê Trail mix
„Ê Applesauce
„Ê Fresh berries and sorbet (all fruit without sugar)
„Ê Fruit smoothies
„Ê Popcorn
„Ê Vegans can't eat white sugar, and most candy is made with it. Ñut there are some
vegan chocolate companies that make some good stuff, and a gummy bear
substitute that isn't bad made with fruit juice. Vegan cakes, donuts, cookies, and
pies are abundant though.



V

 V
VV 


During pregnancy it is vital to maintain a healthy diet for the safety of the developing
fetus. Pregnant vegans have a tremendous advantage since their diet is naturally high in
the vitamins and minerals the baby needs. As long as her diet is varied and incorporates a
reliable source of Ñ12, a vegan woman can be reasonably sure she is meeting her daily
c
 
 

 

requirements. A visit to a registered dietician who specializes in vegan diets can help ease
her mind if she is unsure of her particular diet.

Suggested foods
It is important to eat a varied diet during pregnancy to ensure an adequate supply of many
vitamins and minerals. Ñelow is a list of some food choices that are healthy and rich in
the nutrients a woman needs during pregnancy. These items are good choices even for
non-vegan women.

„Ê Ñreakfast:
Ê Whole grain cereal with soy milk
Ê Whole grain pancakes with pure maple syrup
Ê Fruit smoothies
Ê Oatmeal with dried fruit or apples and cinnamon
Ê Whole wheat toast with all fruit preserves
„Ê
unch:
Ê Romaine lettuce salad with chopped vegetables and low fat dressing
Ê Veggie sandwich on whole grain bread with avocado, lettuce, tomato, and
onions.
Ê Ñaked potato with broccoli and tofu sour cream (non dairy)
Ê Falafel sandwich with humus or tahini
Ê Split-pea soup
„Ê Dinner:
Ê Whole wheat pasta with marinara sauce
Ê Sweet potatoes
Ê Vegetarian pizza with no cheese
Ê Vegetable stir fry with brown rice
Ê Potato-lentil stew
Ê Vegetable stew
Ê Spinach lasagna
„Ê Snacks:
Ê popcorn with nutritional yeast
Ê dried fruits
Ê grapes
Ê fruit juice with sweetened cookies
Ê nuts
Ê trail mix
c
 
 

 

/V V
½VV



It isn't always easy being a vegan. 2ot everyone understands the nature of the diet or how
healthy it really is. The best way to deal with people who challenge the safety of a vegan
diet is to arm yourself with information.

/V V/ 

It's important that a vegan child not feel different just because their diet may not be
shared by those around them. During holidays it's wise to find vegan equivalents to
favorite holiday treats. For example, a vegan !aster basket can include vegan chocolate
eggs and plastic eggs with coins in them. Halloween can be tough, but one idea is to get
together with other vegan parents and have a Halloween party.
et the kids dress up in
costume and enjoy activities like bobbing for apples. Serve vegan cupcakes and
confections in the shapes of monsters, and carve pumpkins too. With a little forethought
and creativity, a vegan child can enjoy the same holidays non-vegan children do.

-

 0V


Raising a vegan child is just as exciting, rewarding, and filled with challenges as raising
any child. Ñut providing your child a vegan diet will give him an early start on leading a
long and healthy life.


   

‰Ê Your baby will get all of his nutrition from breast milk or an iron fortified infant
formula until he is four to six months old. There is no need to supplement with
water, juice or cereal at this time. He will probably be eating every two to six
c
 
 

 

hours and if feeding on-demand and following your baby's cues remember that not
all cries are µhunger-cries' and you may have to set some limits (for example, not
allowing to feed every hour).
‰Ê Most breast feeding babies will eat for 10-15 minutes on each breast every 1 1/2 to
3 hours and formula feeding babies will take 2-3 ounces every 2-4 hours. Ñy 4-8
weeks your baby should be on a more predictable schedule.
‰Ê Feeding practices to avoid are giving a breastfed baby a bottle before he is 4-6
weeks old, putting the bottle in bed or propping the bottle while feeding, putting
cereal in the bottle, feeding honey, introducing solids before 4-6 months, heating
bottles in the microwave, or feeding goats milk.
‰Ê Also, avoid the use of V , which are nutritionally inadequate to
meet the needs of a growing infant. These types of infant formula do not contain
enough iron and will put your child at risk for developing iron deficiency anemia
(which has been strongly associated with poor growth and development and with
learning disabilities). Iron fortified formulas do not cause colic, constipation or
reflux and you should not switch to a low iron formula if your baby has one of
these problems.




‰Ê In most cases, breast milk is the most perfect food for your baby. Ñreast milk
contains easily digestible proteins, many factors that support your new baby's
immature immune system, and other factors that aid indigestion. It is also low in
cost and requires no preparation. Ñreast fed babies are also less likely to have
colic, upper respiratory infections, ear infections, constipation, asthma or allergies.
And breast feeding will burn up almost 500 of mom's calories each day.
‰Ê Despite all of these advantages of breast feeding, you should not feel guilty if you
decide that you would rather feed your baby formula. There are many formulas
available that will provide your baby with good nutrition to promote his growth
and development.
c
 
 

 

/½
½
 VV
1 
‰Ê Infant formulas are available in many different forms, including those that are




, which comes in 32oz cans and requires no preparation. Once

opened, ready to feed formula must be refrigerated and used with forty eight
hours. Ready to feed formulas are usually the most expensive.
‰Ê Formula can also be V
V


 in 13 oz cans, and require dilution with water
on a 1:1 basis (one ounce of water for one ounce of concentrated formula).

 formulas are prepared by mixing one scoop of formula with two ounces
of water. Powder formulas are usually the least expensive. When comparing
formula prices, check to see how much formula the can makes, since many cans
that look like they are the same size do not make the same amount of formula.
‰Ê If you live in a city with sanitized water and you are preparing bottles one at a
time, then boiling water or sterilizing the bottles and nipples isn't necessary. You
may be able to use this water out of the tap and bottles can be washed in hot soapy
water or in the dishwasher. If you are not convinced that your water supply is safe
or if you are using well water, then you should boil the water for five minutes
before preparing formula.
‰Ê Ñoiling the water when preparing infant formula was universally recommended
and was then thought to be unnessesary. In 1993, an outbreak of cyclosporiasis
from contaminated water in Milwaukee prompted officials to again recommend
that water be boiled when preparing infant formula. However, the American
Academy of Pediatrics does recommend that water that is going to be used for
infant formula be boiled. If you don't want to boil the water first, you could use
'sterile' bottled water instead. Ñottled water that isn't marked sterile should
probably still be boiled.
‰Ê You should discard any formula in the bottle that is not finished during the
feeding.
‰Ê Your baby may accept formula prepared with cold water, or he may prefer to have
the formula warmed. You may warm formula by briefly placing it under hot
running water, using a bottle warmer or on the stove. Do not warm formula in the
microwave, as it can produce hot spots in the bottle that can burn your baby. And
always test warmed formula before feeding it to your baby.
‰Ê If you are using ready to feed formula or are preparing concentrated or powder
formulas with bottled or filtered water, then you may need to give your baby
fluoride supplements when he is older. ëheck with your doctor.

 
 


/

-˜
c
 
 

 

‰Ê 
-


+




V  V

½



‰Ê Making baby food can be healthier for your baby, and offers your baby an
introduction to foods rich in variety, flavor, color, taste and smell. All of your
friends (and your mother-in-law) will think you are a super parent for making your
baby's food. The big secret -- it is super easy and takes less than 30 minutes per
week.
‰Ê A common approach to making baby food is called the ice cube tray method.
The concept is simple: make large quantities of basic food purees using a standard
blender or food processor and freeze it in single servings (1 ounce) in ice cube
trays. With this method, you only need to make baby food once, maybe twice, per
week. Over time you build up a large variety of single-serving baby food cubes in
the freezer.
‰Ê Here are the four basic steps of making baby food with the ice cube tray method:
‰Ê 

½"+
½2 Depending on the type of baby food you are preparing, you will
need to wash, chop and peel the fruits and vegetables. You should not use
detergent or bleach when washing fruits and vegetables because these chemicals
can leave a residue that will be absorbed by porous food like produce. If you are
using frozen produce, simply open the package.
‰Ê 

½.+
ëook the food in the microwave or use a stovetop method of
steaming. We prefer microwave cooking for several reasons: saves time because
foods cook faster; retains more nutrients than other cooking methods; and it is
easier clean up. If you prefer the stovetop method of cooking foods, you must use
a steamer basket. DO 2OT boil food, boiling food reduces nutrient content. Foods
must be cooked well. They are done when the can be pierced or mashed easily
with a fork.
‰Ê 

½+ 


Pour the food and cooking juices into a food processor or a

blender and puree. Food consistency is created during this step. You want your
baby to have food that is soft and velvety in texture. You may need to add water to
some foods to get the right consistency. Although water will slightly dilute the
food's nutritional value, the difference is not significant enough to worry about.
‰Ê 

½&+˜



Pour the food puree into ice cube trays. ëover and place them in
the freezer for eight to 10 hours or overnight. Pop the baby food cubes from the
freezer trays. Place the cubes in a freezer storage bags or stackable containers
(
abel the bag/containers with the date and the type of food), and return them
immediately to the freezer. Ñaby food cubes stay fresh for up to two months.

 ½
$
½
+ Apple Puree
6 medium golden delicious apples


½"+
½
Wash, peel, core and cut apples into one-inch (3 cm) slices.
c
 
 

 



½.+
Place apples in a microwave safe dish. ëover. ëook 5 minutes
and let stand for 5 minutes. ëook an additional 5 minutes. The apples are done
when they can be pierced easily with a fork.


½+ 


Place apples and cooking juices into a blender or a food

processor. Puree to a smooth texture.


½&+˜



Spoon into So !asy Ñaby Food Trays or ice cube trays. ëover.
Place in freezer eight to 10 hours or overnight. Remove cubes from trays, place in
storage container or freezer bag, and return immediately to the freezer.
Makes 24 1-ounce servings. Stays fresh for two months in the freezer.
To serve, select frozen apple cubes from the freezer, defrost and warm, check the
temperature and feed.
i

V

+ About 6 months


V/

-˜

‰Ê Using the ice cube tray method of making baby food makes it is easy to create a
large variety of food cubes in your freezer. When it is time for feeding, simply
select the food cubes from the freezer, thaw them and feed them to your baby. You
may want to warm the food first. Ñaby food can be served cold, at room
temperature or slightly warm. 2ever serve hot food to your baby, and always
check the temperature of food or drinks before feeding them to your baby.
‰Ê Ñaby food should have soft, velvety consistency. If you are just starting solids,
thinner food is better than thicker food. If you defrost the food and see that it is too
thick, you can easily thin it by adding some breast milk or formula. This also adds
a little extra nutrition too. If the opposite happens, and the food is too thin, you can
easily thicken the food by adding a little baby cereal, mashed banana or plain
yogurt.
‰Ê After your baby has been introduced to a variety of single flavor foods and he is a
little older, you can begin making meal time more interesting and introduce your
baby to array of tastes, by combining different foods to create medleys.

