Childhood Nutrition

Childhood Nutrition

November 4, 2019 0 By William Morgan


KAITLIN HENNESSY:
Hello everyone,
and welcome to
Childhood Nutrition.
My name is Kaitlin Hennessy.
I’m the Program Coordinator
for WSU Global Connections.
Olivia, who you will see in
the chat box this evening,
and myself, will be
your event moderators.
Tonight, presenting, is
Dr. Michelle McGuire.
She has a PhD in Human Nutrition
from Cornell University,
and has been with WSU since
1997 as a faculty member.
She’s currently a
professor in the School
of Biological Sciences
at the WSU Pullman campus.
Dr. McGuire’s research
focuses on understanding
how maternal dietary intake
and nutritional status
influences human milk
composition, and maternal
and infant health during
the period of breastfeeding.
Throughout the evening, you
may ask Dr. McGuire questions
using the chat box.
Also, let us know if you have
any technical difficulties
and we’ll do our
best to resolve them.
Thank you so much for
coming this evening.
I’m going to hand it
over to Dr. McGuire.
DR. MICHELLE MCGUIRE: Thanks
for joining us tonight.
This is the first one
of these I’ve done,
and I’m pretty excited
to be able to share
some knowledge I have with
everybody about childhood
nutrition.
What to worry about, and
maybe more importantly,
what not to worry about when
feeding babies and kids.
I’m going to briefly go
over some touchstones
that we have in the field of
infant and child nutrition.
I’m going to talk first a
little bit about recommendations
for feeding during the
first year of life.
A little bit about
breastfeeding.
When, how, where, whatever.
A little bit about that.
When to start solid foods,
and what solid foods to start,
and why.
A little bit about sleep
and physical activity,
as they relate to nutrition,
which might surprise you.
And then we’ll move on
and talk about, basically,
the same things in
toddlers and children.
Except there, we’re
going to talk more
about introducing
other foods, and how
to just establish very
good eating habits in kids.
And then I’ll end with
talking just a little bit
about teenagers.
And before I get
started I just want
to tell you that I am very happy
to take questions throughout.
And if you have a question,
go ahead and post it.
Kaitlin will then
read them to me,
and Kaitlin, I don’t
see them right now
on the side of my
screen, so feel
free to interrupt
me and introduce
those questions as they
come in, as appropriate.
So I’ll go ahead and get started
with just talking about why
is early nutrition important.
I think we all have a sense
that nutrition is important,
but what do we know about that?
And how important is it?
And I will tell you, that the
focus in nutrition right now,
in terms of setting
a human being up
for a healthy
lifespan, is talking
about what happens in the
first 1,000 days of life.
This includes nine
months of pregnancy
and about two years of life.
And we know from
many, many studies
that healthy growth
and good nutrition
during that first 1,000
days, sets a person up
to have the best social,
emotional, and cognitive
development, aside from
just having healthy growth.
And one thing that
I want to mention
is that we now know that if a
baby grows too little or too
much in that first 1,000
days, that his or her risk
for later diseases and
obesity is quite a bit higher.
So we’re very interested
in what’s going on
during that first 1,000 days.
We also know that in
that first 1,000 days,
especially during the
second year of life,
children are developing
food habits that
are going to stay with them
for the rest of their lives.
And so it’s super important
during this period.
It is what you feed kids,
and how you feed kids.
It’s not just the foods
that you feed them,
but it’s also the environment
in which children are fed,
and that helps them to
learn how to eat well
for the rest of their lives.
So that’s what we’re
going to be talking
about for the rest of the time.
So I’ll start off talking
about infancy and just
some basics about
infant nutrition.
What are some of the
recommendations during infancy?
And first I’ll
just mention, what
are some of the nutritional
concerns and nutritional needs
of infants?
And I’ll remind you that this
is a period of rapid growth
and development.
So not only is the
baby getting bigger,
but organ systems
are coming on board,
the brain is becoming
more developed et cetera.
And this is really,
really important
that nutrition is
right at that point.
And this is tricky in early
life because babies are tiny.
And they have really tiny
stomachs and small intestines,
and they have to get
a lot of calories,
and a lot of vitamins and
minerals, in very small doses.
So providing enough nutrition
to that baby over that
24 hours, every single day,
is actually somewhat tricky.
They also need really high
quality and digestible protein.
The proteins in human
milk are quite unique.
They’re different
from cow’s milk,
they’re different
from soy protein,
and in human milk, when we
know what should be there.
And so a lot of
formulas are altered
to look like human milk,
in terms of protein,
because we know that’s
super important.
All of the essential
vitamins and minerals
have to be supplied in the
right amount during this period.
We need a proper mix
of fats, important
for neural development.
When I say neural development,
I’m really meaning the brain.
The brain is developing
during that time.
And I should point out that
babies during early life
can’t make some of the fats
that we, as adults, can make.
They have to get it
from their diets.
So super important that they’re
consumed in the first year life.
It’s also important,
we’re learning,
that infants are exposed
to their environment
during this first year of life.
This sets babies up for
fewer allergies and fewer
other problems later on.
And these babies who are exposed
to the normal environment
during early life, via
either the mother’s milk,
or for formula, they do better.
And we’re learning– and
this is part of my research,
which we’re not going
to talk about tonight–
but the microbes, exposure to
microbes during this period,
is really, really important.
And it turns out that breast
milk has microbes in it.
So all of these things are
the most important things
we think about for nutrition
during the first year of life.
We do know that human
milk is ideal for babies.
It’s recommended by all
reputable health organizations,
such as American
Academy of Pediatrics,
the Surgeon General, the WHO.
They all recommend
breastfeeding.
Now, that’s not to
say that you have
to breastfeed your baby,
that’s just the recommendation.
And I’ll talk a little bit more
in a few slides about formula
feeding.
Because, quite frankly,
in this country
we have fabulous options if
you choose to formula feed.
But I’m first going to
talk about human milk
because it is recommended
that all babies that are able
should be breastfed.
Why is that?
Well, there are a lot
of benefits that we know
from a lot of years of studies.
Infants that are
breastfed, we know,
are receiving the perfect
mix of all those nutrients.
And they’re also
receiving live cells
from the mother, immune factors.
And, like I said
before, even microbes,
that are probably
helping the baby
learn to tolerate what is
in his or her environment.
There’s also a lot of
immunological protection
in breast milk.
Breastfed babies have
lower rates, for example,
of upper respiratory infections.
And breastfeeding is
associated with lower risk
of long-term chronic
illness and obesity.
For example, Type 2
Diabetes risk is lower
in breastfed babies.
Breastfeeding also has
some protective effects
for the mother.
