Got a baby starting on table foods and out of ideas? You don’t have to go broke over buying toddler Puffs®.

Babies and young toddlers don’t have a lot of teeth. In fact, a full set of teeth does not come in until around two years of age. In the meantime, to help your new eater avoid choking, cut up food into tiny pieces. Now, sawing at food with a knife is not easy. Meet your new friend: the kitchen shears! Use shears to snip food into perfect toddler bite-sized pieces.

Cut table food into bite-sized pieces smaller than a grape, or approximately Cheerio® sized, and place on a clean surface, such as the high chair tray. Plates are not necessary and often end up on the floor. Go ahead and give your toddler a fork but don’t expect him to use it- most toddlers are eighteen months before they can master a fork or spoon. Always be present when he is eating in case he starts to choke. Toddlers tend to put a handful of food in their mouth at one time, so teach your child to eat pieces of food “one at a time.”

Forget the toddler-food aisle, just grab your shears and cut away. Below are finger-food ideas to help you get started. These foods are appropriate for babies who are able to finger-feed, starting anywhere between 7 to 9 months of age, even without teeth:

canned mandarin oranges

fruit cocktail (in juice, not syrup)

bananas

diced peaches

diced pears
diced mellon
diced berries, cut blueberries in half at first

diced cooked apples

raw tomato pieces

avocado

beef stew

liverwurst cut into small pieces

diced cooked meat

Cooked, diced chicken

Diced cooked salmon, tilapia, mahi-mahi, flounder (careful to discard any bones)

tofu (extra-firm is easiest to cut)

black beans, cooked or canned (rinse off the salty sauce they come in)

egg salad or hard-boiled egg pieces

bits of scrambled egg

soft cheese- such as American or Munster

vegetable soup (just scoop out the veggies and give them to your child. You can put the broth into a cup for him to drink)

diced cooked veggies such as peas, carrots, corn, broccoli, zucchini, etc.

diced cucumbers

cooked diced squash

cooked diced potatoes, sweet potatoes, or yams

rice

noodles

pierogies

mini ravioli

macaroni and cheese

waffles

pancakes

french toast

crackers with cream cheese

toast with jelly

toast with nut-butter (soy, peanut, almond, sunflower, etc.)

stuffing

Cheerios®

Bon appetite!

Naline Lai, MD with Julie Kardos, MD

©2013 Two Peds in a Pod®

We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents. Spoiler: reading myth #4 can save you lots of money.

Myth #1: Don’t give milk to a child with a fever, the milk will curdle (or some other variant).

Truth: As long as your child is not vomiting, milk is a perfectly acceptable fluid to give your febrile child. In fact it is superior to plain water if your child is refusing to eat, which is very typical of a child with a fever. Fevers take away appetites. So if your child stops eating while she is sick, at least she can drink some nutrition. Milk has energy and nutrition, which help fight infection (germs). Take milk, add a banana and a little honey (if your child is older than one year), and maybe some peanut butter for added protein, pour it into a blender, and make a nourishing milk shake for your febrile child. Children with fevers need extra hydration anyway. Even febrile infants need formula or breast milk, NOT plain water. The milk will not curdle or upset them in any way. If, on the other hand, your child is vomiting, then stick to clear fluids until her stomach settles.

Myth #2: Don’t give children milk when they have a cold because the milk will give them more mucus.

Truth: There is NOTHING mucus-inducing about milk. Milk will not make your child’s nose run thicker or make his chest more congested. Let your runny-nosed child have his milk! Yet my own mother cringes when I give my children milk when they have colds. Never mind my medical degree; my mom is simply passing on the wisdom of HER mother which is that you should not give your child milk with a cold. Then again, my grandmother also believed that your body only digests vitamin C in the morning which is why you have to drink your orange juice at breakfast time. But that’s a myth I’ll tackle in the future.

Myth #3: You can’t over- dose a child on milk.