Here are some examples of foods cubes that taste great together:

„Ê Green peas and sweet potatoes

„Ê Green beans and white potatoes
„Ê Ñroccoli, cauliflower and melted cheese
„Ê Ñutternut squash, corn and mashed tofu
„Ê Peaches, pears and rice cereal
„Ê Mango, Papaya and banana
c
 
 

 

„Ê Raspberries, apples, yogurt and ground walnuts

VV
˜ - 

Õ 
VVV
˜ 

Infant formulas are liquids or reconstituted powders fed to infants and young children.
They serve as substitutes for human milk. Infant formulas have a special role to play in
the diets of infants because they are often the only source of nutrients for infants. For this
reason, the composition of commercial formulas is carefully controlled and FDA requires
that these products meet very strict standards.

/
˜i
 

VV
˜ 

The safety and nutritional quality of infant formulas are ensured by requiring that
manufacturers follow specific procedures in manufacturing infant formulas. In fact, there
is a law -- known as the Infant Formula Act -- which gives FDA special authority to
create and enforce standards for commercial infant formulas. Manufacturers must analyze
each batch of formula to check nutrient levels and make safety checks. They must then
test samples to make sure the product remains in good condition while it is on the market
shelf. Infant formulas must also have codes on their containers to identify each batch and
manufacturers must keep very detailed records of production and analysis.


˜i 
V

V
½
 
VVV
 
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FDA regulations list specifications for minimum amounts of 29 nutrients and maximum
amounts for 9 of those nutrients. All formulas marketed in the United States must meet
these nutrient requirements. As more information becomes available about infants'
nutrient needs, FDA's nutrient specifications for infant formulas may be modified to
incorporate that information.


˜i½½
VV
 




 




The law does not require that FDA approve infant formulas but instead requires
companies to provide certain information to FDA before they market new infant
formulas. Manufacturers must provide assurances that they are following good
manufacturing practices and quality control procedures and that the formula will allow
infants to thrive. If such assurances are not provided, FDA will object to the
manufacturer's marketing of the formula; however, the manufacturer may market the new
infant formula over FDA's objection.

/½
V
V 
 





VV


A wide selection of different types of infant formulas is available on the market. Parents
should ask their infant's health care provider if they have questions about selecting a
formula for their infant.

VV

VV
 V





V 
 VV V
 

Infants fed infant formulas do not need additional nutrients unless a low-iron formula is
fed. If infants are fed a low-iron formula, a health care professional may recommend a
supplemental source of iron, particularly after 4 months of age.

FDA's nutrient specifications for infant formulas are set at levels to meet the nutritional
needs of infants. In addition, manufacturers set nutrient levels for their label claims that
are generally above the FDA minimum specifications and they add nutrients at levels that
will ensure that their formulas meet their label claims over the entire shelf-life of the
product.

3  
V3
V
 VV
 
V

V  V
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All infant formulas marketed in the United States must meet the nutrient specifications
listed in FDA regulations. Infant formula manufacturers may have their own proprietary
formulations but they must contain at least the minimum levels of all nutrients specified
in FDA regulations without going over the maximum levels, when maximum levels are
specified.
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Ready-to-feed and concentrated liquid formulas often contain ingredients such as

lecithin, carrageenan, and mono- and diglycerides added to ensure that the formula
doesn't separate during shelf-life.

Õ 



3 
3


VVVV
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The use by date on infant formulas is a date, selected by the manufacturer based on
tests and other information, to inform retailers and consumers about the quality of the
infant formula. Until that declared date, the infant formula will contain no less than the
amount of each nutrient declared on the product label and will otherwise be of acceptable
quality. The use by date is required by FDA regulations on each container of infant
formula.

Õ 

  V



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 / V V ½


ëounterfeit infant formulas are infant formula products that have been diverted from
normal distribution channels and relabeled. Diverted products may be relabeled with
counterfeit labels to misrepresent the quality or identity of a formula. For example, if an
infant formula is past the use by date, a counterfeit label may bear a false use by date
to obscure the fact that the product may no longer contain the amounts of nutrients listed
on the label and may otherwise not be of acceptable quality. As a second example, an
infant formula may be relabeled to disguise the true content of the product. Infants who
are intolerant to certain ingredients and are fed such a counterfeit formula could
experience serious adverse health consequences.

To protect infants, parents or other caregivers should always look for any changes in
formula color, smell, or taste. Parents should make sure the lot numbers and use by
dates on the containers and boxes are the same (if buying by the case), check containers
for damage, and call the manufacturer's toll-free number with any concerns or questions.

 


V




 
 
V½
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 #Õ 




V

The manufacturers of infant formula provide directions for mixing their products with
water and usually do not specify the source of water other than to indicate that the water
should be safe to drink. In most situations, it is safe to mix formula using ordinary cold
tap water that is brought to a boil and boiled for one minute or as directed on the label of
the infant formula. Some water companies wish to make available bottled waters which
c
 
 

 

are marketed for infants and for use in mixing with infant formula. When manufacturers
label their water as intended for infants, the water must meet the same standards
established for tap water by the !nvironmental Protection Agency. The label must also
indicate that the bottled water is not sterile. As with tap water, consumers should boil
bottled water one minute before mixing with infant formula. Water that is sterilized by
the manufacturer and intended for use with infants must meet certain strict FDA
standards.

i



½½

½
 

VV
 

FDA regulates commercially available infant formulas, which are marketed in liquid and
powder forms, but does not regulate recipes for homemade formulas. Great care must be
given to the decision to make infant formulas at home, and safety should be of prime
concern. The potential problems associated with errors in selecting and combining the
ingredients for the formula are very serious and range from severe nutritional imbalances
to unsafe products that can harm infants. Ñecause of these potentially very serious health
concerns, FDA does not recommend that consumers make infant formulas at home.

/iVi$i- 



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V


DHA is docosahexaenoic acid and ARA is arachidonic acid. Ñoth are long-chain
polyunsaturated fatty acids. The body can make DHA and ARA from certain other
dietary fatty acids, which are found in plant oils and other sources; however, DHA and
ARA are also consumed directly in the diet.

Õ 
 V
V



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DHA is contained in varying amounts in fish oils, with oils from cold-water fish
containing higher amounts. DHA and ARA are also found in some algae and fungi, eggs,
and in human breast milk. Some manufacturers make dietary supplements containing
DHA and ARA.

Õ 


V



VV/iVi$i
VV
 

While infants can make these fatty acids from other (essential) fatty acids in their diet,
including the fatty acids in infant formulas, some studies suggest that some infants, such
as premature infants, may benefit from direct consumption. Other studies suggest no
c
 
 

 

benefit. It is known that long-chain polyunsaturated fatty acids (DHA in particular)
accumulate in brain and eye of the fetus, especially during the last trimester of pregnancy.
These fatty acids are also found in the fat of human breast milk. Ñlood levels of DHA and
ARA are typically higher in breast-fed infants than in infants fed formulas not containing
these fatty acids. For these reasons, some infant formula manufacturers and consumers
are interested in providing DHA and ARA directly to infants. These manufacturers and
consumers argue that adding oils containing these fatty acids to the fats and oils already
in infant formula will provide an infant with both pre-formed DHA and ARA and the
essential fatty acids an infant needs to make its own DHA and ARA.

Õ 




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VV
 

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The scientific evidence is mixed. Some studies in infants suggest that including these
fatty acids in infant formulas may have positive effects on visual function and neural
development over the short term. Other studies in infants do not confirm these benefits.
There are no currently available published reports from clinical studies that address
whether any long-term beneficial effects exist.

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Systematic monitoring efforts are not in place to collect and analyze information on
effects of infant formulas containing DHA and ARA in countries where these formulas
are in use.

Õ  ˜i
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These are new ingredients that were not used in infant formulas in this country before
early 2002, and infant formulas containing ARASëO (ARA Single ëell Oil) and
DHASëO (DHA Single ëell Oil) have been marketed in other countries for only a few
years. FDA views any evaluation of the safety of use of new food ingredients such as
DHASëO and ARASëO as a time-dependent judgment that is based on general scientific
knowledge as well as specific data and information about the ingredient. Therefore,
scientific data that become available after specific products containing a new ingredient
enter the market must be considered as a part of the totality of information about the
ingredient. Pre-market clinical studies evaluating the effects of infant formulas containing
DHASëO and ARASëO on physical growth and some aspects of development are short-
c
 
 

 

term studies, while some studies suggest that feeding of infant formulas with oils
containing DHA and ARA to infants may have long-term effects on growth and
development. For all these reasons, manufacturers have been asked to closely monitor
these new infant formulas in the marketplace


   

‰Ê Starting your baby on solid foods is the beginning of lifelong eating habits that
contribute to his or her overall health. For this reason we have some general
guidelines that can help you start your baby out on the right track to a healthy life.
‰Ê Ñreast milk or infant formula supplies all of your baby's nutritional needs for at
least the first 4 to 6 months of life, so don't be in a rush to start solid baby foods.
Starting solids too early can cause your baby to develop food allergies. Your
baby's intestinal tract is not as fully developed during the first few months and
introducing solids at this time can be too much to handle
‰Ê Another reason for not giving solid foods earlier than 4 to 6 months is
unintentional overfeeding, since younger babies can not offer you signals when
they are full, such as turning away or showing disinterest.
‰Ê A third reason for holding off on solids is your baby's inability to swallow solids
correctly before 4 to 6 months of age and this can potentially cause choking. And
contrary to the popular myth, starting solids early will not help your child to sleep
through the night.
‰Ê When offering a new type of food, always feed it for several days in a row before
starting another new food. This makes it easier to detect food allergies, which can
present with diarrhea, vomiting, coughing, hives or a rash. Do not offer mixed
ingredient foods until you are sure that the baby isn't allergic to any of the
individual ingredients. Also, don't add any seasonings to your baby's foods.
‰Ê Other practices to avoid are putting your baby down for a nap or sleep with a
bottle of formula or juice, as this allows sugar to pool in your baby's mouth and
can lead to cavities. Don't feed your baby cow's milk, honey or egg whites until
your baby is at least one year of age. Also, do not give carbonated or caffeinated
drinks, candy or other foods that your baby may choke on.
‰Ê Remember, these are general guidelines and the amount and types of food that
your baby eats may vary from day to day.

˜i





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V

 may be possible, especially if your child is at high
risk of having a food allergy, including already having an allergy to aother food
or formula, having other family members with food allergies, or having other
c
 
 

 

'allergic' type conditions or family members with these conditions, such as
eczema, allergic rhinitis (hayfever) and/or asthma.

Most importantly, 



 and avoid supplementing with infant formula or

offering solids for at least the first six months of your child's life. If you are not
breastfeeding or need to supplement, then consider using a ½

V 
VV
  such as 2utramigen or Alimentum(soy formulas and goat's
milk may not be good alternatives, because many infants that are allergic to
cow's milk may also be allergic to soy). If you are breastfeeding, then you
should avoid peanuts and tree nuts in your own diet, and consider avoiding milk,
fish and eggs too (discuss this with your doctor, as avoiding too many foods
may cause poor nutrition).