We know that women who
breastfeed actually
have a lower risk for
breast cancer, particularly
premenopausal breast cancer.
Breastfeeding may also
help some moms lose weight.
And you hear that
all the time, but I
would like to put a little
caveat in here that that’s not
always true.
Breastfeeding takes a
lot of time and energy,
and a lot of breastfeeding
moms have a really hard time
getting away and exercising.
So this idea that
breastfeeding actually
helps women lose weight actually
isn’t true a lot of the time.
So that, in itself, is not
a good reason to breastfeed.
But most women who
do breastfeed find it
convenient, and relatively
easy, and it is cheap.
A woman can produce milk for
very little financial input.
But I should mention that
breastfeeding doesn’t always
work beautifully.
In fact, in a lot of
situations there are problems.
And I would like to highly
recommend that if you do
breastfeed a baby at some point,
or have a partner who does,
and there are any problems,
get straight to a lactation
consultant and get some help.
Look up the La Leche
League in your area.
Breastfeeding is tricky.
And a lot of women
don’t have support.
Their mothers aren’t around,
their aunts aren’t around.
People aren’t
there to help them.
So as wonderful as it
is, there are problems.
There are real problems with
it, and if you have problems,
you need to get some help
solving those problems.
So with that, let’s
talk a little bit
about what’s recommended.
If you do breastfeed
a baby, which
is the recommended
form of feeding,
how often do you feed the baby?
And the answer is
very, very often.
A lot of times you’ll
hear people say, put
the baby on a schedule, don’t
let that baby run your life.
And, actually, the baby
does run your life.
And the baby should
run your life.
And when you look at
data from studies,
we see, typically, that
healthy breastfeeding women
breastfeed their babies anywhere
from eight to 12 times per day.
That’s a lot.
That’s every couple hours,
sometimes more frequently,
even.
And surprisingly,
this number stays
constant for most
of the first year.
So I know a lot of
breastfeeding women
feel like they’re breastfeeding
their babies all the time
and there must be a problem,
but, actually, this is normal.
And in other countries where
women have their babies
with them all the time, they
breastfeed at least 24 times
a day.
Breastfeeding on demand is best.
It’s not recommended anymore
that we schedule feed,
unless, of course, it has
something to do with going back
to work, et cetera.
And then, of course, you
might need to do that.
But it’s not necessary.
It’s not something
that the baby needs.
And we call this breastfeeding
on demand “responsive feeding.”
And I’m going to talk more about
the importance of responsive
feeding when we talk about
feeding toddlers and children.
And so I wanted to point
out here, what really
needs to happen in infancy.
Starting in infancy, and
going through childhood,
is that we do this
responsive feeding.
What does that mean?
It means that we
feed kids, we feed
babies, when they’re hungry.
And we stop feeding
them, or let them
stop eating, when they’re full.
And so that means we have
to look for signs for hunger
and signs for satiety.
And I’m not going to
go through all of these
because you’re going to have
access to this slide set
when I’m done.
But there are very clear
signs of hunger in babies.
For example, they start
sucking on their fist.
They get fussy,
et cetera, and we
need to pay attention to those.
That’s when babies
are hungry, and that’s
when they should be fed.
And we should stop
feeding them when
they’re done eating, when
they turn their head away,
et cetera.
This is a best time
in the universe
to teach kids when to eat
and when to stop eating.
Because, as a lot of us know,
we stop paying attention
to those cues later in life.
And that can lead to obesity.
And so we really,
really need to make sure
that kids are learning
to sensor on hunger
and satiety as early as infancy.
So I will leave
this slide for you
to come back to if
you’d like to look
at some of these signs
of hunger and satiety.
You need to start working
on that early on in infancy.
Some more rules of the
road for breastfeeding?
How long do you breastfeed?
If you’re going to breastfeed,
what’s the recommendation?
Well, the current
recommendation–
and this recommendation
is put forth
by the American
Academy of Pediatrics,
and the World Health
Organization–
is that women
exclusively breastfeed–
and that means
that you don’t feed
anything else for the first
four months, up to six months.
So four to six months.
And then continue as
long is desirable.
But the recommendation is try
to breastfeed a little bit up
to a year, and breastfeed then,
as long as you and your baby
want to continue with that.
And a lot of women
are able to do this,
even going back to work,
because you can buy pumps now.
And in fact, the
Affordable Health Care
now requires that pumps
are available to women.
And women commonly pump.
And there really
isn’t any difference
between pumped milk
and breastfed milk,
in terms of nutrition.
Pumping can be super
inconvenient and stressful
for some women, but
it’s a good alternative
if you can’t be with
the baby all the time
and you want to pump
and freeze milk.
So some more breastfeeding
rules, and rules
of the road recommendations.
A lot of women are curious–
You don’t know how
much milk your baby’s
getting because
they’re breastfeeding.
And what we usually
tell people is,
if you’re breastfeeding
at the breast
and that baby is growing
adequately– in other words,
they’re doing as expected
on those growth curves.
And they’re producing enough
wet diapers and soiled diapers,
you’re doing fine.
So it’s a sort of
a secondary way
of looking at how much
milk you’re producing.
And here’s just some
guidelines that we
tend to use about how
many wet diapers a day you
should expect in the
first couple of days,
when you’re not
producing a lot of milk.
If the baby produces one wet
diaper, or a couple diapers,
that should be fine.
And at this point, they’re
producing this first feces
called meconium.
After that, the milk
turns from colostrum
into more mature milk.
Milk comes in.
The woman starts
producing a lot more milk.
And the way that you can
tell if that’s happening,
is looking at the
number of diapers.
Typically, and there’s range–
you can be below
and above this–
five to six disposables,
or six to eight cloth,
wet diapers per day, suggest
that everything is fine.
And, actually, those
numbers continue all the way
through six weeks,
up to a few months.
So these are sort of benchmarks.
Of course, a healthy baby
can be below and above that.
But these are just some
sort of typical numbers
that we normally see.
KAITLIN HENNESSY: Dr. McGuire?
DR. MICHELLE MCGUIRE: Yes.
Yes.
KAITLIN HENNESSY: We had
[INAUDIBLE] from the chat box
asking, “I thought the WHO–
capital W, capital H
capital O– recommend
two years for breastfeeding.”
DR. MICHELLE MCGUIRE: The
World Health Organization, yes.
That’s a good question.
I was focusing more on
the American Academy
of Pediatrics recommendations.
And what they’re recommending,
at least one year,
but possibly up to two.
World Health Organization
does recommend two.
So you’re right on that.
Somebody out there knows their
World Health Organization
recommendations.
I was just kind of
morphing the two of them.
So thanks for bringing that up.
Thanks for that clarification.
OK.
A couple other things
that I want to mention
about breastfeeding.