Truth: Actually, while milk is healthy and provides necessary calcium and vitamin D, too much milk CAN be a bad thing. To get enough calcium from milk, your child’s body needs somewhere between 16 to 24 ounces of milk per day. Of course, if your child eats cheese, yogurt, and other calcium-containing foods, she does not need this much milk. New recommendations for healthy Vitamin D requirements have been increased recently to 400 IU (international units) daily which translates into 32 ounces of milk daily. BUT we pediatricians know from experience that over 24 ounces of milk daily leads to iron-deficiency anemia: calcium competes with iron absorption. You’re better off giving an over-the-counter vitamin such as Tri-Vi-Sol or letting older children chew a multivitamin that contains 400 IU of vitamin D. In addition to iron-deficiency anemia, drinking all that extra milk is bad for teeth (all milk contains sugar) and can also lead to obesity from excessive calories or can in fact lead to poor weight gain in children who are picky eaters to begin with: the milk fills them up too much for them to have any appetite left for food.

Myth #4: Organic milk is healthier than non-organic milk.

Truth: If you compare organic milk to non-organic milk, the nutrients on the label of the milk carton are the SAME. “But what about the growth hormones in milk,” you may wonder. First of all, cows may be supplemented with growth hormone, but their milk is not. In addition, let me explain about growth hormone. Some children are actually born without growth hormone, and other kids develop growth hormone deficiency because of kidney failure, or cancer treatment, or other medical problems. These children need supplemental growth hormone. Unfortunately for these kids, the only way that we have to give growth hormone to these kids is by injection (a shot) every day. Do you know why? Growth hormone gets DIGESTED in the stomach and is not active if a child eats/drinks it. SO, even if non-organic milk contained growth hormone (which it doesn’t) then your child would have no effects of it anyway because their guts would break it down before it could act on their bodies. WHEW! So unless you just like the taste better, you do NOT have to spend twice as much money on organic milk. Just buy regular milk. Put that extra money away in your college funds.

In summary, you can safely continue serving your children milk in sickness and in health, in moderation, at a lower cost than organic, every day. Now, all this talk about milk really puts me in the mood to bake cookies…

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®

Update: Please read this article , by the American Academy of Pediatrics in 2012, for a comprehensive, unbiased review of the data comparing health benefits of conventional vs organic milk and other foods–Drs. Kardos and Lai, October 6, 2013.

Revised from the original post from 10/5/2009

Pediatricians associate Back to School with “Time to get your flu vaccine.” At least this pediatrician mom does. As I try to figure out when I can get my own three children over to my office to get their flu vaccines, we want to give you a flu vaccine update.

Good News.

Last year we responded to your concerns about arsenic in food, particularly rice, and shared with you the FDA’s recommendation at that time.

We are relieved that after considerable research which included analyzing over 1300 samples of rice products, the FDA scientists determined that “… the levels of inorganic arsenic found in the samples are too low to cause immediate health damage.” Please see this link for the details of the investigation and recommendations.

Bottom line: continue to offer a well-balanced diet to your children and vary the types of grains that you serve to your families.

Julie Kardos, MD and Naline Lai, MD
©2013 Two Peds in a Pod®

“You just don’t appreciate a picky eater until you have one. ”
—Overheard at Dr. Lai’s dinner table.

Picky eaters come in two major varieties. One kind is the child who eats the same foods every day and will not vary her diet; for example, cereal, milk, and a banana for breakfast, peanut butter and jelly with milk or juice for lunch, and chicken, rice, and peas for dinner. This diet is nutritionally complete (has fruit, vegetable, protein, dairy, carbohydrate) but is quite “boring” to the parent.

The other kind of picky eater is the child who either leaves out entire food groups, most commonly vegetables or meat, or leaves out meals, such as always eats breakfast but never eats dinner.

My own children range from the One Who Tries Anything to the One Who Refuses Everything (these are my twins!). My oldest child lived on cheerios and peanut butter and jelly for about two years and now eats crab legs and bulgur wheat and other various foods. My point: I know where you’re coming from, I feel your frustration, and I will give you advice that works as well as optimism and a new way of thinking about feeding your children.

Fortunately, from a medical point of view, toddler/child nutrition needs to be complete as you look over several days, not just one meal. For example, if every 3 days your child has eaten some fruit, some vegetables, some protein, some dairy, and some complex carbohydrates, then nutritional needs are met and your child will thrive! 

Twelve ways to outwit, outplay, and outlast picky eaters

1) Never let them know you care about what they eat. If you struggle with your child about eating, she will not eat and you will continue to feel bad about her not eating. Talk about the day, not about the food on the table. You want your child to eat for the simple reason that she feels hungry, not to please you or anyone else, and not because she feels glad or mad or sad or because of what you the parent will feel if she eats or doesn’t eat. Along these lines, NEVER cook a “special meal” for your toddler. I can guarantee that when she knows how desperately you want her to eat your cooking, she will refuse it.