If your child is at high risk of having food allergies, you should also delay
offering solids until he is at least six months old (and continue breastfeeding),
and begin with an iron fortified infant

 . It is best to start with rice and oat
cereals and introduce wheat cereals later. 2ext you can introduce 



,
but avoid legumes (foods in the bean and pea family) at first, and then VV


  
 and fruit juices. Meat and protein foods can be added once your
child is 8-9 months old.

Foods to avoid until your infant is at least a year old include cow's milk, citrus
fruits and juices, and wheat and egg whites until he is two. Also, avoid giving
½
V
 (as smooth peanut butter), fish and shellfish until your child is at least
three years old. Whole peanuts and tree nuts should be avoided until your child
is four because of the choke hazard.

When you do introduce new foods, do so slowly and only give one new food
every four to five days. This way, if your child does have a reaction or allergy,
then you will know which food caused it and you will be able to avoid giving it
again.

˜ 
˜
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At this age, breast milk or formula is the only food that your baby needs and he should be
taking 4-6 feedings each day (24-32 ounces), but you can start to familiarize your baby
with the feel of a spoon and introduce solid foods. ëereal is the first solid you should give
your baby and you can mix it with breast milk, formula or water and feed it to your baby
with a spoon (not in a bottle). Start by feeding one tablespoon of an iron-fortified Rice
c
 
 

 

cereal at one feeding and then slowly increase the amount to 3-4 tablespoons one or two
times each day.

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‰Ê While continuing to give 4-5 feedings of breast milk or formula (24-32 ounces)
and 4 or more tablespoons of cereal each day, you can now start to give well-
cooked, strained, or mashed vegetables or commercially prepared baby foods.
Start with one tablespoon of a mild tasting vegetable, such as green beans, peas,
squash or carrots and gradually increase to 4-5 tablespoons one or two times each
day.
‰Ê Start fruits about a month after starting vegetables and again, gradually increase to
4-5 tablespoons one or two times each day. You can use peeled, cooked, or canned
fruits (but only those packed in light syrup or water) that have been blenderized or
strained
‰Ê You can also begin to offer 2-4 ounces of 100% fruit juices. Start by mixing one
part juice with two parts of water and offer it in a cup.

!

2V
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‰Ê While continuing to give 3-4 feedings of breast milk or formula (24-32 ounces)
and 4 or more tablespoons of cereal, vegetables and fruit one or two times each
day, you can now start to give more protein containing foods. These include well-
cooked, strained or ground plain meats (chicken, beef, turkey, veal, lamb, boneless
fish, or liver), mild cheese, peanutbutter (this is controversial though), or egg yolks
(no egg whites as there is a high chance of allergic reactions in infants less than 12
months old). If using commercially prepared jars of baby food, do not use
vegetables with meat as they have little meat and less protein and iron than jars
with plain meat.
‰Ê Start with 1-2 tablespoons and increase to 3-4 tablespoons once each day. If your
baby doesn't seem to like to eat plain meat, then you can mix it with a vegetable
that they already like as you offer it.
‰Ê You can also start to offer soft table foods and finger foods at this age. Give soft,
bite-size pieces of food, such as soft fruit and vegetable pieces, pastas, graham or
saltine crackers, and dry cheerios, but do not give these foods if the child is going
to be unattended in case of choking.
‰Ê You can also begin to offer 3-4 ounces of formula or 100% fruit juice in a cup at
this time.
c
 
 

 



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Your baby's diet will begin to resemble that of the rest of the families, with 3 meals and 2
snacks each day and will include 3-4 feedings of breast milk or formula, iron fortified
cereal (1/4 ± 1/2 cup at breakfast), vegetables and fruits (1/2 cup/jar at lunch and dinner),
protein foods (2-4 tablespoons each day), 100% fruit juice (2-6 ounces in a cup each
day), and some finger foods.

It is important to offer a variety of foods to encourage good eating habits later.

Õ 

There is no set age at which you should wean your baby. The current recommendations
of the American Academy of Pediatrics is to continue to breast feed until your child is at
least age one. It is also an age when most children can successfully drink from a cup and
is therefore a good time to wean. You can gradually wean your child from breast feeding
by stopping one feeding every four or five days and then gradually reducing the amount
of nursing when you are down to one feeding each day.

If you wean before the age of one, then you should introduce an infant formula and not
cow's milk.



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V-
V

‰Ê You may now give your baby homogenized whole cow's milk. Do not use 2%, low
fat, or skim milk until your child is 2-3 years old.
c
 
 

 

‰Ê If using soy milk after your child is a year old, keep in mind that it is low fat. A
toddler soy formula may be a better alternative, or try to make up for the reduced
fat intake from milk in other areas of your child's diet.
‰Ê Your child should now want to feed himself with his fingers and a spoon or fork
and should be able to drink out of a cup. The next few months will be time to stop
using a bottle. As with weaning from breastfeeding, you can wean from a bottle by
stopping one bottle feeding every four or five days and then gradually reducing the
amount in the bottle when you are down to one each day.
‰Ê Remember that your baby's appetite may decrease and become pickier over the
next few years as his growth rate slows.
‰Ê Until your child is at least 4 years old, you should avoid foods that can cause
choking, including chewing gum, nuts, raisins, popcorn, chunks of peanut butter,
hard candy, or hard, round foods (such as chunks of raw carrots, celery, grapes, or
hot dogs).
‰Ê
arge amounts of sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated
cereals, chips or candy, should be avoided, as they have little nutritional value.
‰Ê Also avoid overfeeding. Do not encourage your child to eat after he is full, as this
can lead to a habit of overeating.
‰Ê Following these guidelines will help you give your baby the good nutrition he or
she needs to grow up to his or her full potential and a healthy life.

j   



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V


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ëongratulations on taking the decision to prepare your own food for your baby! Ñy doing
so, you're treating him to two of life's greatest gifts -- good health and delicious food.

Ñefore you get started, here are some important points to keep in mind...

2!iij!
Introduce new foods to your baby's diet one at a time. Allow at least five days between
each new food. This will give you time to spot any allergic reactions. Introduce them at
breakfast or lunch to reduce the risk of any allergic symptoms developing during the
night. Ñe sure to only give your baby foods that are appropriate for his/her age.

i(!2!
Make the progression from thin liquid purees to more solid, chunkier meals slowly,
making sure that your baby is able to cope comfortably with the new texture every step of
the way.
c
 
 

 


(!!Õ/0!j!
Add no salt, little or no sugar and little or no fat to your baby's food.
et's leave the
unwanted additives to the baby food manufacturers. !ven if, to you, the food seems to
lack something, your baby won't mind (it's still much tastier than anything that comes in a
jar).

21˜$!J4$-i-J!i˜/!,/!!21Õi2
We all have a tendency to over-react if our little bundle of joy doesn't want his supper.
Ñut, remember, we all have times when we just don't feel hungry -- it's just that your
baby has no way of telling you this. Give him/her the amount he/she wants, no more and
no less. Don't worry, he/she will make up for it next time.

21˜$!/!-i
Always test the temperature of the food before you serve it. Keep in mind that your
baby's mouth is more sensitive than yours. Ñe sure to pay attention to good hygiene
practices when preparing your baby's food.

2!
!$-!˜$!&j2/
You may find that your friends and family -- with the best of intentions -- will tell you to
begin adding cereals to the bottle when your baby is just a few weeks old. The story goes
that this will help him/her sleep better at night. Please ignore this advice -- it is a myth.
Your baby's body isn't ready to cope with any solid foods yet. Do 2OT give your baby
A2Y solid foods before he/she reaches four months of age. Most babies begin the
transition somewhere between five and seven months (no later than eight months is
recommended).

Finally, always keep in mind that every baby is unique. While there are some rules that
are true for every child, feeding your baby is largely a process of 'learning on the job'.
After all, it's your baby who'll let you know when he/she is ready to try out new foods
and it's your baby who'll tell you what he/she likes or doesn't like.


 
 
-1˜


 +j

  


Rice is easily digested and has low allergen aspects, so it is commonly recommended as
the first food you introduce to your baby. Many of the recipes for making baby cereals
are time consuming, but with the use of the freezer and a blender, homemade rice cereal
is simple and convenient.
c
 
 

 

This recipe is perfect for infants, but by adding a few extras it will tempt the taste buds
of kids and adults.

-

 V

V
+

„Ê 3 cups of brown rice, cooked according to package directions

„Ê 12 ounces breast milk, water, or infant formula

-

 

V+

1.Ê Place the cooked brown rice in a blender with the breast milk/water/formula.
2.Ê Puree until completely smooth ± you cannot make this cereal too smooth.
3.Ê Pour the cereal into ice trays, cover and freeze overnight.
4.Ê Once frozen, pop the cubes out of the trays, place in a freezer bag or container,
labeled with the date and return to the freezer.
asts up to two months.

-

 
VV

V+

Defrost the cubes, and add breast milk or formula to develop a smooth consistency. For
babies just starting solids, thin the cereal to a semi-liquid consistency. Warm the cereal, if
desired. You can also change the flavor of the cereal by adding fruit or veggie baby food,
once your baby has started to eat those foods.

1-1

 !)
 
  
V+

„Ê Ground nuts and maple syrup

„Ê ëinnamon, nutmeg, raisins and honey
„Ê Fruit preserves
„Ê ëinnamon sugar and dried fruit



V
VV
 
V iV

‰Ê Iron deficiency is still a big problem today. In fact, the World Health Organization
lists iron deficiency as one of the 'Top Ten Risk Factors ëontributing to Death'.

Other facts about iron deficiency:

„Ê as many as 4-5 billion people, 66-80% of the world¶s population, may be iron
deficient
c
 
 

 

„Ê 2 billion people ± over 30% of the world¶s population ± are anemic, mainly due to
iron deficiency
„Ê in total, 800,000 (1.5 percent) of deaths worldwide are attributable to iron
deficiency

‰Ê Surprisingly, iron deficiency anemia is not just a problem in developing countries

of the world. According to the ëDë, 'although iron deficiency is more common in
developing countries, a significant prevalence was observed in the United States
during the early 1990s among certain populations, such as toddlers and females of
childbearing age.'
‰Ê In one study, 7% of toddlers aged 1-2 years and 9-16% of adolescent and adult
females aged 12-49 years were found to have iron deficiency.
‰Ê Also at risk are premature babies who are born with low stores of iron in their
bodies.
‰Ê Although the incidence of childhood iron-deficiency in the United States has been
decreasing and iron deficiency anemia is uncommon, we are still above the
Healthy People 2010 objectives of 5%, 1%, and 7% for toddlers, preschool
children, and females aged 12--49 years, respectively.

Õ 

VV
 
V  ½
V


Ñecause 'iron deficiency anemia significantly impairs mental and psychomotor

development in infants and children,' leading to developmental delays and behavioral
disturbances. It can also increase the risk for a preterm delivery and delivering a low-
birthweight baby in pregnant women who are iron deficienct.