There is a concern–
women want to know, is my
milk composition adequate?
Some women feel more
comfortable feeding formula
because they feel like it’s
been manufactured in such a way
that we know that it
is perfect for babies.
And in fact, formula
is manufactured
to look just like human milk.
So that argument
doesn’t really hold,
but there are some
concerns some women have
that maybe their
milk is inadequate.
And, absolutely,
milk composition
is adequate for babies until
about four to five months.
And this is when we know
that some babies might become
a little iron deficient, or
a little protein deficient,
if they’re not given
supplementary foods.
OK?
So this four to five,
or four to six months,
is probably a little bit
of a better range in there.
And this is exactly
why the recommendation
to start introducing
supplementary foods
is also in that period of time.
So these are the two
nutrients that we
are worried about babies
becoming deficient
in in that period of time.
And you’ll see that we
actually recommend, therefore,
that the first foods are
good sources of protein
and are good sources of iron.
Because that’s
what we’re worried
about between four
and six months,
and especially after six months.
Having said that, it is fine
to exclusively breastfeed
until six months.
Babies are not going to get
too iron deficient, or too
protein deficient.
They will be fine
if you exclusively
breastfeed for six months.
There’s also a concern
about vitamin D.
There is a current
recommendation now
by the American
Academy of Pediatrics
that all breastfed babies
receive vitamin D drops.
Without going into all
the research behind this,
this is because there are some
populations of breastfeeding
women, and breastfed
babies, that
do become vitamin D deficient
when they’re exclusively
breastfed.
However, these mothers and
babies tend to be dark-skinned,
or they wear a lot of sunscreen.
Or they wear a lot of clothes
that decreases sun exposure.
We make vitamin D from the sun.
This is the recommendation.
You certainly can’t do any
harm giving your baby vitamin
D drops.
It doesn’t mean that milk, in
general, is low in vitamin D.
And in fact, I like to suggest
that, better yet, make sure you
and your baby get moderate
amounts of sun exposure,
protective sun exposure.
Not too much sunscreen.
OK.
So as I mentioned
before, there are
women who choose not to
breastfeed, and that’s fine.
And luckily, in this country, we
have fabulous formula choices,
and we have clean water.
So we’re fine with that.
If you do choose
to formula feed,
I would recommend that you
look for a formula that
is iron-fortified,
that’s critical.
That has two
important fats in it,
they’re abbreviated DHA and AA.
These are important fats
that babies can’t make.
They’re high in
human milk, so we
need to add them to formulas.
And also, I wanted
to mention that there
are cow’s milk-based, and
soy-based formulas out there.
They’re both fine.
One isn’t better than the other.
They’re both just fine.
So these are all
things that are good.
And I just did want
to mention, sometimes
you’ll see expensive formulas
that say, for example, non-GMO.
This is, Genetically
Modified Organisms.
You’ll see that on this.
Or they’ll be organic.
Or they’ll say that
you’ve added more vitamins
and minerals, et cetera.
And what I would like to
say about these things
is, if you live a lifestyle
where you avoid GMOs,
and you consume organic
foods, and you’re
going to want to
choose these formulas.
However, these formulas
are no more nutritious
than other formulas.
And you’re going
to pay a premium
for these sorts of labels.
And from my perspective, I
know absolutely no nutritional
benefit from
spending extra money
on these sorts of products.
And also the ones that have
added this, and added that.
There are actually
regulations about what
needs to be in
formula, and they all
have to be up to
those standards.
So any formula that you buy
will be up to those standards.
So just a summary.
Make sure it’s iron-fortified.
Make sure it has these
fatty acids in it,
doesn’t matter if it’s
cow’s or soy-based,
unless your child has
some sort of allergy.
I wouldn’t worry about
GMOs and organic,
but that’s my
personal preference.
If that’s the sort of food that
you like to purchase, and then
that’s fine.
And don’t worry about buying
something with added vitamins,
OK.
A couple other things that I
wanted to mention before we
move on to toddler hood.
Some concerns we have, if you
happen to be a vegan woman.
And that means you consume
absolutely no animal
products, whatsoever– no milk,
no fish, no chicken, et cetera.
We do know that breastfeeding
vegan women produce milk
with very low vitamin B-12.
And this is an
essential nutrient
that absolutely is needed
for neural development.
B-12 is found primarily
in the animal foods.
It’s also found in
some fermented foods
because bacteria
make vitamin B-12.
So if you are a vegan
breastfeeding woman,
I would recommend that you
either take a B-12 supplement,
or better yet, just
make sure you’re
getting enough B-12
from fermented foods,
or for foods that
contain bacteria.
That’s really
important for the baby.
A couple other things
I wanted to mention–
It’s perfectly fine to
breastfeed and formula feed
together.
There’s no problem with that.
A lot of women, when
they go back to work,
they introduce formula and
continue to breastfeed.
I also want to mention
that whole milk is
OK to add as a supplemental
beverage to breastfeeding
after about six months.
But before six
months of age, it’s
recommended that babies are
not fed whole milk at all.
And it’s never OK to substitute
whole milk for formula
during the first year.
And this is because–
we’re not exactly sure why–
but when you feed a young child,
an infant, whole cow’s milk,
it causes them to lose
iron in their feces.
And so a little bit of
whole cow’s milk is OK,
but substituting it, for
example, for formula, is not
OK.
The child will become
iron deficient.
So you have to be
careful about that.
And then finally, I wanted to
mention, no child, no baby,
should ever be put
to bed with a bottle,
unless the bottle
only contains water.
And that’s because the
carbohydrates, the sugars
in almost everything,
including formula,
can cause this [INAUDIBLE]
called tooth decay–
baby bottle tooth decay.
And this is a picture of a child
with baby bottle tooth decay.
And what happens is that those
fluids build up in the mouth,
they feed the bacteria in
the mouth, and the teeth.
Even before they’ve come
through, start decaying.
So we recommend that
babies are never put
to bed with any sort of bottle.
KAITLIN HENNESSY: Dr. McGuire,
we have another question.
DR. MICHELLE MCGUIRE: Yes.
KAITLIN HENNESSY:
Our question is,
if a baby is regularly
gassy and on formula,
would this be a
sign of something
wrong with that type of formula?
DR. MICHELLE MCGUIRE: That’s a
really, really good question.
As long as the child is
growing appropriately,
OK, we don’t consider that
a significant problem.
If the child is crying
and in distress,
it might be worth
having the child
tested for an allergy
or a sensitivity.
But aside from that,
babies are gassy.
And you expect that.
So unless there’s
growth faltering,
or there’s distress and
crying, we typically
don’t worry about
things like that.
How old is the baby?
We probably don’t have that.