2) Let them help cook. Even young children can wash vegetables and fruit, arrange food on platters, and mix, pour, and sprinkle ingredients. Older kids can read recipes out loud for you and measure ingredients. Kids are more apt to taste what they help create.

3) Let them dip their food into salad dressing, apple sauce, ketchup etc., which can make their food more appealing or interesting to eat.

4) Let them pick their own food. Whether you grow your own foods, visit a farm or just let your kids help you in the supermarket, kids often get a kick out of tasting what they pick.

5) Hide more nutritious food in the foods they already like (without them knowing). For example, carefully mix vegetables into meatballs or meatloaf or into macaroni and cheese. Let me know if you want my recipe for zucchini chocolate chip muffins or Magic Soup.

6) Offer them foods that you don’t like—THEY might like it. Here’s an example: a few years ago, my children were decorating Easter eggs with Dr. Lai’s children. My kids asked if they could eat their decorated hard boiled eggs. Now, hard boiled eggs are one of the few foods that I do NOT like. I don’t like their smell, their texture, and I really don’t like the way they taste. Yet, all three of my kids, including my pickiest, loved those hard boiled eggs dipped in a little bit of salt. Go figure. Now I have an inexpensive, easy, healthy protein source to offer even though I can’t stand the way my kitchen smells when I cook them… but hey, if my kids actually will EAT them…

7) Continue to offer foods even if they are refused. Don’t force feed; just have them on the table. It could take 20 -30 exposures before your kids might try them so don’t despair. It took eight years of exposure to brocoli until two of my three kids decided they loved it.

8) Hunger is the best sauce. Do not offer junk food as snacks. Pretzels, crackers, cookies, candy, and chips have NO nutritional value yet fill up small bellies quickly. Do not waste precious stomach space with junk because your insightful child will HOLD OUT for the junk and refuse good nutrition if they know they can fill up on snacks later. Along these lines, never bribe food for food. Chances are, if you bribe eating vegetables with dessert, all the focus will be on the dessert and a tantrum will follow. You and your child will have belly aches from stress, not full bellies.

9) It is okay to repeat similar meals day after day as long as they are nutritious. We might like variety as grownups but most toddlers and young kids prefer sameness and predictability.

10) Turn off the TV. Trust me and trust numerous scientific behavioral studies on this, while it sometimes works in the short term, it never works in the long term. In addition, watching TV during meals is antisocial and promotes obesity.

11) Do not become a “short order” chef. If you do, your child will take advantage of you and likely will not end up eating anyway. When your child says, I don’t want this dinner/lunch/breakfast, I want something else,” you say “The meal is on the table.”
One variation of this that works in some families is to have one back-up meal that is the same every day and for every meal and must be completely non-cook and nutritious, for example, a very low sugar cereal and milk, peanut butter and jelly sandwich, or yogurt with nuts or fruit mixed in it, etc, that you agree to serve if your child does not want to eat what the rest of the family is eating.

12) You can give your child a pediatric multivitamin. This tactic is not “giving up,” nor is it cheating, and it can give the Parent as Provider of Nutrients peace of mind. You can either give a multivitamin every day or just on the days that you are convinced that your child has eaten nothing.

If all else fails, your consolation is that your child will likely become a parent of a picky eater too, and she will ask you how to cope. You’ll be able to tell her what worked for you when she was a picky eater.

Julie Kardos, MD with Naline Lai, MD
©2013 Two Peds in a Pod®
Originally posted on July 24, 2009, with modifications

We had such a great response to our Two Peds in a Pod® visual diagnosis post that we are posting another summertime picture puzzle:

What is it? Pictured below are the toes of one of my best friend’s toddler. She is happy, has no fever, and plays nearly everyday in the neighborhood pool. The round shiny pink bumps and dots on her toes appeared yesterday morning and haven’t changed much in a day. They don’t seem to bother her very much… answer below.