V
VV
 
V 
VVV
V


‰Ê It can help to understand how to prevent iron deficiency if you understand how the
body stores iron. Ñabies, unless they are born premature, are born with all of the
iron they need for the first 5-6 months of life. After that, unless they are given an
iron supplement, they can develop iron deficiency, which means that they don't
have enough iron in their body. If it continues, it will then lead to iron deficiency
anemia.
‰Ê So to prevent iron deficiency, you should breastfeed or give your infant an iron
fortified infant formula (avoiding low iron formula) until they are at least 12
months of age, and begin an iron supplement by about 6 months of age.
‰Ê Starting an iron supplement doesn't necessarily mean starting them on a vitamin
with iron though. The usual supplement is simply an iron fortified infant cereal
c
 
 

 

given once or twice a day. Remember that preemies or low birth weight infants do
usually also need a vitamin with iron.
‰Ê After you have introduced an iron fortified infant cereal, start one feeding a day of
foods rich in vitamin ë (e.g., fruits, vegetables, or juice) to improve iron
absorption, preferably with meals.

 
V
 
V 

‰Ê It is now easy to see why some infants develop iron deficiency, which is usually
because they aren't getting enough iron. However, other causes or iron deficinecy
can include blood loss and impaired absorption of iron, although that is rare.

Most kids become iron deficient because they aren't getting:

„Ê breastmilk or an iron fortified infant formula until 12 months

„Ê an iron supplement after 6 months
„Ê a vitamin with iron if they were born premature or low birth weight

or if they are getting cow's milk or goat's milk before 12 months, instead of breastmilk or
formula.

‰Ê Unlike breastmilk and iron fortified formula, cow's milk and goat's milk have
minimal amounts of iron in them and they are poorly absorbed. ëow's milk may
also cause younger infants to have some gastrointestinal bleeding, which makes it
even more likely that they will develop iron deficiency anemia.
‰Ê Toddlers who drink more than 16-24 ounces of milk are also at risk for developing
iron deficiency. In addition to not having much iron in it, cow's milk decreases
how well your body absorbes iron from other foods. And toddlers who are
drinking a lot of milk are likely getting filled up and probably aren't eating a lot of
foods with iron in it anyway.
‰Ê Ñecause preschool and younger school age children are not going through periods
of rapid growth and they have lower ron requirements, they are not at big risk of
iron deficiency.
‰Ê The risk does go up again during the teens years, because they are growing rapidly
and have increased iron requirements. Girls who have started their periods,
especially if they have heavy menstrual blood loss, are also at increased risk of
iron deficiency.



V
VV
 
V V

V
c
 
 

 

To prevent iron deficiency in teens, they should be encouraged to eat iron-rich foods and
foods that enhance iron absorption. Those who are at risk of becoming iron deficient
should be tested and given an iron supplement if they do have iron deficiency.

 

VVV
 
V 

‰Ê The ëDë recommends that children who are at high risk for iron-deficiency
anemia should be tested for anemia between ages 9 and 12 months, 6 months later,
and annually from ages 2 to 5 years.
‰Ê It is also recommended that, starting in adolescence, you should screen all
nonpregnant women for anemia every 5-10 years throughout their childbearing
years during routine health examinations, annually for women having risk factors
for iron deficiency, and at the first prenatal care visit if they are pregnant.
‰Ê The American Academy of Pediatrics recommends screening by 9 months of age
and again between ages 11 and 21 years for all menstruating teens.
‰Ê 2o routine screening for iron deficiency is recommended for teen boys.




V
V
 
V 

In addition to improving the child's diet, treatment of iron deficiency involves giving the
child an iron vitamin. For infants and younger children, this usually means prescribing 3
mg/kg per day of iron drops to be administered between meals divided once or twice a
day.

Adolescent girls and women who have anemia are usually prescribed an oral dose of 60-
120 mg/day of iron.

˜


 
V

„Ê Meats -- beef, pork, lamb, and liver and other organ meats
„Ê Poultry -- chicken, duck, and turkey, especially dark meat; liver
„Ê Fish -- shellfish, like clams, mussels, and oysters; sardines; anchovies; and other
fish
„Ê
eafy greens of the cabbage family, such as broccoli, kale, turnip greens, collards
„Ê
egumes, such as lima beans and green peas; dry beans and peas, such as pinto
beans, black-eyed peas, and canned baked beans
„Ê Yeast-leavened whole-wheat bread and rolls
„Ê Iron-enriched white bread, pasta, rice, and cereals. Read the labels.
c
 
 

 

˜i


‰Ê True 

 are not as common as most people believe and only affect
about 2% of children, although they are more common in younger children
(affecting about 5-8% of younger children). And fortunately, most younger
children will outgrow these food allergies by the time they are three years old.

‰Ê  ½
  of a food allergy can include wheezing and difficulty breathing, itchy
skin rashes, including hives, vomiting, diarrhea, nausea, abdominal pain and
swelling around his mouth and in his throat. These symptoms usually develop
fairly quickly after your child ingests the food he is allergic to, often within
minutes to hours. 2asal symptoms by themselves, such as congestion or a runny
nose, are usually not caused by food allergies.
‰Ê Symptoms may be mild or very severe, depending on how much of the food your
child ingested and how allergic he is to the food. A severe reaction can include
V½  ), with difficulty breathing, swelling in the mouth and throat,
decreased blood pressure, shock and even death.
‰Ê More common than food allergies are V

V
 to certain foods, which can
cause vomiting, diarrhea, spitting up, and skin rashes. An example of such a
reaction occurs in children with lactose intolerance, which occurs because of a
deficiency of the enzyme lactase, which normally breaks down the sugar lactose.
ëhildren without this enzyme or who have a decreased amount of the enzyme,
develop symptoms after drinking lactose containing food products, such as cow's
milk. However, because this reaction does not involve the immune system, it is not
a real food allergy.
‰Ê If you notice that your child develops symptoms after being exposed to certain
foods, then you should  those foods. The most common foods that can cause
allergies include: peanuts, tree nuts (walnuts, pecans, etc.), fish, shellfish, eggs
(especially egg whites), milk, soy, and wheat. Keeping a  for a few weeks
and recording what foods your child has been eating, especially new foods, and
when he develops symptoms may help figure out what he is allergic to.
‰Ê Once you determine what your child is allergic to, it is important to learn to read
 
 because the food your child is allergic to may be an ingredient of
many other foods. You should also avoid eating foods that may have been
prepared using equipment that was also used to prepare the types of food that your
child is allergic to.
‰Ê When trying to determine what your child is allergic to, parents often incorrectly
assume that if he has eaten a food before and not had problems, then he probably
is not allergic to that food. They usually only suspect new foods as being able to
cause a food allergy. However, it is important to keep in mind that it takes time for
the immune system to build up a reaction against something that the body is
c
 
 

 

allergic to. It may take days, weeks, months or even years to build up enough of a
response to cause noticeable symptoms. So your child may be allergic to a food
even if he has eaten it many times before without problems.
‰Ê In addition to avoiding what you think your child may be allergic to, children with
more severe reactions should be evaluated by their Pediatrician or an allergist.
Testing may be done, either V


V or $i (radioallergosorbent test, a
blood test to check for antibodies against certain things your child may be allergic
to) to see if specific food allergies can be found. In addition, your child will be
prescribed an
½V
½ V

V-

V

(such as the !piPen or !piPen
JR) and should wear a medical alert bracelet to notify others of his allergy.



V
V

 may be possible, especially if there is a strong family history
of having allergies to foods.



V
V



‰Ê may be possible, especially if your child is at high risk of having a food allergy,
including already having an allergy to food or formula, eczema, hayfever, or
asthma, or having other family members with these conditions or a food allergy.

‰Ê Most importantly, 



 and avoid supplementing with infant formula or

offering solids for at least the first six months. If you are not breastfeeding or need
to supplement, then consider using a ½

V VV
 (soy
formulas and goat's milk may not be good alternatives, because many infants that
are allergic to cow's milk may also be allergic to soy). If you are breastfeeding,
then you should avoid milk, eggs, fish, peanuts, and tree nuts in your own diet.
‰Ê If your child is at high risk of having food allergies, you should delay offering
solids until he is at least six months old (and continue breastfeeding), and begin
with an iron fortified infant

 . It is best to start with rice and oat cereals and
introduce wheat cereals later. 2ext you can introduce 



, but avoid
legumes (foods in the bean and pea family) at first, and then VV

  
 and
fruit juices. Meat and protein foods can be added once your child is 8-9 months
old.
‰Ê Foods to avoid until your infant is at least a year old includecow's  and other
dairy products, citrus fruits and juices, and wheat. Also, avoid giving
 until
age two, and ½
V
 (as smooth peanut butter) and shellfish until your child is at
least three years old. Whole peanuts and tree nuts should be avoided until your
child is four because of the choke hazard.
c
 
 

 

‰Ê When you do introduce new foods, do so slowly and only give one new food every
four to five days. This way, if your child does have a reaction or allergy, then you
will know which food caused it and you will be able to avoid giving it again

 V˜i


‰Ê ëow's milk is the most common cause of food allergies (in addition to being a
common cause of food intolerances). Unlike cow's milk intolerance which is
usually a reaction to the sugar lactose, allergies to cow's milk are usually from the
proteins that are in the milk. Infants who have an allergy to cow's milk based
formulas should usually be changed to an elemental or hydrolyzed formula, such
as 2utramigen or Alimentum. Soy formulas and goat's milk may not be good
alternatives in this case, although they usually are for older children, because
many infants with allergies to cow's milk proteins are also allergic to the proteins
in soy and goat's milk.

‰Ê Other foods to avoid if your child is allergic to cow's milk include, but are not
limited to, buttermilk, cheese, evaporated and condensed milk, ice cream, yogurt,
instant mashed potatoes, margarine, casein, cream, hydrolysates, lactalbumin,
nougat, sour cream, whey, and other foods made with milk. Older children who
are unable to drink milk or eat milk based foods should be sure to have additional

‰Ê

‰Ê To help prevent allergies to eggs, it is a good idea to avoid giving egg whites to
infants under a year old.

‰Ê

sources of calcium in their diet, including calcium fortified juices.

