Pediatric Nutrition

At Pediatrics & Adolescents Clinic, we prioritize the nutritional well-being of your child. During the initial year of life, we provide comprehensive guidance, assisting both you and your child in the transition from the introduction of solids and finger foods to a diet resembling that of adults. Throughout the subsequent years and during routine well-child examinations, we engage in conversations about your child's dietary habits, ensuring that they maintain a healthy and balanced dietary lifestyle. We firmly believe that instilling healthy eating habits from a young age not only fosters sound decision-making as adolescents and adults but also promotes lifelong health.

Breast Milk and Formula The arrival of your newborn is a momentous occasion, and we extend our heartfelt congratulations. The decision to breastfeed or use formula is a profound one, often reflecting much contemplation and consideration on the part of parents. At Pediatrics & Adolescents Clinic, we unequivocally endorse and respect the well-documented advantages of breastfeeding and the entire breastfeeding experience. Simultaneously, we acknowledge that unique circumstances may necessitate formula feeding, and we wholeheartedly honor and support this choice. Whether you choose breastfeeding or formula feeding, please rest assured that your decision will be met with unwavering respect and support by our dedicated team. If you opt for breastfeeding, we offer a wealth of advice and share our experience. Moreover, we can connect you with experienced lactation consultants if the need arises. For parents opting for formula feeding, we understand the multitude of choices available and will guide you in selecting the most suitable formula for your child. Our primary goal is to ensure that your child is thriving, eating well, and achieving healthy weight gain, alleviating any stress surrounding the experience of feeding newborns and infants.

Your Baby's Weight The early stages of newborn and infant life often trigger parental concerns about weight gain. While reassurance is an integral component of our well-child care visits, certain general principles may provide insight for many parents:

• In the first 24 hours, most newborns experience a weight loss of 2-3 ounces. Remarkably, a newborn's loss of approximately 10% of their birth weight within the initial days of life is considered normal.
• Key indicators that your newborn is consuming sufficient nourishment include regular bowel movements and contentment within 2-3 hours following each feeding, translating to approximately 8-12 feedings per day.
• Once the breastfeeding or formula feeding process is well-established, daily weight gain typically ranges between ½-1 ounce.
• Growth spurts, which are often observed around the 3rd, 6th, and 9th weeks of age, may cause increased hunger, leading to more frequent feedings.
• Babies typically double their birth weight by around 4-5 months and triple it by the time they reach 12 months of age.

In cases where concerns about inadequate weight gain arise, particularly in breastfed infants, we offer guidance on increasing maternal milk supply. Strategies may include suggestions such as consuming fenugreek tea, maintaining proper hydration, using a breast pump to stimulate milk production, and consulting a lactation specialist for an assessment of the breastfeeding process. If all avenues are explored, and weight gain remains a concern without any underlying medical issues, supplementing with formula or caloric additives to breast milk may be considered as an option.

Milk Protein and Other Food/Protein Allergies Although not explicitly mentioned in the preceding title, the discussion pertains to food or food protein allergies that children may encounter during their first year of life. While the concept may initially appear intricate, there is a notable occurrence of certain components in breast milk or milk-based formula that can elicit allergic responses in infants. This phenomenon is not uncommon. Allergic symptoms may manifest as heightened fussiness, increased gas, elevated instances of spit-up, which can initially make it challenging to distinguish from reflux or gastroesophageal reflux disease (GERD). Additionally, stool consistency may appear greenish and mucousy, and a specific rash may emerge on the face, upper chest, and back region. Heightened nasal congestion may also be observed.

The primary food proteins responsible for these allergies encompass milk, soy, egg, nuts/peanuts, and wheat. Allergies may involve any one of these food groups or even all of them. It is important to note that it may take several weeks for an allergy to become evident. Thus, it is advisable not to promptly eliminate these foods immediately after birth. Parents who are breastfeeding may become suspicious if their child exhibits significant discomfort and other aforementioned symptoms a few hours after consuming a specific meal or food group. In such cases, we often request a sample of the baby's stools, which can be conveniently sealed in a zip-lock bag. Subsequently, a simple in-office test can be conducted to detect trace amounts of blood. If the test returns positive, a plan is formulated to pinpoint the specific food responsible for the allergy by excluding certain foods from the breastfeeding mother's diet.

The question that weighs on every parent's mind is whether these allergies will persist. In most instances, children tend to outgrow these allergies before the conclusion of their first year of life.

