Most of us, including me, are not always health food angels. However, a family who is a regular customer at a fast food restaurant may simply not know how to break the habit. For those who still need to get those healthy eating New Year’s resolutions rolling, our February podcast, “Helping the Overweight Child,” gave the 5-4-3-2-1-0 rules for healthy eating.  This post gives more hints:

BMI, or Body Mass Index (weight in kg divided by height in meters squared) is a number which indicates whether your child’s weight is normal for his or her height and age. Normal weight school aged kids DO look a bit scrawny.Children’s bellies should NOT hang over their pants. On the other hand, normal weight toddlers do look a bit pudgy. The Centers for Disease Control and Prevention has a nice BMI calculator. 

Snacks aren’t needed at sports games which last only an hour. Supply water bottles and forget the snack.

Don’t feed your younger child snacks to keep him occupied during an older sibling’s event. Bring books, paper and crayons, a doll, or a matchbox car instead.

 Make a stack of peanut butter and jelly or cheese sandwiches and keep them wrapped, ready to go, in the fridge. Keep some washed apple slices or carrot sticks along side the sandwiches and this stash can be your “fast food” at those times you need to feed your family “on the run”. 

 Don’t give your children a junky snack in order to carry them over until dinner. If your kids come home from school STARVING!!, give them a REAL dinner, and then give them a fruit or vegetable when the entire family later sits down.

holiday is one day, Halloween is October 31^st. ^. Why eat the candy for days and weeks afterwards?

Don’t keep junk food in your home. This will avoid arguments about what to eat.

Have your children ask you if they can have something to eat, rather than allowing “free access” to your pantry/refrigerator. That allows you decide if it is too close to mealtime to have a snack (remember from the Picky Eaters blog post,“hunger is the best sauce”) and will allow you to choose an appropriate snack and portion size. If kids inherently knew healthy choices and portion sizes, they wouldn’t need parents! Also this allows you to determine if the child is truly hungry, bored, or attention seeking. 

Now back to the the fast food establishment I find myself in with my family. “Maybe this restaurant chain should offer a Two Peds in a Pod kid’s lunch box,” I mused as my family finished up their greasy, salty meal. Everyone’s curiosity was piqued. My husband and I began to hypothesize what kind of food would be inside a Two Peds box.

“What do you think?” I asked the kids.

“We’re actually more interested in what kind of prize would you would offer,” they said.

Gotta love my regular customers.

Naline Lai, MD and Julie Kardos, MD

©2010 Two Peds in a Pod®

For families with young children, holiday time can be magical yet stressful. Often families travel great distances to be together and parties tend to run late. Fancy food and fancy dress are common.  And winter holidays, well, they occur in the winter, usually during flu season, stomach virus season, and in general multi-illness season. Here are some suggestions about how to keep your kids healthy and happy during this time.

We preface by referring you to suggestions # 1, 2, and 3 of Part 1of A Happy, Healthy Holiday. HANDWASHING, HANDWASHING, AND HANDWASHING will prevent spread of germs. In addition:

Traveling 400 miles away from home to spend the week with close family and/or friends is not the time to solve your child’s chronic problems. Let’s say you have a child who is a poor sleeper and tries to climb into your bed every night at home and you have chronic fatigue from arguing with her/walking her back to bed. Knowing that even the best of sleepers will often have difficulty with sleeping in a new environment, just take your “bad sleeper” into your bed at bedtime and avoid your usual exhausting home routine of waking up every hour to walk her back into her room. That way everyone gets better sleep. Similarly, if you have a very picky eater, pack up her favorite portable meals and have them available during the fancy dinners. (But when you return home, please refer to our podcast and blog posts on helping your child to establish good sleep habits and on feeding picky eaters.) Good sleep and good nutrition keep children and their parents healthy and happy.

Think of giving your children a wholesome, healthy meal at home before a holiday party which you know will be filled with junk food and food that may seem “foreign” to your children. Hunger fuels tantrums, so eliminate that meltdown source by taking them to the party with full bellies. Also you won’t feel guilty letting them have some of the sweets because they already ate a healthy meal.

Speaking of sweets, ginger-bread house vomit is DISGUSTING.   Dr. Kardos found this out first-hand with one of her children after a holiday party where the hostess served the kids a beautiful (and generous sized) ginger bread house for dessert. While Dr. Kardos was engrossed in conversation with a long lost friend, one of her boys over-ate. Make sure you supervise what your child is eating at parties. 

If you have a young baby, be careful not to put yourself in a situation where you lose control of your ability to protect the baby from germs.  Well-meaning family members love passing infants from person to person, smothering them with kisses along the way. Unfortunately, kisses can spread cold and flu germs, as well as stomach virus germs.