‰Ê !ggs, especially the proteins in egg whites are also a common cause of food
allergies. To help prevent allergies to eggs, it is a good idea to avoid giving egg
whites to infants under a year old. Other foods to avoid include, but are not limited
to foods that are derived from eggs, including egg substitutes, and foods that
contain albumin, globulin, ovalbumin and vitellin. Also avoid foods that are
prepared with eggs, which may include French toast, cake, cookies, pancakes,
eggnog, bread, ice cream, pasta, puddings, creamy salad dressings and foods with
custard or cream fillings.
c
 
 

 

‰Ê

‰Ê Soybean allergies are usually found in infants given a soy formula, but can also be
found in older children who drink soy milk. Other foods that contain soy proteins
and may cause allergic symptoms in children allergic to soy include, but are not
limited to tofu, miso soup, soy sauce, foods prepared in soybean oil, veggie
burgers and hot-dogs, and ingredients on a food labile including emulsifiers,
hydrolyzed or textured vegetable protein,
‰Ê Wheat allergy can develop in infants given a wheat cereal, and is probably best to
offer a rice or oat cereal first and delay giving wheat until after your child is 6-8
months old. Other foods that may cause problems in children allergic to wheat
include, but are not limited to many breads and cereals (unless they are made from
oats, rye, corn or rice) made with wheat flour or enriched flour. Also avoid foods
with cornstarch, gluten, semolina, all purpose or white flour.
‰Ê Peanuts are not true nuts, but rather are actually legumes from the pea and bean
family. ëhildren with allergies to peanuts can be very sensitive to foods with even
very small amounts of peanuts in them. Avoid all foods with peanuts, including
candy, baked goods, chili, many ethnic foods (including Thai, Asian, and
Indonesian foods), peanut butter, and mixed nuts. ëhildren who are allergic to
peanuts can often eat tree nuts, such as walnuts or pecans, since they are from
separate plant families.
‰Ê Tree nut allergies are also possible, and can include allergies to walnuts, pecans,
cashews, almonds and hazel nuts and other nuts in hard shells. You should avoid
foods prepared with tree nuts, including many kinds of candy, baked goods and
different oils.
‰Ê ëorn is rarely a cause of food allergies. If your child does seem to be allergic to
corn, you should avoid corn based cereals and breads, corn syrup, and caramel.
‰Ê ëertain food dyes and preservatives, especially sulfites, may also cause food
allergy symptoms.

á  


„Ê While children often outgrow their food allergies, if your child had a severe
reaction to a food, then you should talk with your Pediatrician or allergist before
reintroducing the food.
„Ê Talk with and educate other family members and caregivers about your child's
food allergies. Most people do not understand how serious food allergies can be,
and may think it is all right to give just a small amount of a food that your child is
allergic to.
c
 
 

 

„Ê !ducate your child about his allergy, so that he can learn to avoid foods that he is
allergic to.
„Ê If your child does not improve with these interventions or if he has had a severe
allergic reaction, then you should consider having him see an 
½
 

for


V to figure out what foods he is allergic to and to possibly start allergy
injections.
„Ê ëhildren with severe allergic reactions or anaphylaxis should wear a
  





to notify others of his condition and should carry an epinephrine
autoinjector (such as the !½
V5$) to ensure rapid treatment during an allergic
reaction.
„Ê Most importantly, learn to read food labels and look for ingredients that your child
may be allergic to and practice 

V
of those foods. If you don't know
what an ingredient is, then call the manufacturer before giving it to your child to
be safe.

Õ

0½
‰Ê It is well known that obesity or being overweight is a growing epidemic among
children, leading to increases in diabetes and other serious health effects.

‰Ê It is also well known what you have to do to lose weight, by eating less and
exercising more. The problem is that it is hard to stay motivated to do these things.
‰Ê And if it is hard for adults, you can expect that it is even harder for kids, who don't
necessarily understand the negative health effects of being overweight.

0VÕ



‰Ê How do you help your children lose weight?

‰Ê It can help to stick to the basics. Don't worry about counting calories and
carbohydrates and fat grams. Instead, provide healthy meals and snacks and
encourage regular physical activity.
‰Ê Ñeing a good role model is also important, starting when your kids are young. This
can help the whole family to be healthy.
‰Ê If your child is already overweight, you will likely have to make some changes to
his diet. Ñut this isn't as hard as you think. It doesn't have to involve counting
every calorie that he eats and drinks, which can be especially hard when your kids
are eating at school.
‰Ê Instead, keep in mind that a pound is equal to about 3500 calories. So if your child
is gaining an extra pound a week, he needs to cut his diet back by 3500 calories a
week or 500 calories a day so that he doesn't gain any more weight.
c
 
 

 

‰Ê Fortunately, most kids don't need to make such drastic changes to their diet. Your
overweight teen is likely just gaining an extra 10-15 pounds a year, which would
be equal to just 100 to 150 calories a day, about equal to a can of non-diet soda.


½VÕ

V

‰Ê An important first goal for most overweight kids is to simply stop gaining weight.
‰Ê Using the method above, instead of counting all of your child's calories and trying
to stay below some set goal, you can use the fact that he probably eats about the
same number of calories each day to help him not gain any more weight.
‰Ê So just figure out how much extra weight your child gained in the past year and
adjust his diet to compensate for these extra calories. The change might be as
simple as changing to non-fat milk, diet soda or a more healthy after school snack.
‰Ê Keep in mind that this 'extra weight' is above what your child would be expected
to normally gain each year.

!)
Õ

V
 2 
 


0
J
 !  V

! 

1 pound 10 calories/day

5 pounds 50 calories/day

10 pounds 100 calories/day

15 pounds 150 calories/day

20 pounds 200 calories/day

25 pounds 250 calories/day

30 pounds 300 calories/day

‰Ê ëutting back on the above number of calories each day should help your child to
stop gaining weight. If your child is not very overweight and he hasn't finished
puberty yet, then not gaining more extra weight might be not enough, as he gets
taller and 'grows into' his weight.
c
 
 

 

0VÕ



‰Ê Again, not gaining any more extra weight is an important first goal, but many
overweight kids also need to lose some weight.
‰Ê You can use the same calculations to figure out how much more to cut your child's
daily calories by to lose weight. So, once your child is at a stable weight and not
gaining, if you want to help your child lose 5 pounds a year, cut his diet back by
50 calories a day. To lose 10 pounds, eliminate 100 calories a day, and so on.
‰Ê If your child is still gaining weight, then you will have to cut more calories out of
his diet. For example, if he has been gaining an extra 5 pounds a year and he needs
to lose 10 pounds, then that is a total of 15 pounds that you need to compensate
for. So he will need to cut back his diet by 150 calories a day.



iV 

‰Ê Although you don't need to count calories each and every day and know where
every fat gram is coming from, you do need to understand your child's diet to help
him lose weight.

Some good questions to answer include:

„Ê How many calories does your child get from the things he drinks?

„Ê How many snacks does he eat?

„Ê What are his portion sizes like?

„Ê On average, how many calories does he get at each meal?

„Ê After you look closely at your child's diet for a few days or a week, you should be
able to see patterns of where the extra calories come from. ëutting back on
calories might be as easy as eliminating a bedtime snack, changing to diet drinks
or low fat milk, or not super-sizing his portions.

!)
 


‰Ê More exercise and being more active is another good way to stop gaining and
losing weight. Instead of thinking about how to diet to decrease the number of
calories your child is taking in, you could also think about how much exercise he
needs to do to burn those calories.
‰Ê So just like we said that you had to cut back your diet by 50 calories a day to lose
5 pounds a year, you could also exercise to burn an extra 50 calories a day and
lose weight.
c
 
 

 

‰Ê Or even better, do a combination of both.
‰Ê How can children burn 50 calories a day exercising?
‰Ê Your children should be able to burn 50-100 calories a day in 30-60 minutes of
regular activities that children enjoy, such as walking, roller blading, bicyling, or
playing baseball, basketball or soccer.

 
(Vi


‰Ê Younger children who are overweight have one big advantage. Since they are still
getting taller, if they stop gaining weight, they I said before, they will often 'grow
into' their weight.
‰Ê Once a teen finishes going through puberty, to get thinner, he actually has to lose
weight. The same principles discussed above work though for both older teens and
adults.
‰Ê !at less or exercise more or do some combination of both.
‰Ê This is not meant to minimize the difficulty of losing weight though. If losing
weight were easy, there wouldn't be so many different exercise programs and
diets. The popularity of so many diets, such as the Atkins diet, Weight Watchers,
etc. and frequent advertising for 'easy' weight loss programs helps illustrate just
how difficult losing weight is.
‰Ê Ñut these basic tips should give you a better understanding of what you need to try
to do to help your child get to a more healthy weight. You can get more help from
your pediatrician and/or a registered dietician.



V
V˜

V

‰Ê The best way to prevent feeding problems is to

    
V



 
 as early as possible, provide them with

 
 and allow

)½

V

V. Mealtimes should be enjoyable and pleasant and not a source of
struggle.

‰Ê ëommon 

 are allowing your child to drink too much milk or juice so that
they aren't hungry for solids, forcing your child to eat when they aren't hungry, or
forcing them to eat foods that they don't want. Also, avoid giving large amounts of
sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or
candy, as they have little nutritional value.
‰Ê As a toddler, your child may start to refuse to eat some foods, become a very
½ 


 or even go on V
 where they will only want to eat a certain food.
An important way that children learn to be independent is through establishing
independence about feeding. !ven though your child may not be eating as well
c
 
 

 

rounded a diet as you would like, as long as your child is growing normally and
has a normal energy level, there is probably little to worry about. Remember that
early childhood is a period in his development where he is not growing very fast
and doesn't need a lot of calories.

‰Ê Also, most children do not eat a balanced diet each and every day, but over the
course of a week or so their diet will usually be well balanced. You can consider
giving your child a daily vitamin if you think he is not eating well, although he
probably doesn't need it.
‰Ê While you should provide three well-balanced meals each day, it is important to
keep in mind that 
  
V V 

V

 
 
 . If
you child has had a good breakfast and lunch, then it is okay that he doesn't want
to eat much at dinner.
‰Ê Although your child will probably be hesitant to try V
, you should still
offer small amounts of them once or twice a week (one tablespoon of green beans,
for example). Most children will try a new food after being offered it 10-15 times.
‰Ê Other ways to prevent feeding problems are to not use food as a bribe or reward
for desired behaviors, avoid punishing your child for not eating well, limit
mealtime conversation to positive and pleasant topics, avoid discussing or
commenting on your child's poor eating habits while at the table, limit eating and
drinking to the table or high chair, and limit snacks to two nutritious snacks each
day.
‰Ê You should also not prepare more than one meal for your child. If he doesn't want
to eat what was prepared for the rest of the family, then he should not be forced to,
but you should also not give him something else to eat. He will not starve after
missing a single meal, and providing alternatives to the prepared meal will just
cause more problems later.

˜$
  

Ê
c
 
 

 

‰Ê Older children may refuse to eat some foods, become ½ 


 or even go on
V
 where they will only want to eat a certain food. An important way that
children learn to be independent is through establishing independence about
feeding.

‰Ê !ven though your child may not be eating as well rounded a diet as you would
like, as long as your child is growing normally and has a normal energy level,
there is probably little to worry about. Remember that early childhood is a period
in his development where he is not growing very fast and doesn't need a lot of
calories.
‰Ê Food refusal in younger children and infants, especially refusing to begin to take
solids, is usually a different matter.
‰Ê It is recommended that infants be started on solids foods when they are about four
to six months old. ëereal is the first solid you should give your baby and you can
mix it with breast milk, formula or water and feed it to your baby with a spoon
(not in a bottle). Start by feeding one tablespoon of an V


$



at one feeding and then slowly increase the amount to 3-4 tablespoons one or two
times each day.
‰Ê If your infant refuses to take the cereal with a spoon when you first introduce it,
then just wait a week or two and try again. 2ot all children are ready to begin
solids at the same time.
‰Ê Ñy seven or eight months however, if your child still refuses to take solids, then
you should have an evaluation with your Pediatrician. If he is otherwise growing
and developing normally, then his refusing to take solids may very well be normal,
but it is important to rule out other disorders, so that treatment, if necessary, can be
started.
‰Ê An evaluation is especially important if your child is not gaining 

(failure to
thrive) and developing normally, or if he   , 
, , or  
 during
feedings, which may indicate that he is aspirating during feedings and can lead to
recurrent respiratory problems.