Yeah. Yeah.
The person who
asked the question,
if you want to give
me more information
I can talk more about
that, if you give me
a little more information.
Or you can shoot–
oh three months.
OK, I see it.
Three months– if
it were earlier,
I’d be more concerned about it.
Those gases that
are being produced
are being made by the
bacteria in the GI tract.
So what’s happening
is you’re feeding
the baby formula that is
feeding the microbes in the gut.
They’re producing the gas.
And we all produce gas.
It’s actually microbes
that produce gas
we consider to be good for us.
Most things that produce
gas are good for you,
like beans and broccoli,
and things like that.
So really unless there’s
a growth problem,
I wouldn’t worry
about it at all.
Especially at three months.
Not at all.
And I hope that
answers your question.
OK.
Thank you.
So now let’s switch
gears a little bit.
Now we’re in this period
from four to six months.
We’re considering
introducing other foods,
and as I mentioned before,
the real concern here
is iron and protein.
So good first foods
tend to be things
like iron-fortified cereal.
This is one of the reasons
why a lot of people
start with iron-fortified
rice cereal.
But interestingly,
many, many cultures
start their babies on
pureed fish and meat.
And actually a few
recommendations,
including the American
Academy of Pediatrics,
have now come out and
said that’s actually
a very good first food.
Of course it has to be
extremely well pureed.
And has to be smooth so that
the baby will accept it.
But, nutritionally,
something like that’s
a fabulous first food.
Also pulses like dahl.
This is an Indian dahl.
Lentils, kidney beans,
garbanzo beans– also,
extremely pureed–
are really good first
foods because they’re
good sources of protein.
And then the question is,
when is this appropriate?
When do you start
feeding other foods?
And the answer to that
is, it’s individualized.
It depends on the baby.
It depends on the situation.
There’s no one right
answer to that.
However, when we
talk about this,
we do talk about some key
developmental milestones
that we look for,
that you probably
don’t want to start
supplementary foods
before these happen.
So for example,
sits without support
and has good head
and neck control.
That just has to do with
swallowing and not choking.
And I’ll let you read
through these on your own,
but you want to make sure
that the baby is actually
anatomically and physiologically
ready for that food.
And when they are, and
they’re interested,
then it’s time to start.
And that is a very
personalized question,
and has very personalized
answers for every baby.
But just know that this
whole range of time
is perfectly fine.
If you have a child that
shows absolutely no interest,
then just continue to
breastfeed for six months.
If you have a child
that’s grabbing food
off your plate at four months,
they’re probably ready.
And as long as the
food is safe, it’s
probably a good time to start.
There is that window
of opportunity
where we want to introduce
good foods to kids,
and when they’re ready, it’s
time, both nutritionally,
and cognitively, as well.
So with that, I want
to mention a little bit
about food allergies.
This is a big issue in
this period of time.
For years, we have recommended
that people put off
introducing highly allergenic
foods like peanuts–
especially peanuts–
cow’s milk, et cetera.
Because we were afraid of an
allergic response early on.
And so it used to be recommended
that these foods not even
be introduced, maybe, in the
whole first year of life.
I will tell you that
our thinking on this
has completely switched
over the last few years.
We now know that delaying
these sort of allergens
might actually increase
the risk for allergies.
The idea here, is
that the baby has
to develop a tolerance
for these common foods.
And if you miss the
window of opportunity
for developing tolerance,
you might actually
increase the risk for allergies.
So the recommendations
are rapidly switching.
We’re now actually
saying, go ahead
and introduce these foods
in small quantities,
just along with other foods
that you’re introducing,
and just be careful about it.
But don’t avoid them.
It’s also recommended
that foods– any new food,
especially the
potential allergens–
are introduced at home,
rather than in a daycare
or restaurant.
That way you’re just
paying attention.
And if there’s some sort of
reaction you can respond.
But also, if your child
has a known allergy,
or your whole family
is allergic to peanuts,
or something like
that, you might
want to consult your
doctor before you move
on introducing these foods.
But this is sort of an
older recommendation,
and I can guarantee you
that the new recommendations
you’re going to see deal more
with introducing these foods,
earlier rather than later.
Some other things
I want to mention
is that we also used
recommend that you
would introduce
one food at a time,
and separate each one by a week.
And, actually, if you
did that, you’d hardly
be feeding a whole meal by
the time they were three.
And so now we recommend
that there’s really
no need to do that.
You can introduce foods
individually, wait a day
or so, and make sure that
there is no reaction.
But that old recommendation
is really behind us now.
Also, I just want to mention
there is absolutely no reason
to purchase baby foods.
If you have a food processor–
which many people do now–
you can puree anything up,
put it in ice cube trays,
stick it in a Ziploc bag, and
have ready-to-go baby foods.
And in fact, when the baby gets
old enough to eat mixed foods,
et cetera, you can take
leftovers from your meal,
puree it together, and you
have fabulous baby foods
ready to go.
No reason to spend
money on that.
Couple other things
I want to mention.
Don’t give up on your baby.
If he or she doesn’t like
something, try, try, try again.
The statistics on
this is something
like, babies often need to be
introduced to a food six to ten
times in order to accept it.
So just because they didn’t
like broccoli the first time,
try it again, try
again, try it again.
And also introduce finger
foods when your child is ready.
Make sure they can sit up.
Make sure that the food,
itself, is right size.
That it’s not a choking hazard.
And most parents are
very familiar with that.
It’s one of our biggest fears.
By the way, I have
three children.
I have fed three children.
They’re all out
of the house now.
OK.
I want to mention–
looking at the time here.
I want to mention a
little bit about sleep.
This at first seems a
little bit out of place,
and a little bit out of context.
But emerging data, both
in children and in adults,
is consistently
showing that there
is a relationship between
not getting enough sleep,
or lack of sleep, or a little
sleep, and risk for obesity.
We don’t understand it.
But it appears to have some
very physiologic mechanisms
behind it.
And we’re now also
seeing this in children.
So we’re very interested now
in what is this relationship.
What’s going on, and what
kind of recommendations
should we make about sleep
so that we decrease risk
for obesity?
OK?
And as I’ll mention
in a few minutes,
obesity is one of our biggest
public health challenges
right now.
So we’re trying to decrease
the risk early, early on.
And one of the things
that we think we can do,
is make sure our kids
get enough sleep.
And I have presented here a
very recent recommendation
by the Academy of
Sleep Medicine.
I’ve put some
references in here.
This one came from 2016.
And it’s now recommended by
the Academy of Sleep Medicine,
that infants between
four and 12 months
should sleep 12 to 16
hours per day, including
naps on a regular basis.
This has been also acknowledged
by some nutrition groups,
with the idea that this
might help decrease obesity,
although I think we don’t
have very good data on that.