On the flip side, there are some family events, such as having your 95-year-old grandfather meet your baby for the first time, that are once in a lifetime. While you should be cautious on behalf of your child, you can balance caution while looking at the whole context of a situation before deciding whether or not to attend a gathering.

Once you have children, their needs come before yours. (Of course there is a healthy balance-but that is a talk for another day.) Although you have anticipated a holiday reunion, your child may be too young to remember it.  An ill, overtired child makes everyone miserable.  If your child has a cold, is tired, won’t use the unfamiliar bathroom, has eaten too many cookies and has a belly ache, and is in general crying, clingy, and miserable, just leave the party. You can console yourself that when your child is older his actions at that gathering may be the stuff of legends, or at least will make for a funny story. 

For the allergic families- think twice before you drag in a live Christmas tree into your house.  The trees are often covered in dust and mud.  Washing the tree off with a hose in the driveway will keep the sneezing down to a minimum.  Every year Dr. Lai tells families about rinsing off the tree in the driveway. Most parents dismiss the idea as too time consuming.  However, she is pleased to report that a family recently told her they did rinse the tree and it did help keep the allergens at bay.

No one else baby proofs.  Remember this when you are on the road. We worry less in our own homes.  But with their medication pills lying on the end tables and their menorah candles within a toddler’s reach, other people’s homes should make us more cautious.  One year at holiday time Dr. Lai’s family was in a hotel room and her six year old came running up saying “look what I found”…It was a pill of Viagra. 

We wish you all the best this holiday season.

Julie Kardos, MD and Naline Lai, MD
©2009 Two Peds in a Pod®

I’ve heard some interesting things about milk over the years. I am going to share with you three myths about milk that  I heard when I was a kid and I still hear from my patients’ parents.

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

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 is not eating while he is sick, at least he 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 protein, pour it into a blender, and make a nourishing milk shake for your febrile child. Children with fevers need extra hydration. 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, I advise sticking to clear fluids until his 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 any of 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. The recommended daily intake of  Vitamin D was increased recently to 400 IU (International Units).  This amount translates into 32 ounces of milk daily.  But, we pediatricians know that over 24 ounces of milk daily leads to iron deficiency anemia because calcium competes with iron absorption from foods. 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 excessive amounts of milk is bad for teeth (all milk contains sugar).  Extra milk can also lead to obesity from increased calories. Ironically, too much can also lead to poor weight gain in children who are picky eaters.  The milk will fill them up, leaving them without an appetite for food.

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

Julie Kardos, MD

Saturday morning at my home this past weekend. Three sets of misplaced shin guards. Three new coaches to remember. Three kids running in different directions.  And nearly forgotten as we fly out the door… three water bottles.  Forget the balls, forget the money for pictures, even forget the coaches’ names. But even in this beautiful cool autumn air, don’t forget the water bottles to help hydrate your kid.

We are all accustomed to reminding our children to hydrate well during summer sports, but when the weather grows cooler we sometimes let our guard down. Because thirst does not always correlate with dehydration,  children often misjudge their own hydration status. Teach your children to recognize  headache and nausea as one of the first symptoms of dehydration. If  they “just don’t feel right ,” take a break.

Don’t depend on the coach.  Learn to recognize when your child needs to rest and hydrate.  A mother I met at field hockey Saturday says she can always tell if one of her girls needs a break because a subtle white ring appears around her mouth.

For hydration outside of sports, the best liquids for kids over two years old are skim milk and water.  Reserve juice for constipated children or the picky eater who will not eat fruit.  Even then, limit juice to once a day.  Consumption of sweet beverages multiple times a day encourages a sweet tooth and gives only empty calories.  Also, even juice diluted with water has the power to decay teeth- just ask my nephew who had over ten cavities filled two days ago.

Drink water up to half an hour prior to a sports activity.  For young children who only play for an hour or so, water is a good choice for hydration.  Enforce drinking approximately every 20 minutes.   For the more competitive players who churn up a sweat, electrolyte replenishers such as Gatorade and Powerade  become important. After 20-30 minutes of sweating, a body can lose salt and sugar. At that point, switch to rehydration with electrolyte replenishers. My sister, an Emergency Medicine doctor, tells the story of a young woman played ultimate frisbee all day, and lost a large amount of salt through  sweating.  Because she also drank large amounts of water, she “diluted” the salt that was still in her blood and had a seizure.  If your child plays an early morning sport, start the hydration process the night before so that they don’t wake up already behind on fluids.

Avoid caffeine which is found in  some sodas, iced tea and many energy drinks. Caffeine tends to dehydrate. Alcohol also dehydrates (think of the copious amount of fluid lost in urine after consumption of beer).