ëommon reasons for infants to refuse to take solids and have difficulty swallowing
(½ ) include, but are not limited to:

„Ê 

½ 
 
 ): children with this condition will usually spit up a lot,
which can lead to esophagitis and pain when swallowing, causing irritability.
„Ê   
 V
V: can lead to aspiration and recurrent pneumonia,
especially in children that cough or gag when eating.
„Ê 
V
: this usually occurs in children with a chronic medical
problem, who may have been hospitilized at a young age, requiring help breathing
with a ventilator, intravenous nutrition or tube feedings.
c
 
 

 

„Ê V
  
: such as cerebral palsy can cause trouble swallowing.
„Ê 

V: delayed gastric emptying or other gastrointestinal obstruction
„Ê   : an uncommon condition, especially in younger children, in which the
muscles of the esophagus do not work properly, so that foods do not move through
the esophagus to the stomach normally.
„Ê many other anatomical and neuromuscular disorders can also cause dysphagia.

‰Ê A thorough evaluation by your Pediatrician, with special attention to your child's

growth and development, is usually required for children with dysphagia. If your
child is growing and developing normally and has good weight gain, then it is not
unreasonable to wait a month or two and continue to try and feed small amounts of
solids.
‰Ê Additional testing may be required if your child has dysphagia and he is not
growing and developing normally, or if he is not improving after a period of
watchful waiting.
‰Ê Further evaluation is usually with a ½

½
 
or occupational therapist,

who can observe how your child swallows, or attempts to swallow, foods of
different consistencies. These specialists are usually part of the
    
V


V
V programs that are available in most areas.
‰Ê The most common test performed for children with swallowing difficulties is a

  or videofluoroscopy, which is a type of barium swallow. In this
test, barium with different consistencies is given to the child to drink. X-rays are
then taken to see if the barium is swallowed or aspirated. This test is usually done
with the assistance of a speech pathologist who can observe and look for
swallowing abnormalities.
‰Ê Treatments for dysphagia depend on the underlying cause. Reflux is usually
treated with an antacid. Food aversion and oral motor dysfunction is usually
treated by a speech pathologist and/or an occupational therapist.
‰Ê Treatments include changing the ½
V the child is in when he feeds, and
offering foods with different V

V 
. The speech pathologist will also
attempt to 

V

your child to having solid foods in his mouth, especially if
he seems hypersensitive to having things in his mouth. Special ½



V


 may also be used.

!
V

‰Ê iV
)V
 is a common eating disorder that usually begins at the age of
fourteen or fifteen, with another peak in incidence in eighteen year olds. It is more
common in adolescent girls (affecting almost 1% of adolescent females), but it is
also found in boys and its incidence has been increasing. Anorexia causes an
overwhelming 

V


V



V, leading to a
c
 
 

 

restriction of calories that can lead to being V


. Teens with anorexia
may also have    nervosa, with a loss of control and binge eating, followed
by purging behaviors.

‰Ê It is not known what causes eating disorders, but it does seem to be associated
with certain 
V

 attributes and it is more common in children who have a first-
degree relative with an eating disorder. Other factors that put you at risk for an
eating disorders is participating in certain  ½






 (especially ballet,
skating, athletics, and fashion modeling,), having a perfectionist or obsessive
½
V 
, and having a parent with an eating disorder or weight problem
(obesity, frequent dieting). !ating disorders are probably also more common in
children with a past history of physical or sexual abuse.
‰Ê !arly risk factors for eating disorders include having 



and being
dissatisfied with their body. Some other factors that you should look for if you
suspect that your child has an eating disorders include:

„Ê recent 

 
„Ê a 
 of gaining weight or of being overweight
„Ê ½ V
 (vomiting or using diuretics (water pills) or laxatives to lose
weight)
„Ê having a 


 


1
 ½
(for example, believing
that she is overweight even though she is at a healthy weight)
„Ê a ½
 ½
V with thoughts of food, calories and their weight
„Ê 





V½


V, which can lead to a failure to gain weight or to being
underweight and can include skipping meals, fasting, or eliminating entire food
groups
„Ê preference for eating alone
„Ê 
V
 (absence of menstrual cycles) or delayed onset of puberty and
menarche
„Ê being V


, with a body mass index that is below normal. Use the body
mass index calculator to see if your child is underweight.
„Ê
)
 V compulsively
„Ê an extreme 
V that there she may have an eating disorder
„Ê 
 from friends and family
„Ê wearing bulky clothing to hide weight loss
„Ê has had a recent or past event in their life that was very stressful

Ouestions you or a physician may ask if they suspect someone has an eating disorder
include:

„Ê How do you feel about your weight?

c
 
 

 

„Ê When you look in the mirror, which parts of your body look best and worst and
why?
„Ê How often do you weigh yourself?
„Ê Have you ever used diet pills, laxatives, diuretics (water pills) or vomiting to lose
weight?
„Ê Do you ever feel that your eating is out of control?
„Ê And get a detailed history of what they eat each day at each meal and their daily
exercise routine.

‰Ê You should have your child seen by a physician as soon as possible if you think
she might have an eating disorder. At this visit, your doctor will probably perform
a nutritional assessment, including taking a look at her eating patterns, daily
caloric intake, measuring her height, weight and body mass index, and evaluating
her for depression.
‰Ê Your doctor will also try and rule out other causes of weight loss and decreased
appetite, including other psychiatric disorders (depression, obsessive compulsive
disorder), drug abuse, inflammatory bowel disease (which is usually accompanied
by vomiting, diarrhea and abdominal pain), hyperthyroidism, diabetes (usually
accompanied by frequent urination (polyuria) and excessive drinking
(polydipsia)), and other medical problems. However, children with most of these
medical problems don't have a preoccupation with food or a distorted body image.
‰Ê There are many serious  ½  
V of anorexia, including fainting from low
blood pressure, electrolyte disorders, being intolerant to cold, constipation,
decreased energy, changes in mood, anemia, kidney failure, osteoporosis (brittle
bones), suicide, heart rhythm abnormalities, heart failure, sleep problems,
confusion, irritability, and dizziness and even death.
‰Ê Some ½   V that are found in patients with bulimia include an
enlargement of the parotid glands (causing chubby cheeks), dental erosions
(especially on the back surfaces), and having calluses on their knuckles. Other
signs found in teens with eating disorders include having dry and brittle hair,
losing hair, and having muscle wasting.
‰Ê The



V
of eating disorders is slow and difficult (and sometimes requires
hospitalization) and should be overseen by a mental health professional that is
familiar with treating patients with this disorder to begin psychotherapy and
behavior modification. Patients with anorexia also require nutritional and medical
intervention to make dietary recommendations, ensure a slow and steady weight
gain and correct the medical complications
c
 
 

 

   



‰Ê ëonstipation is a very common and frustrating problem in children. It is usually
defined as the passage of V½V 
  or going four or more days
without a bowel movement. ëonstipation is most commonly caused by a diet that
is low in fiber, but can also be caused by drinking too much milk (more than 12-
16oz/d), not drinking enough water or waiting too long to go to the bathroom.
‰Ê Once a child develops constipation and has hard and painful stools, he will then
begin to hold in his bowel movements to prevent it from hurting again. This
creates a cycle that makes the constipation continue and become worse.



VV
½
V

ëonstipation is best treated by making changes in your child's diet. Until the constipation
has improved with a non-constipating diet, your child will most likely also be on stool
softeners. The goal of treatment is for your child to have one to two soft stools each day.






V
VV


‰Ê ëonstipation is uncommon in breastfed infants. Ñecause breastmilk is digested so

well, it can be common for a baby that is exclusively breastfed to only have a
bowel movement every one to two weeks. If the bowel movement is soft or
watery, then it is not constipation, even if it occurs infrequently.
‰Ê It can also be normal for infants (whether breastfed or drinking an iron fortified
infant formula) to strain and groan when they have a bowel movement. Again, if
the bowel movement is soft or watery, then it is not constipation, even if your
infant has to strain or groan to have a bowel movement. And remember that the
iron in infant formulas does not cause constipation. You should not switch to a
low iron formula because your child has constipation.
‰Ê If you do think your infant has constipation, then you can:
‰Ê V 

 + Give 2-4 oz of water or diluted fruit juices (such as apple or
prune) 1-2 times each day, or try switching to a soy formula.
‰Ê V 


+ If your infant is over four months old and has constipation, you
may also try feeding foods with a lot of fiber, such as cereals, strained prunes,
apricots, or spinach.
‰Ê Keep in mind, that although rare, the first symptoms of botulism in infants is
usually constipation. If your infant has severe or difficult to treat constipation,
especially if he also has other symptoms, like weakness and poor muscle tone, ask
your doctor about botulism.
c
 
 

 






V
  
V

‰Ê ëonstipation in children is best done by making changes in your child's diet. Some
things that you can do to treat and prevent constipation in your children include:
‰Ê V 
V + Increase the amount of water and fruit juices (minimum of 2-3
glasses) that your child drinks each day.
‰Ê V 
V
+Increase the amounts of  
 and 



 that your child
eats. Raw, unpeeled fruits and vegetables (especially beans, sweet potatoes, peas,
turnip greens, raw tomatoes and corn) have the most fiber. ½ V also has lots
of fiber in it. Give enough grams of fiber to equal their age in years plus 5 each
day (check the nutritional label for high fiber foods and snacks with at least 3-4g
of fiber per serving).




 ½ are especially high in fiber and also add
more fluid to your child's diet.
‰Ê V 
VV in your child's diet by offering bran cereals, bran muffins,
 



, graham crackers, or whole wheat bread.
‰Ê 

V V
½
V+ The foods most notorious in causing constipation
include cow's milk, yogurt, cheese, cooked carrots, and bananas. Drinking too
much milk (your child may only be drinking 2-3 cups a day, but it may be too
much for his system to handle) is heavily associated with having constipation.
Switching to    has been shown to soften stools. If your child is unable to
drink milk, then offer a daily multivitamin or other sources of calcium (such as
calcium fortified orange juice).


 

V


‰Ê Most of these medicines for constipation are available in the pharmacy over the
counter and do not require a prescription. They include Metamucil, Milk of
magnesia, ëitrucel, or mineral oil.
‰Ê Unlike laxatives in adults, they are generally not considered to be habit forming.
You should use them once or twice a day and work up on the dose until your child
is having a soft ÑM each day. If you child starts to have diarrhea, then you are
giving too much and you should cut back on the dose. See the table below for
dosing information for treatment of children with constipation.
‰Ê Senokot is also often commonly used in children, but it is actually a stimulant
laxative and not a stool softener, so you may not want to use it for long periods of
time.
‰Ê A newer medicine, j ), is available only by prescription to treat constipation,
but is very effective.