And I just want
to note that there
are no data on younger infants.
We don’t really have
sleep recommendations
below four months of age.
And I should also say,
that I want to remind you
that these are ranges.
Your baby may be below
that, or above that,
and be perfectly healthy.
This is just sort of the
standard median, range.
And what about
physical activity?
If we’re talking
about obesity, it’s
not just about
energy consumed, it’s
also about energy expended.
And I don’t think
many of us think
about physical
activity in infants,
but actually, it’s never
too early to be active.
And some of the changes
that have happened
in our society
over the last year
have actually decreased
activity, even in our youngest.
So I do want to mention
some physical activity
recommendations
currently out there.
And again, these are to really
help babies regulate their,
what we call, energy balance.
Their energy
expenditure should be
similar to their energy
consumption, balanced
for growth.
And so what do we recommend?
And this recommendation
comes from Shape America,
which is a nationally
recognized organization.
And what they recommend
for physical activity
of our youngest babies
is their caregivers–
moms, dads,
babysitters, et cetera–
should place infants in settings
that encourage and stimulate
movement experiences and active
play for short periods of time,
several times a day.
And in layman’s terms, ditch the
car seat, ditch those carriers.
I see so many well-meaning,
busy parents– we all do it–
but their kids are in car seats
and carriers all the time.
And they’re strapped in,
and they’re not very active.
Get the kids out of those.
Get them on the floor.
Give them tummy time.
Babies are actually
quite active.
Put them on their back.
Put them on their stomach.
Even before they’re crawling,
they’re very active,
and it’s very important.
Also, the infants
should interact
with caregivers in daily
physical activities that
are dedicated to exploring
movement in the environment.
What this means is,
get kids engaged.
They will move when
they’re engaged.
Take them on walks.
Encourage them to look and
explore as early as possible.
They will be more
physically active.
So, in summary, it’s really
never too early to be active.
Start this with your infant.
OK.
So let’s move on now and talk
a little bit about toddlers
and young children.
They’re so cute.
And this is the age–
we’re in the
terrible two’s here,
if that’s what you
want to call it.
Toddlers we consider from
one to three years of age,
and then young
children we usually
consider from four to eight.
Of course, this includes
the preschool years.
This is a super
critical, and super fun,
and super challenging
time to feed kids.
Anybody with kids knows this.
You just look at
this little gal.
You don’t know if she’s going
to eat that, or throw it at you,
or smear it on the table,
or feed it to the dog.
And it’s fun, and it’s
crazy, and for some people
this is the worst few
years of their lives.
But we all get through it.
But it’s really
important for kids,
and really challenging
for parents.
And so I want to
talk a little bit
about how we think is
the best way to do this.
And I want to talk
about the role
of parent and role of child.
And we’ll come back
to this a few times.
The role of the parent in
this challenging, crazy time
is simple.
Provide frequent access
to healthy food choices.
That’s your job.
Your job isn’t to
make your kids eat it.
Your job isn’t to make your
kids eat Brussels sprouts.
Your job is to just make
sure they have access
to healthy food, all the time.
Some parents go wacko
about this, right?
They have all this
crazy stuff that they’re
trying to feed their kids,
and there’s no need for that.
There’s a lot of
healthy food choices.
Provide a variety,
provide it frequently,
and then let your child
choose what to eat
and how much to eat.
And, honestly, if you take
that pressure off of yourself
as a parent, making sure your
kid eats, eats, eats eats,
life gets a little bit simpler.
Even though this whole period–
there’s nothing simple about it.
But there’s loads going
on in this period of time.
Loads of stuff going
on, developmentally,
in this decade of childhood.
And it’s really a moving target.
So I would encourage people
with toddlers and young children
to just go with it.
Have fun with it.
Know that your role is simple.
Provide frequent
access to healthy food.
Let your child choose
when, and how much, to eat.
So– I can’t move that–
but I wanted to show you–
this is the set of behavioral
milestones for children.
And this is put out by the
United States Department
of Agriculture in
coordination with the MyPlate
in dietary guidelines.
And it’s so funny if
you read through this.
These are all
developmental milestones
for children age two
through five years.
And it goes through simple
things that they can do.
Blah, blah, blah.
And these are the sort of
things that are normal.
Annoying, but normal.
And what I had
highlighted on here is,
may suddenly refuse
certain foods.
It’s in every category
until you get to five.
So just know that
this is normal.
Your kid may have eaten
something yesterday
and today they won’t touch it.
Maybe they won’t
touch anything today.
And that’s completely normal.
That’s completely normal.
Let’s see.
I keep moving the
wrong thing here.
So how do we feed these kids?
How do we deal with
this crazy period?
And the answer I
want to give you
is something that we
call responsive feeding.
And there’s a reference
down here at the bottom,
you’ll have access to it.
And I actually have it
right here in front of me.
I’m going to highlight a
publication that was actually
just published last week.
And these are new guidelines for
feeding toddlers and children.
And so look this up.
You can find it free
on the internet.
And again, if you just
Google that, it’ll come up.
And so this is a
really nice synopsis
of how we think
kids should be fed.
And the bottom
line is they should
be fed via this idea
of responsive feeding,
and I talked about this
with breastfeeding.
That we just feed on demand.
So the idea of
responsive feeding,
is this responsive parenting
involving reciprocity
between the child
and the caregiver
during the feeding process.
So what that doesn’t mean, is
you don’t sit your child down
with some Cheerios and cheese
and walk in the other room,
and come back, and
just clean it up.
The idea is you pay
attention to what’s going on.
If the child isn’t
interested, they’re done.
If they need more, whatever,
but you’re actually
engaged in this.
And we’re busy
parents now, and I
think a lot of times we forget
about this responsive feeding
thing.
This is a great example,
a great illustration,
of responsive feeding.
And it is fun.
So responsive feeding is
grounded in three steps.
The child signals
hunger and satiety
through what they do, how
they look, how they sound.
The caregiver recognizes the
cues and responds promptly.
And the child experiences some
sort of predictable response
to their signals.
They’re not ignored.
This really isn’t
rocket science.
I think it’s just
once in a while
we need to be reminded of this.
This is how we’re
supposed to feed kids.
So what is responsive feeding?
As I mentioned, it’s really
the parent, the adult,
paying attention to hunger
and society signals,
and helping the child.
If they’re hungry, get the food.
If they’re full, they’re done.
And this is a list of hunger and
satiety signals that are pretty
common– again, not
rocket science–
from five months to two years.
And again, this is out
of this publication
that they’ve referenced,
another public publication.
So those of you who have kids,
you recognize these things.
If a child is hungry they
might reach for food, right?