Introduction of Solid Foods Around the age of 4-6 months, infants may begin to show a growing interest in the foods that adults consume. This fascination is often discerned when infants reach out for items such as toast or closely watch their parents enjoy their meals. This is the opportune moment to commence introducing solid foods. However, it is important to acknowledge the flexibility in this timeline, as some infants may exhibit readiness at four months, while others may prefer to wait until six months. As parents, you will be the best judges of when the right time has arrived to initiate the introduction of solid foods.

The question that naturally arises pertains to the choice of solid foods. It is pertinent to clarify that the guidelines for introducing solid foods may evolve over time. Presently, the approach is straightforward and rests on one essential guideline—introduce one new food every 3-4 days. This approach is crucial because it allows for the identification of the cause in the event of a reaction, such as a skin rash, vomiting, diarrhea, or heightened fussiness. The ability to discern which specific food triggered the reaction would be challenging if multiple foods were introduced simultaneously.

Typically, during the 4-month well-child visit, a comprehensive discussion takes place on the introduction of solid foods. This includes the commencement of iron-enriched baby cereal—options include rice, barley, or oatmeal. Each type is introduced for 3-4 days, and it can be incorporated into the diet 1-2 times a day, mixed with either breast milk, formula, or water. After this initial phase, parents can select their child's preferred cereal and continue offering it 1-2 times daily. Subsequently, the introduction of pureed vegetables and fruits, particularly those with a stage one consistency, begins. Parents are encouraged to create homemade pureed foods. Nevertheless, it is imperative to ensure that freshly cooked foods are adequately pureed, avoiding excessively chunky textures. It is advisable to peel root vegetables and foods that grow close to the ground to minimize the risk of contamination from soil spores and nitrite accumulation.

Approximately two months into the process, infants are likely to consume several meals a day. For instance, a cereal with fruit, chosen from a selection, may be offered in the morning, followed by a vegetable, again selected from a range of options, and another fruit sometime later in the day. And remember, this is to be a positive experience, so keep it fun. Each of us may vary in our advice as to how frequently to feed your baby, so there are no hard or fast rules here.

Advancing Solid Foods After conquering the stage one pureed veggies and fruits, it's time to move on to the stage two and three pureed foods. Again, it's great to make your own, but it might be worthwhile to buy a jar just to get a sense of what the consistency should be. At around 7-8 months, when your baby is able to rake food into his/her hand and fingers, and has lots of active jaw movement, it's okay to start finger foods — Cheerios, puffs, Gerber wheels, and soft pieces of fruit (banana, avocado). Shortly after, it is okay to start some yogurt and other pasteurized dairy (cheese and cottage cheese). Regular milk as a primary beverage, however, is not introduced until 1 year of age.

Teen Nutrition During the teen years, growth is very rapid, and the requirements for nutrients increase to keep up with this growth spurt. This is especially true of calcium and iron, so it’s important for teens to increase their calcium intake for their lifetime bone health and to eat adequate amounts of high-iron foods to prevent anemia, fatigue, and weakness. Teens’ pubertal growth accounts for about 20% of their final adult height and 50% of their adult body weight.

Since eating habits are pretty well set by now, it may be challenging to change these less than desirable habits. One way to influence teen dietary changes is to inform your teen about the short-term consequences of a poor diet: which can include a decrease in athletic ability, poor appearance, and lack of energy, which may lead to an inability to enjoy life.

One way for teens to lead healthy lifestyles is to have regular family meal times. Although it may become more difficult as children become teenagers, it is still very important to schedule family meal times in order to avoid such problems as obesity, inadequate nutrition, and eating disorders in adolescence. Even if parents are able to schedule a few family meals a week, this will go a long way in assuring that their teen’s health is optimal.

In one recent study, the frequency of how many meals a week teens ate with their families was shown to have an effect on decreasing the teens’ chances of disordered eating. When teens eat meals with their families, parents are able to recognize early signs of disordered eating and take steps to work through it before it becomes a bigger problem.

Another area where nutrition is important is sports performance. Since many teenagers are involved in sports during their high school years, understanding the basics of a healthy diet is a necessity, and achieving good nutrition is essential in maximizing their athletic performance.

As adolescence is the last stage before adulthood, parents have one last chance to influence their teens' eating habits and contribute to a lifetime of healthy habits.

Nutrition professionals such as registered dietitians are available to assist in the nutrition care of teens.

The following links offer some basic teen nutrition information:

• HealthyChildren.org
• KidsHealth.org