 VV

 

V

c
 
 

 

‰Ê Once your child is having 1-2 soft stools each day you should continue with the
doses of the medicines that you are using for 6-12 months until he is accustomed
to his new non-constipating diet. You can then gradually stop the stool softeners
by slowly lowering the amount you are giving every 1-2 weeks.
‰Ê If stools are too loose then cut back on the dose by one-third. If stools are still too
hard then increase the dose by one-third. Avoid making changes in the medicines
based on one bowel movement, or you will wind up µseesawing' with the doses.




V
i

V
½
V

If your child has been constipated for a long time or he is having discomfort or significant
pain with bowel movements then you may need to µclean out' backed up stool before the
stool softeners will work by using an enema, a glycerine suppository or high doses of
mineral oil. See your pediatrician for information on how to start begin this treatment for
acute constipation.

-
j 
V

You should encourage your child to have regular bowel patterns. Have your child sit on
the toilet for about ten minutes after meals 1-2 times each day.

The use of simple rewards or a daily calendar with stars or stickers for days that your
child takes his medicine and has a bowel movement may be helpful.

 ½
V
$
V


„Ê -
½

V
#ëonstipation in children is a chronic problem that can take time to
improve. Avoid embarrassing or punishing your child.
„Ê i


%
V
 

V
 ½½

#
„Ê   ½

 Vif your child's constipation is not improving in 2-3 weeks,
if he is regularly needing to use enemas or suppositories, or he is soiling his pants
because of leakage of stool (encopresis).

j
 
VV
½
V

 

V
 i


Metamucil/ëitrucel 2-5 years 3/4 teaspoon 1-3 times

each day
(mix in 8oz 6-11 years
water/juice) 1/2

½V 1-3
>12 years
c
 
 

 

times each day

1

½V 1-3
times each day
Mineral oil 4-11 years 1-4 teaspoons 1-2
times each day
(stir into oatmeal >12 years
or mix with orange 1-3

½V 1-2
juice). times each day
Milk of magnesia <2 years 1-3 teaspoons 1-2
times each day
(mix with 1-2 tsp. 2-5 years
of Tang or 2estle 1-2

½V 1-2
Ouick) 6-11 years times each day

>12 years 2-4


½V 1-2
times each day
Senokot (stimulant 1-5 years 1/2 -1 teaspoons 1-2
laxative to be used times each day
less than a week at 5-15 years
a time) 1-2 teaspoons 1-2
times each day
ëolace Syrup 1-3 years 1/2 ²2 teaspoons
(20mg/5ml) each day
3-6 years
1-3 teaspoons each
>6 years day

1 ²2

½V
each day
Maltsupex <2 years 1 ²2

½V 1-2
times each day
(mix in 8oz >2 years
water/juice)

actulose >6 months Ñy prescription only
(10g/15ml)
c
 
 

 

˜ 

 

‰Ê
Parents are often concerned about their children's weight, especially if they seem
to be smaller than other children that are the same age. While there are many
medical causes for being small and having poor weight gain, including inadequate
nutrition, metabolic diseases, gastroesophageal reflux, parasite infestations,
hyperthyroidism, and many chronic medical conditions, including congenital heart
disease, renal failure, etc., it is often difficult to find a reason for a child's poor
growth.

‰Ê ˜ 



is a term commonly used to describe younger children who
aren't gaining weight normally. ëhildren with failure to thrive usually have a
weight that is 



½

V

for their age and a 
VV


 
 (meaning they are not gaining weight as expected) and/or a shift
downward in their growth percentiles, crossing two or more percentiles on their
growth charts.
‰Ê If your child is just below the 3rd or 5th percentile for his weight, but he has been
VV

V   and has a growth curve that runs ½
to the 3rd or
5th percentile and he has no other symptoms, then he probably has a normal
weight. Your Pediatrician may just want to follow his growth and development at
his normal well child checkups. ëhildren with failure to thrive usually have a
growth curve that over time is moving further away from the 3rd or 5th percentile
or is becoming  
.
‰Ê ëhildren normally grow at a rate of about 30 g (1 ounce)/day in
 VV 
(birth to 3 months) and this then slows to about 20 g/day from 
 V
 and to
only 12-15 g/day in 

VV  (6 - 12 months). Older children grow even more
slowly, with

 (1-3 years) growing, at about 8 g/day, and ½
  age
children at about 6g/day.
‰Ê Many children between the ages of 6 and 18 months move up or down on their

½

V

, but by 24 months, most children follow their growth curve
and stay on the same percentile or growth channel. Still, it is usually concerning if
any child, even those under 18 months, crosses more than two major percentiles
downward, for example, going from the 80th percentile to the 40th (crossing the
75th and 50th percentiles), especially if he continues to have poor growth.
‰Ê Among the V
V
 on a child's growth is his overall genetic potential for
growth, which can be determined from the height of his parents, his nutritional
status, and the presence of any chronic medical problems.
‰Ê It is also important to look at a child's length, in relation to his weight. Õ



V
measurements can also be plotted on a growth curve and can help to
determine a child's fat stores. A child's V 
 V
, which can be
c
 
 

 

determined by measuring their mid upper arm circumference is another measure of
subcutaneous fat stores and malnutrition. Also, a child's
  

V

should be measured and followed.

‰Ê There are many causes of failure to thrive. Among the ways to categorize the
different conditions that cause failure to thrive and poor weight gain is to group
them into conditions that cause a 


V

of calories or an V 


 of calories. ëhildren may also have failure to thrive from having an V 



% 

V
for calories, such as from having a chronic infection,
hyperthyroidism, congenital heart disease or chronic lung problems.

Among the conditions that can cause your child to have a diet that doesn't provide enough
calories for normal growth (


V

  
) include:

„Ê anorexia or refusal to eat from V 

  ½
, such as renal disease,
cancer, congenital heart disease, metabolic disorders, liver disease, HIV infection,
or gastroesophageal reflux with esophagitis.
„Ê having a restrictive or fad 


„Ê preparing formula improperly
„Ê poor milk supply for 



V moms
„Ê physical abnormalities that cause difficulty swallowing (½ ), such as
neurological disorders including cerebral palsy, trauma to the mouth, congenital
abnormalities, or disorders with motility or movement of the uppger
gastrointestinal tract (such as achalasia).
„Ê ½

 can lead to inadaquate access to food. If you need assistance ask about
getting help from WIë or other government programs.

There are many conditions that can cause an V 


   
 including:

„Ê illnesses that can cause persistent  
V (such as pyloric stenosis, intestinal
obstructions (such as a volvulus), or a brain tumor).
„Ê conditions associated with  ½
V, usually with diarrhea which can be
foul smelling and oily, such as from cystic fibrosis, allergies, celiac disease,
inflammatory bowel disease, parasite infestations or other intestinal infections.
„Ê 




 (usually includes weight loss, increased urination (polyuria) and
increased thirst and drinking (polydipsia) and other metabolic conditions..

‰Ê ëhildren with failure to thrive should have a full evaluation by their Pediatrician.
This will include a detailed V

V  
, including amounts and types of
foods that your child eats and drinks (including the amount of juice he drinks), a
c
 
 

 

description of associated  ½
  (especially vomiting, diarrhea, or fever), a
½   
) and a review of prior 

 to evaluate your child's rate
of growth. The rate of growth is among the most important things that will be
assessed. If your child is below the 3rd or 5th percentile, but is growing normally
with a growth curve that is parallel to the 3rd or 5th percentile, and he has a
healthy diet and no associated symptoms, then your Pediatrician may just observe
his weight gain over the next few months.
‰Ê If your child is not growing well, with a growth curve that is flat, moving
downward across more than 2 major percentile or is moving further away from the
3rd or 5th percentile, then your Pediatrician may do further testing. This testing
will usually include a  ½


   V
(screens for anemia or low blood
counts),

 



V

V

(!SR which can be elevated with
inflammation or infections), a V and V


(can show evidence of
a renal tubular acidosis or chronic renal disease or infections),  





 (includes electrolytes, ÑU2 and creatinine (renal function tests), liver
function tests, and albumin, protein and mineral levels (calcium and magnesium)),

 


 for fat, culture and parasites, a 

 



(for cystic fibrosis),
an HIV test, PPD (for tuberculosis) and a blood lead level.
‰Ê Other testing will depend on a child's specific symptoms, and may include (but are
not limited to) an upper gastrointestinal series for persistent vomiting, serum
glucose to look for diabetes, thyroid function tests, blood and urine tests to look
for metabolic problems, and upper or lower gastrointestinal endoscopy for
persistent vomiting and/or chronic diarrhea.
‰Ê 


V
of failure to thrive is usually carried out with a team approach, with
your Pediatrician, a Pediatric V

V
, and appropriate specialist referrals as
indicated. There are many Pediatric ½
 
 that can evaluate a child with
failure to thrive, depending on your Pediatrician's suspicion of the cause. Often,
especially if they have gastrointestinal symptoms, such as vomiting or chronic
diarrhea, a Pediatric Gastroenterologist will evaluate your child.
‰Ê Treatment depends on the underlying cause. If no medical reason is found for your
child's failure to thrive, then often treatment will consist of V

V 

½ to
see if your child will gain weight if given an adequate amount of calories. This
may be done in the hospital over a few weeks or it may begin as an outpatient.
Feedings may be given orally, by a nasogastric tube (usually as overnight slow
drip feedings) if your child just won't eat enough calories, or by an intravenous
(IV) line as total parenteral nutrition (TP2) if your child is not able to digest and
absorb oral feedings.

To make mealtimes easier and maximize the chances that your child will eat, you can:
c
 
 

 

„Ê avoid trying to force or bribe your child to eat. Turning meals into a ½


 
usually doesn't help and may make your child more resistant to eating.
„Ê Have a schedule for meals and snacks, which should include 3 meals and 2-3
snacks each day of high calorie foods with lots of nutrients (see below).
„Ê Allow your child to feed himself, especially finger foods, as much as possible.
„Ê Only offer liquids, especially juice, after the meal.
„Ê Avoid large amounts of juices, sodas, or water. Offer milk or formula, which have
more calories and protein, instead.