And this is in this age where
they might be breastfeeding,
right?
And you might be thinking,
oh my gosh, my kid’s hungry.
He’s reaching for food.
Well, maybe they’re hungry.
Go ahead and feed them.
Points to food.
And, obviously, as they get
older they can ask for food.
But just as important, you make
sure you’re paying attention
to the satiety signals.
Are they slowing down?
Are they pushing the food away?
Those are satiety signals.
We want to encourage
the child to recognize
those satiety signals
and know that that’s
time to stop eating.
Because, unfortunately, many
of us don’t do that as adults.
So that gets me to this next
question of, how much control
should you exert over
your child’s choices?
Obviously, we want to
be good parents, right?
We want our kids to
eat a variety of foods.
We want them to be introduced
to a whole bunch of new foods.
We want them to like
a variety of foods.
And sometimes that takes
the parent being the parent,
and having a little
bit of control.
But how much
control is too much?
That’s the question.
Obviously, we
don’t want our kids
foraging through the
refrigerator on their own.
We’re going to help
them with that.
But some things that
we know from research–
We do know that parents
who restrict foods–
So we’re talking
about control here.
Parents who restrict
foods are more
likely to have obese
or overweight children.
So what I’m talking
about here is,
I’m never going to take
my kid to McDonald’s.
That’s restricting a
commonly consumed food.
Or, they’re not going to get any
chocolate until they’re five.
That’s a common restriction.
Parents who have that
sort of attitude,
and that sort of
response, are more
likely to have obese
or overweight children.
That doesn’t mean they all
will, they’re just more likely.
Parents who pressure kids to
eat everything on their plates
have children of normal
weight, but these kids
do not learn to self-regulate,
and often become obese adults.
So that’s an interesting,
long-term look at this.
So this is a sort of family
situation where you sit down
and you say, you’re going
to finish everything
on your plate.
Maybe you put the stuff on
their plate, maybe they did.
Regardless, we do know that
there is a relationship here.
That sort of
parenting style often
leads to adults who are obese.
And, interestingly,
men are more likely
than women to use
pressure-to-eat behaviors.
Which is surprising to many,
but the data play this out.
And boys are more likely than
girls to be pressured to eat,
which is very interesting.
So we need to be careful
about these things.
We don’t really recommend
heavily restricting foods.
Of course you can
restrict some foods.
Some foods are just
ridiculous, like soda.
There’s no redeeming
quality in soda.
However, having
soda once in a while
is not going to
hurt anybody, right?
Save it for that party,
sort of situation.
We don’t want to pressure
kids to eat everything
on their plates.
What we want to do
is encourage them
to only put on their plates what
they think they can eat, right?
That’s a better approach.
We don’t want to waste food,
but there is a balance there.
So nothing’s simple, right?
So best practices with children.
I’m just going to go
through a few things,
as I just mentioned.
We highly recommend
that we avoid
using food to control behavior.
We don’t use it as
reward or punishment.
That usually turns out
badly, and it sets kids up
for having food issues later on.
It’s super important to
model good eating habits.
Loads of research show that
children’s eating patterns
mirror their parents’
eating patterns,
and that shouldn’t
be a big surprise.
Another thing, is be patient
with your kids, right?
Kids are commonly food-phobic.
They don’t want
to try new things.
Just be patient with them.
Introduce new foods.
Reintroduce foods.
Over reintroduce foods.
As I mentioned before, studies
show that children often need
repeated exposures to
foods– up to 26 times–
to actually accept a new food.
So be patient.
Encourage nutritious snacking.
Remember they have
tiny little tummies.
Even this little
toddler, not a big tummy.
So snacks are still important
to get all those nutrients in.
And promote
self-regulation, which
means kids should eat only
as much as they need to eat.
So I want to mention a
little bit about obesity.
I’ve already touched
upon it a little bit.
But aside from the
fact that we need
to get all the essential
nutrients into our kids,
and we want them to
develop good eating habits,
we also want to prevent
them from becoming obese.
This really is the most
pressing health concern
we have in the United
States right now.
I’ll show you some statistics.
This is obesity in
infants and toddlers.
So this is birth
to two years old.
These are percent
of children that
have high weight per length.
Which basically means
they’re overweight, or obese.
So they’re heavier
than their length
would suggest they should be.
So this is the
total population–
US population.
That’s about 7.1% of our
infants and toddlers are already
overweight.
That’s bad.
By the time they’re
two, that’s going
to go up as they get older, OK?
Girls are more likely than boys.
And what’s really,
also, very interesting,
is that this is different
across different ethnic groups.
So we have Asian kids
with the highest–
now this is interesting,
because this one actually
does reverse later in life–
but we have Hispanic and Black
infants and toddlers with
higher obesity early on.
And these actually
increase as time goes on.
And we’re seeing
these statistics–
they’re starting to level out–
but they’ve been going up.
And so we’re very
concerned about this.
So obesity in preschoolers
and school-aged children.
Here are some statistics
for the Centers
for Disease Control
and Prevention,
otherwise called the CDC.
17% of US children
and teens are obese.
So these are older kids.
That’s a lot of kids.
And here are the total numbers.
If you get up to the teenage
years, we’re already at 20,
21% of our population
is overweight or obese.
I think this is actually obese.
So we’re very
concerned about that.
Again, we see these
differences amongst
the different ethnic groups.
And it’s interesting.
By this age, the non-Hispanic,
Asian youth actually
have a lower risk for obesity.
But this is what we’re
trying to prevent now.
Because if you’re
an obese child,
you’re likely to
be an obese teen,
and you’re very likely
to be an obese adult.
And it’s a lot harder
to treat than prevent.
So the best way to avoid
obesity, we believe,
is via reasonable
responsive feeding
and being a good role model.
Now that means that a lot
of us, as parents, have
to change what we’re doing.
And that’s probably even harder
than feeding your kid right.
So it is a time for
the whole family
to try to adjust what they’re
eating to become more healthy.
So bottom line
with kids, as long
as the available
choices are healthy,
we really recommend
backing off forcing kids
to eat, or not eat.
Your job is really to
provide the choices
and be a good role model.
And remember that
kids won’t go hungry.
They just won’t.
They generally won’t.
They will eat when
they’re ready to eat.
I want to mention a few
things about picky eaters.
We all know some picky eaters.
I, luckily, didn’t
have any, but this
is one of the
frustrations for parents.
Where your kid will
only eat peanut butter
and jelly sandwiches and
bananas, and that’s it.
And, of course,
you’re very worried
then about vitamin deficiencies,
et cetera, et cetera,
et cetera.
But the research
really says that kids
go through these phases
and in the long run,
there’s almost no evidence
of poor nutritional status
amongst picky eaters.