It’s Swimming pool pulpitis- a fancy word for a reaction of the pulp (the meaty tip) of fingers or toes. Mostly seen on the finger tips, the pulpitis is usually caused by irritation of the fingers by the rough side of the swimming pool as kids pull themselves in and out. Kids are sometimes annoyed by the dots, but they go away on their own as soon as the kids decide to use the ladder. In this case, this little swimmer irritated her toes, not her fingers, while “monkey walking” along the side of the swimming pool in the water.

Naline Lai, MD with Julie Kardos, MD

We interrupt your summertime to present another Two Peds in a Pod® visual diagnosis learning session. Do you recognize this rash? Hint: it is mildly itchy and painful and can result from scratching bug bites or a skinned knee. Read on for the answer.

The rash on this child’s arm is impetigo. Impetigo is just a fancy name for a crusty skin infection on the surface of the skin. The infection is caused by the common germs that often lurk on our skin, Staphylococcus and Streptococcus. (You may recognize the germ Streptococcus from our sore throat post because it can also cause Strep throat). The germs wait for a break in our skin, from a tiny cut, pimple or a scrape, then invade the skin and spread. Impetigo is often seen next to the nose because the germs love to lurk in the nasal passages and kids often pick at the skin under the nose when it gets irritated from a cold virus.

Doctors tend to describe infections with appetizing food analogies (yes, we know- eew). In this case, impetigo is often described as having honey-colored-crusted lesions. The areas are tender and red, and often itchy. Kids often spread this infection on themselves when they scratch at the infection and then touch other areas of their skin.

Pediatricians treat impetigo with either a topical antibiotic or oral antibiotic for anywhere from 7 to 10 days. The choice of how to treat depends in part how much of the skin is affected and which body surfaces are involved. The infection is contagious until 24 hours after starting treatment.

Prevent this infection: Hand washing is a great way to prevent spread of impetigo. Washing all skin wounds well with soap and water is another way to prevent the emergence of this infection. See our prior post on wound care.

Ok, now back to the pool and barbeques for all our summertime readers. Just remember your bug spray and remind your children not to scratch and pick at their skin.

Naline Lai, MD and Julie Kardos, MD

©2013 Two Peds in a Pod®

Remember when we used to call sun screen lotion “suntan lotion,” and tolerating red blistering shoulders was considered a small price to pay for a tan?  Live and learn.

Dr. Kardos’s dad is a pediatrician and during our long grueling hours of residency training he’d always serve as a source of encouragement. One of my favorite memories will always be the proud look in his eyes years later as he watched his daughter present at a physician conference.

Today we honor all Dr. Dads- dads or father figures- who help their children in times of crisis, illness, or injury.  Following is a tribute sent by one of our readers, Jennifer Taylor.

Happy Father’s Day!

Dr. Lai with Dr. Kardos
_________________________

We are parents to three boys so needless to say, our house is always full of cuts, bruises or injuries of some sort. Band-Aids and “feel better” kisses are a regular part of our daily activity. And while my husband is a great “Doctor Dad” to all three boys, it is his every day involvement in my youngest son’s medical care that makes him a truly amazing father.

My son Luke is 4 years old. At the age of 6 months, he was diagnosed with an in-utero stroke. We were told at the time of his diagnosis that he may never talk or walk based on where the stroke hit. We’ve had several years of therapy, doctor’s appointments and testing. Throughout it all, Kris has been an amazing supporter- both for Luke and me.

While I tend to see the glass half-empty, Kris is perpetually positive. He always says “When Luke can” instead of “If”. He does research on therapies that might shake things up in Luke’s progress and is certainly a very active participator in all the therapies we receive. Kris stops in to chat with all the therapists so that they know he is Luke’s Dad. He is at every medical appointment: driving us to CHOP at 7:00 in the morning because he knows I hate driving on Route 76 by myself; heading up to Lehigh Valley Hospital for a speech consult; sitting by me while Luke has some sort of test done, holding my hand and telling me it will be okay. He is compassionate throughout it all and yet he still pushes Luke to succeed, knowing that our little boy can accomplish anything. When Luke gets frustrated, it is my husband who can calmly get him to try, try again. And they say laughter is the best medicine so my husband pulls out all the jokes and silly behavior he knows to get Luke to go “one more time.”

I really could go on and on about what a wonderful Dad my husband is but the true testament to him is sitting on the floor next to me singing and playing. Luke wouldn’t be where he is now without Kris.

And for that, I am eternally grateful.

Jennifer Taylor
©2013 Two Peds in a Pod®