A Pediatric nutritionist can also suggest ways that you can provide your child with more
calories by offering    



  V½

V
 
V

V
,
especially since he will need additional calories to help him catch-up with his growth,
including (disclaimer: only use these suggestions for increasing the calories that you are
giving your child under the guidance of your Pediatrician or a Pediatric nutritionist):

„Ê avoid junk foods, such as candy, which may have calories, but are usually low in
protein.
„Ê for younger children, under the direction of your Pediatrician or a nutritionist, your
infant's   V
 V
V


 to provide more than the regular 20
calories/ounce.
„Ê for older children, over 12 months of age, instead of milk, you can offer

 
, which has 30 calories/ounce (vs 20 calories/ounce for whole milk) 2-3
times a day.
„Ê or mix whole milk with a packet of V
V


½
 (adds 130 calories)
or   ½
 (adds 33 calories per tablespoon) to increase calories.
„Ê when baking and cooking, substitute whole milk, half and half, evaporated milk or
condensed milk mixed with dry milk powder for water or milk.
„Ê for high calorie snacks, offer    
 made with a cup of whole milk, a
packet of instant breakfast powder and a cup of ice cream blended together (can
provide over 400 calories).
„Ê ½ V can also provide a lot of calories if you add 1/2 cup of dry milk powder
to the milk and instant pudding mix.
„Ê add


as a topping for sandwiches, vegetables, etc.
„Ê use ½
V



 (about 100 calories/tablespoon) as a snack and as a topping for
vegetables, crackers, and fruits or blended with milk, ice cream or yogurt
„Ê make a high calorie  
V  using fruits canned in heavy syrup, add sugar or
yogurt to fresh fruit or add a packet of instant breakfast powder to strained fruits.
„Ê make high calorie -
 by substituting fruit juice for water in its preparation
„Ê serve meats and breads with added butter, margarine, gravy or sauces
„Ê serve 
, such as fish and chicken and add breading or flour before
cooking
c
 
 

 

Your child may also need to see an occupational therapist or speech therapist if he has a
food aversion or difficulty swallowing.

Psychosocial factors can also cause a child to have failure to thrive. This may involve
behavioral factors of the child that make him difficult to handle and feed, or
psychological factors in the parents and their relationship with their child.

Among the factors that will make your Pediatrician suspicious that there is a medical
reason for your child's low weight and that a further evaluation is necessary include:

„Ê if your child's plotted weight on a growth curve is V½


V


Vespecially after he is 18-24 months of age or if it has crossed more
than two major percentiles. For example, if his height had been following along at
the 70th percentile and has now moved down to the 20th (crossing the 50th and
25th percentiles).
„Ê poor appetite and/or poor nutrition
„Ê chronic abdominal pain and diarrhea
„Ê persistent fever
„Ê weight loss
„Ê chronic worsening headaches and/or vomiting
„Ê a growth curve very much below the 3rd percentile
„Ê a height that is much below that predicted by mid-parental height
„Ê if your child's short stature is disproportionate or he has other dysmorphic signs
which can indicate a chromosomal disorder.

Õ (i
˜


„Ê There has been a lot of debate lately about why so many kids are overweight...
„Ê Is it fruit juice and soda, fast food, unhealthy school lunches, or too much time in
front of a Play Station playing video games?
„Ê Most likely, it is a combination of things.
„Ê It would be nice to have someone to blame though, because that would imply that
there is something easy to fix or change that could tackle this big problem.
„Ê If you really want to narrow the reason for the rise in obesity to only one thing, it
would have to be  
. Kids are either eating and drinking too many calories,
which are converted to fat, aren't active enough to burn excess calories, or are
doing a combination of both of these things.
c
 
 

 

„Ê Remember that you gain weight if your body has more calories going in (the stuff
you eat and drink) than are going out (calories burned by daily activity and extra
exercise and physical activity).
„Ê jV 
V
„Ê In addition to oversized portions, many kids get extra calories by eating extra
meals.
„Ê ëonsider an overweight seven year old I recently talked to, who would have a
peanut butter and jelly sandwich as an after school snack and a bowl of cereal at
bedtime. If you added in the 2-3 glasses of fruit drinks and soda he was drinking
each day, that easily translated into an extra 600 or 700 calories each day and
helps explain why he gained about 35 pounds in the past year and now weighs as
much as the average 14 year old!
„Ê Switching to a more reasonable afterschool snack, eliminating the bedtime snack,
and choosing healthier drinks, like low fat milk, water, or diet drinks, would help
this child quickly get to a good first goal of not gaining any more weight.
„Ê 2
!V   


„Ê The other big problem is that most kids aren't active enough.
„Ê Remember that the latest Dietary Guidelines for Americans recommends that
children and adolescents should 'engage in at least 60 minutes of physical activity
on most, preferably all, days of the week.'
„Ê In addition to encouraging more 'free play' afterschool and on weekends, you can
help your kids get more active by getting them involved in sports at an early age.
This might include a team sport, like baseball or soccer, individual sports, or other
activities, like gymnastics or a dance class.
„Ê iV

! 
V
„Ê If you aren't sure why your child is overweight or what you can do about it, be
sure to schedule an appointment with your Pediatrician to talk about it.
„Ê The new food pyramid assessment tools can also help you evaluate your child's
diet and level of physical activity.
c
 
 

 




   

˜

V
!

VjV


„Ê You may now give your baby homogenized whole cow's milk. Do not use 2%, low
fat, or skim milk until your child is 2-3 years old. Your baby's diet will begin to
resemble that of the rest of the families, with 3 meals and 2 snacks each day. You
should limit milk and dairy products to about 16oz each day (in a cup or bottle)
and 100% fruit juice to 4-6oz each day (offered in a cup only) and offer a variety
of foods to encourage good eating habits later.
„Ê Your child should want to feed himself with his fingers and a spoon or fork and
should be able to drink out of a cup. He should have given up the bottle by now.
Remember that your baby's appetite may decrease and become pickier over the
next few years as his growth rate slows. Your baby should also have given up
middle of the night feedings by this age.
„Ê To avoid having to supplement with fluoride, use fluorinated tap water. If you are
using bottled or filtered water only, then your child may need fluoride
supplements (check with the manufacturer for your water's fluoride levels).
„Ê Feeding practices to avoid are giving large amounts of sweet desserts, soft drinks,
fruit-flavored drinks, sugarcoated cereals, chips or candy, as they have little
nutritional value. Also avoid giving foods that your child can choke on, such as
raw carrots, peanuts, whole grapes, tough meats, popcorn, chewing gum or hard
candy.


 

J

„Ê You should now be giving your child homogenized whole cow's milk. You can
also begin to use 2%, low fat, or skim milk instead. Your child's diet should
resemble that of the rest of the families, with 3 meals and 2 nutritious snacks each
day. You should limit milk and dairy products to about 16-24oz each day and
c
 
 

 

100% fruit juice to about 4-6oz each day and offer a variety of foods to encourage
good eating habits later.
„Ê Your child should feed himself with his fingers and a spoon or fork and should be
able to drink out of a cup. He should have given up the bottle by now. If not, you
can wean from a bottle by stopping one bottle feeding every four or five days and
then gradually reducing the amount in the bottle when you are down to one a day.
Remember that your baby's appetite may decrease and become pickier over the
next few years as his growth rate slows.
„Ê To avoid having to supplement with fluoride, use fluorinated tap water. If you are
using bottled or filtered water only, then your baby may need fluoride supplements
(check with the manufacturer for fluoride levels).
„Ê Feeding practices to avoid are continuing to use a bottle, giving large amounts of
sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or
candy, as they have little nutritional value. Also avoid giving foods that your child
can choke on, such as raw carrots, peanuts, whole grapes, tough meats, popcorn,
chewing gum or hard candy.



V
V˜

V

„Ê The best way to prevent feeding problems is to teach your child to feed himself as
early as possible, provide them with healthy choices and allow experimentation.
Mealtimes should be enjoyable and pleasant and not a source of struggle.
ëommon mistakes are allowing your child to drink too much milk or juice so that
they aren't hungry for solids, forcing your child to eat when they aren't hungry, or
forcing them to eat foods that they don't want. Also, avoid giving large amounts of
sweet desserts, soft drinks, fruit-flavored drinks, sugarcoated cereals, chips or
candy, as they have little nutritional value.
„Ê Your child may now start to refuse to eat some foods, become a very picky eater
or even go on binges where they will only want to eat a certain food. An important
way that children learn to be independent is through establishing independence
about feeding. !ven though your child may not be eating as well rounded a diet as
you would like, as long as your child is growing normally and has a normal energy
level, there is probably little to worry about. Remember that this is a period in his
development where he is not growing very fast and doesn't need a lot of calories.
Also, most children do not eat a balanced diet each and every day, but over the
course of a week or so their diet will usually be well balanced. You can consider
giving your child a daily vitamin if you think he is not eating well, although he
probably doesn't need it.
„Ê While you should provide three well-balanced meals each day, it is important to
keep in mind that most children will only eat one or two full meals each day. If
you child has had a good breakfast and lunch, then it is okay that he doesn't want
to eat much at dinner. Although your child will probably be hesitant to try new
c
 
 

 

foods, you should still offer small amounts of them once or twice a week (one
tablespoon of green beans, for example). Most children will try a new food after
being offered it 10-15 times.
„Ê Other ways to prevent feeding problems are to not use food as a bribe or reward
for desired behaviors, avoid punishing your child for not eating well, limit
mealtime conversation to positive and pleasant topics, avoid discussing or
commenting on your child's poor eating habits while at the table, limit eating and
drinking to the table or high chair, and limit snacks to two nutritious snacks each
day. You should also not prepare more than one meal for your child. If he doesn't
want to eat what was prepared for the rest of the family, then he should not be
forced to, but you should also not give him something else to eat. He will not
starve after missing a single meal, and providing alternatives to the prepared meal
will just cause more problems later.

2042

„Ê Diet and nutrition for kids is a challenge. Most children are bombarded with
persuasive and attractive advertising from a very young age. Most foods
advertised tend to be high in sugar or salt and are often sponsored by colorful
cartoon characters.
„Ê ëhildren need to be given a choice and must be allowed to eat little and often.
„Ê ëurrently there is no dietary recommendation of global utility available for
children and adolescents.
„Ê However, individuals and populations are advised to:

„Ê increase the consumption of fruit and vegetables, as well as legumes, whole grains
and nuts;
„Ê limit the energy intake from total fats and shift fat consumption away from
saturated fats to unsaturated fats;
„Ê limit the intake of sugars.
$
V
½ 



V

V
„Ê Healthy nutrition strengthens the learning potential and well-being of children and
adolescents.
„Ê Healthy nutrition contributes to decreasing the risk of today's leading health
problems in children and adolescents (including obesity, cardiovascular diseases,
cancer and eating disorders).
„Ê Healthy nutrition in early life enables healthy adulthood and ageing.
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1.Ê ëoffin
ewis A. ëhildren¶s 2utrition: A ëonsumer¶s Guide
Rennes Publishing, 1984 ëopyright
Pp-184-189
2.Ê Tamoralane William V. Weiswasser Janet, The Yale Guide to ëhildren¶s 2utrition
Randy Publishing 1997 ëopyright
Pp-415-417
3.Ê Sizer Frances, Whitney !llie 2utrition: ëoncepts and ëontroversies
William & William Publishers, 2007
Pp-234-240
4.Ê Marotz
ynn R, Ñrown Judith !, Isaac Janet S 2utrition The
ife ëycle
2007 ëopyright
5.Ê www.google.com

6.Ê www.keepkidshealthy.com

7.Ê www.google.books.co.in /ëHI

DR!2¶S 2UTRITIO2

8.Ê Rullere Wilkin, ëhidren¶s Guide to 2utrition

Grand Publishing, copyright 2004

Pp78-90
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