They figure it out.
They do fine.
They don’t grow
poorly, et cetera.
And in fact, I just
read a recent study
were picky eaters were actually
at lower risk for obesity
later on than non-picky eaters.
So that’s kind of an
interesting twist on that.
And again, remember kids need
to be introduced to foods
lots and lots of times.
So you might feel like
your kid is a picky eater,
but maybe they just haven’t
been introduced to that food
20 times yet.
And they will, maybe,
eat it in the long run.
And do remember, kids are very
sensitive to certain flavors.
They have to learn how to like
bitter foods, for example.
Which are a lot of vegetables.
And again kids won’t go hungry.
Just make sure you always have
some sort of foolproof backup
that you’re happy to
have them eat if they
won’t eat what you serve them.
I always think that
that’s a good idea.
In our house, it was a
peanut butter and jelly
sandwich and a glass of milk.
They don’t like what we’re
having for supper, they
could always go get that.
Again, I just want to mention
a little bit about sleep.
These same sort of
recommendations–
As I mentioned before, babies
are supposed to sleep a lot.
And you can see the numbers
go down, as the years go up.
But still recommended for
a three to six-year-old.
So this is the preschool,
kindergarten, first grade
years.
10 to 12 hours a day,
that’s quite a bit.
So we do need to make sure
our kids get enough sleep,
because we do think
that that is somehow
related to risk for obesity.
And physical activity
for kids, what
are the recommendations here?
I pulled these recommendations
from both, SHAPE America
and the US Department of
Health and Human Services.
And these are the
recommendations right now,
that toddlers and
preschoolers should
engage in a total of
at least 30 minutes
of structured physical
activity each day.
And at least 60 minutes–
and up to several
hours per day–
of unstructured
physical activity.
So structured physical
activity is like recess, PE,
soccer game– well, these are
toddlers and preschoolers but–
tumbling, whatever.
Some sort of
structured activity.
And then there’s just play.
It’s super important.
Another recommendation is
that the young ones should not
be sedentary for more
than 60 minutes at a time,
except when they’re sleeping.
So pay attention to that.
School-aged children
should be physically active
for at least 60 minutes
on most, if not all, days.
And, yes, that is seven days a
week, and that’s a lot of time.
So unless your child has
a [AUDIO OUT] PE component
at school, or they’re in some
[AUDIO OUT] like basketball
after school, or they’re
doing something like that–
60 minutes a day, actually, is
somewhat difficult to get to,
unless your kid is active.
So pay attention to that.
And finally, I just want
to mention a little bit
about the teens.
You think
two-year-olds are hard,
teens might be even
harder, because you have
almost no control over them.
And they’re wonderful, as well.
But what we’re worried
about in the teenage years–
This is a graph of growth
velocity in humans.
Males are the blue line,
females are the red line.
So this is velocity.
This doesn’t mean that the
kids are losing growth,
but they’re growing less,
less, less, less, less.
And then all of a sudden
they hit puberty, and boom.
The growth spurt happens.
This is the most rapid
growth spurt, relative,
throughout the whole lifespan.
So not only do we have
to provide enough energy,
and all the nutrients needed
for this growth spurt,
but also, there’s a lot
of maturation going on
at this time–
reproductive system, et cetera.
And so we need a lot
of energy and nutrients
for that, as well.
And I think sometimes we forget
about the really high nutrient
requirements during
the teenage years.
Those kids are out of the house,
we don’t see them whole lot.
But, actually, we really
need to pay attention
to what’s going on
in these teen years.
Considerations when
feeding your teen.
Some things that we are
concerned about here–
very concerned about iron.
As girls hit their
first menstruation,
they start losing
iron every month.
It’s very difficult
to get enough iron
if you’re not eating meat.
Difficult for vegetarians.
And so if that is a category
of your child, your daughter–
they’re not eating meat.
And even if they are, it’s
hard to get enough iron.
So we pay attention to that.
And I should point out that
a relatively high percentage
of girls do experiment
with vegetarianism
during their teen
years, which is fine.
It’s a perfectly
healthy lifestyle.
But it is hard to get iron.
So pay attention, and
if that’s going on,
maybe your daughter needs
to take an iron supplement.
Calcium, also, super important
during this time period.
Both boys and girls are
putting on a lot of bone,
and you need a lot of calcium.
You also need a lot of
protein to go with that,
because your bone is actually
made, mostly of protein,
with calcium embedded in it.
So calcium and protein,
super important.
And again, calcium
is hard to get
if you’re not consuming dairy.
It really is.
And so if your child is
not consuming dairy–
if they’re lactose
intolerant, or something
like that– you really
need to pay attention
that they’re getting enough
calcium from other food
sources.
A lot of very unhealthy
eating practices
do develop during
the teen years,
particularly around body image.
This is not just girls at all.
Boys, as well.
This is actually
increasing in prevalence.
That boys, basically,
want to bulk up
and they want to look good.
Girls tend to want to get thin.
So it’s kind of an
opposite effect going on.
But these can lead to very
unhealthy eating habits
and we need to really
pay attention to that.
One thing that I would
highly recommend,
is pay attention to how
much soda and sports drinks
your teens are consuming.
These are, absolutely,
empty calories.
They’re fine once in a while.
But relying on sodas
and sports drinks
as a beverage on a daily
basis is a really bad idea.
Lots of sugar, lots of salt. No
vitamins and minerals at all.
I highly recommend
you avoid them,
except for party situations,
or sport situations.
So adolescence is complex.
All this stuff is
going on, right?
Feeding that kid.
All they really care about
is getting enough calories,
but you really need to
make sure that they’re
getting all of the nutrients
that they need, as well.
Which is basically eating
a variety of foods,
and that will work.
And it’s still fundamentally
important for parents
to provide healthy food choices
in the adolescent years.
I think a lot of times
we just sort of back off.
But we really need
to pay attention
to what our kids are,
and aren’t, eating.
Are they eating lunch?
Where are they eating?
It’s hard to keep
track sometimes,
but it’s worth asking.
Are they cutting
out certain foods?
Are they becoming vegetarians?
Are they getting sensitive
to milk, et cetera?
And I would like
to just remind you
that family meals
are always important,
but they’re super important
at this stage of time
because your child
actually sits with you
for more than five minutes
and you can talk to them.
And you can also see
what they’re eating,
and see how much they’re eating.
And rule of thumb,
that we always say,
is make sure you eat
together at least once a day.
And don’t underestimate
the importance
of family breakfasts.
I know a lot of families have
found that breakfast might
become the most important meal
of the day with their teen,
because by the end of the
day they’re off to football
practice, or off doing stuff–
And anyway, the parents
are so tired that you’re
beat at that point.