So, before your kid’s next sports activity, remember the helmet, remember the shin guards, remember the padding and remember one of the most protective pieces of equipment  of all – the water bottle.

Naline Lai, MD and Julie Kardos, MD
Updated June 3, 2012, Two Peds in a Pod®

It is one week before the start of school and I watch as my daughter’s sixth grade teacher stabs an onion with a needle.It’s a back to school ritual for my family with food allergies.Usually a piece of fruit is a proxy for my daughter’s thigh, and the needle contains epinephrine, a potentially life saving medication that my daughter would need if she were to eat a cashew.

Two of my children are part of a growing number of people with food allergies. According to the Food Allergy & Anaphylaxis Network, an estimated 11 million Americans have a food allergy. Despite the numbers, the etiology of food allergies remains a mystery. One of the most popular theories is that a child develops a sensitivity when the gut is exposed to a bit of the offending food during an unknown critical time in development–perhaps even in- utero, or before birth. My son had an allergic reaction to peanuts at eight months of age without ever ingesting a peanut. He had been touched by an unwashed hand that had just handled peanuts.

To add to the confusion, experts wonder if there is a relationship between allergies and how food is processed.In China, despite an abundance of peanut containing entrees, relatively few people are allergic to peanuts. It is postulated that the smaller number is somehow connected to the fact that most peanuts are boiled not roasted. Strangely, only eight categories of food: milk egg, soy, peanut, tree nut (i.e. cashews and pecans), fish, wheat and shellfish cause ninety percent of allergic reactions.

Reactions can range widely from a single, pesky, itchy welt to a choking off of all airway passages. The type of suffocation that occurs can be impossible to treat, even with a respirator. The medication which can thwart allergic reactions, epinephrine, is available in a portable form. Yet one study showed that even after medical evaluation, epinephrine was prescribed to only half of children and less than one quarter of adults with nut allergies. More distressing, as a pediatrician, I find families fail to recognize the symptoms of respiratory distress and do not realize the urgency of the situation. Even when respiratory symptoms are obvious, families are sometimes too panicked to think clearly. I know of cases of parents who injected the medicine into their own fingers rather than into their child.

Unfortunately, even epinephrine can not always stop catastrophic consequences. The only real treatment is avoidance.  This can be tough in a world where many confuse food allergies with a personal choice—like a person who chooses to be a vegetarian. Adding to the confusion is the mistaken belief that food intolerance is synonymous with food allergy. For instance, in milk intolerance, people have difficulty digesting the sugar in cow’s milk, whereas people with a milk allergy are reacting to the protein in cow’s milk.

Watching an allergic person eat at a restaurant is like watching a person eat Japanese puffer fish- every bite could be lethal. It took only one cashew to cause my daughter to break out in hives, vomit and experience a tightening of her throat. During my first two weeks of college, I remember a  freshman at my college dying  because of peanut butter hidden as “the special thickening ingredient” in a restaurant’s chili.

Perils are everywhere. A milk allergic person worries if a meat slicer has been previously used for cheese, the fish allergic individual needs to worry about Worcestershire sauce because it often contains anchovies and the egg allergic person needs to be suspicious of foamy toppings on specialty drinks. In my pediatric practice, one of my patients, a peanut-allergic girl, started wheezing simply because the child next to her in the car opened up a bag of peanut butter filled snacks.

Despite the sometimes small amount of an allergen required to set off an allergic reaction, one study showed that at least the major allergen in peanuts is relatively easy to clean from hands with simple soap and water. Common household cleaning products remove the allergen from counter and table tops. But kids, especially toddlers, are not known for their meticulous sanitation practices. Schools and daycare centers often find keeping an entire classroom free of an offensive food easier than keeping kids from touching each other.

So when that letter comes home this fall identifying someone in your child’s class with a food allergy, don’t moan and groan. Abstain from sending in potentially allergenic foods with your child. Imagine sending your children to school knowing that a well meaning friend might try to share a deadly snack. Like the millions of allergic Americans, your picky eater could learn to modify his or her diet. Our family went from eating daily peanut butter and jelly sandwiches to becoming a nut free home. What is an inconvenience to you may save a kid’s life.

Naline Lai, MD and Julie Kardos, MD
©2009 Two Peds in a Pod®

For more info:
Food Allergy, Asthma and Anaphylaxis Network =”http://www.kidswithfoodallergies.org”
an online  resource and discussion group 

References:
Distribution of Peanut Allergen in the Environment
Perry TT et al J Allergy and Clinical Immunology 2004;113:973-976

Prevalence of Peanut and Tree Nut allergy In the United States Determined By Means of A Random Digit Dial Telephone Survey: A 5 Year Follow-Up Study
Sicherer S. et al. Journal of Clinical Immunology 2003;112:203-1207