So you might want to get
up a little bit early
and put breakfast on the
table in these last few years
that you have your
child at home.
So with that– good timing–
Just a summary.
Infancy.
Breastfeeding is recommended.
We recommend that
you feed on demand,
which is responsive feeding,
and exclusive from four
to six months.
If you do feed infant formula,
feed an iron-fortified formula.
Never put your baby
to bed with a bottle.
And I should recommend up here–
It is recommended
that we breastfeed
for a year, or two years, it
depends on the recommendation.
Introducing solids.
Start with high iron,
high protein foods.
Be careful that it’s
pureed extremely well.
Introduce new foods and keep
mixing it up with your kids.
You don’t need to purchase them,
you can make them yourself.
Adequate sleep and physical
activity is important.
And, basically, the same
thing goes through childhood
and adolescence.
Responsive feeding is important.
The parent’s job is making
sure the right food is there.
And the child’s job is to decide
what, and how much, to eat.
Be patient and positive
with your child.
And again, adequate sleep
and physical activity
are important for
decreasing risk for obesity.
And again, this doesn’t
stop in adolescence.
A parent’s job never stops.
So with that, I’d
like to say thank you.
And I am very open
for questions.
I’m in no hurry to stop.
I have nothing to do tonight,
so if you have questions,
I’d be happy to answer them.
KAITLIN HENNESSY: Dr. McGuire,
we do have a couple questions.
The first is, my
three-year-old hates chicken.
What would you recommend
for a replacement?
DR. MICHELLE MCGUIRE:
Does he like any meat?
So if he doesn’t like chicken–
he doesn’t like any meat.
Then your issue is
going to be getting
enough protein in your child.
And I would go to other
high protein foods.
Corn is a good
source of protein–
beans, lentils chick peas.
I would just go to the
high protein legumes.
I like eating chickpeas, yeah.
So those are good sources.
But keep trying, OK?
That’s what I’m going to say.
Keep trying.
Cut it into different–
how old is your child?
Can you respond real fast?
Three years?
Three years old.
Try dips.
Yeah.
OK.
So just keep trying.
Try it different ways.
Put different sauces on it.
You’ve probably tried all this.
Just keep trying.
They’ll grow out of it, and
they’ll like it, eventually.
But in the meantime,
your concern is protein.
So stick to the high
protein legumes, corn–
look up protein complementation
and how that works.
So you can mix proteins like
corn and beans, rice and beans.
And make sure you have
plenty of protein.
There’s actually no
problem with that.
A lot of the world is
vegetarian like that.
And as long as you mix
those proteins, you’re fine.
But keep trying on the chicken.
Yup, absolutely.
Yup.
There’s a lot of options
when it comes to protein.
But if you want them to
eventually consume it,
just keep trying.
Maybe they were born
a vegetarian, though.
KAITLIN HENNESSY: All right.
Our next question is, my
concern with responsive feeding
is getting your infant to
sleep through the night.
As it’s become common to do a,
quote, “dream feed,” unquote,
at the parents’ bed time,
to avoid middle-of-the-night
feedings.
Also, that responsive
feeding wouldn’t
be the best choice for a
daycare preschool child,
since they are on a schedule
in those environments.
What are your thoughts on this?
DR. MICHELLE MCGUIRE: Right.
That’s a really,
really good question.
And, obviously, the person
that asked the question
has experience with kids.
So you know how
complicated this is.
So the issue–
I’m not sure I
completely understand
the issue of feeding kids
right before bed, or to get
him to sleep through the night.
Obviously, we all want to
sleep through the night,
but quite frankly, some babies
cannot consume that amount
of food to get them
through the night.
Oh, these are large children.
OK.
These are three, four,
and five-year-olds.
We do not– that’s
a bedtime snack,
and that’s not a good idea.
Different questions–
Oh, different questions–
I’m reading these
responses as we go.
OK, infants.
OK.
Some infants absolutely cannot
get through the night without
waking up and eating.
Breastfed babies
are expected to wake
up in the middle of
the night and feed,
and so are formula-fed babies.
And I know we all want
to sleep, but really,
overfeeding a child
so that they’ll
sleep through the night is
not an ideal feeding practice.
Now I understand
the need for sleep,
and I also understand that
some babies sleep through
the night, early on.
But these are
child-to-child differences.
And so I think we
need to respect those.
I hope that answers
the question.
KAITLIN HENNESSY: The next
question we have is regarding–
I have a lot of friends that
give their children Ensure
because their child refuses
to eat “quote unquote”
healthy foods.
What do you think about this?
DR. MICHELLE MCGUIRE:
I’m not a fan of this.
Quite frankly, these are really,
really well-meaning parents,
and they’re absolutely
on track, they
want to make sure
that their child is
getting all the nutrients
that he or she needs.
I completely respect that.
But I think it’s an
overreaction to the situation.
I think that solution is
not a long-term solution.
And what does that
teach the child?
The child really
needs to just be
introduced to a variety of
foods over and over and over.
As annoying, and
difficult, and challenging,
as that is for the parent,
that’s a better solution.
And I will liken that
to– there are parents
that also give their
children one-a-day vitamins
and then they don’t worry
about what kind of food
that they eat.
And that’s not a good idea.
We really need to be
teaching good eating habits.
So giving a liquid food
replacement, not ideal.
It’s a good backup.
It’s a good emergency
sort of thing,
but it’s not a good
fix to the situation.
KAITLIN HENNESSY: Excellent.
Our next question is, do you
recommend a nutrition-feeding
book for young mom’s?
DR. MICHELLE MCGUIRE: Oh, golly.
I wish I could answer that.
Let me look into that.
I was more into those books
when I was a young mom.
And so I don’t even know
what’s on the market.
So let me look into
that and see if I
can shoot Kaitlin a
good answer to that,
and she can send it
out to everybody.
I think, Kaitlin, you have
everybody’s email addresses?
KAITLIN HENNESSY:
That is correct.
DR. MICHELLE MCGUIRE: OK.
So I’ll look that up and try
to get an answer to that.
KAITLIN HENNESSY: Thank you.
Our next question is regarding,
do boy babies, and young boys,
need more food than girls?
Going along with that thought
of boys eat more than girls,
in general.
DR. MICHELLE MCGUIRE: Yes,
so that’s a good question.
So food requirements
are completely
based on nutrient and
energy requirements.
Boys do tend to be bigger
than girls, so, therefore,
they do tend to require more
energy and more nutrients.
So the general answer
to that is, yes.
Boys do require more.
However, if you have
a small boy they’re
not going to require more.
Of course, nutrient
requirements are also
based on activity level.
So you have to factor that in.
But if you looked at the
recommended dietary allowances
for boys, they are
higher than girls.