Monday, April 21, 2014
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POSTED: Tuesday, April 8, 2014, 5:30 AM
Filed Under: Beth Wallace | Nutrition | Tips

Whether your child has a sweet tooth or not, parents often have questions about sugar. Sugar is a type of carbohydrate that the body uses as a source of energy. Some foods naturally contain sugar like fruit (fructose) and dairy (lactose).

Added sugars are the biggest dietary concern because excessive intake of sugar can cause unnecessary weight gain. In children, early excessive weight gain can lead to type 2 diabetes and other adult-type conditions like high triglycerides. 

In recent years, there seems to be a growing list of sweetening options available on grocery store shelves, but here are 5 things you really need to know.

  1. Your child’s body doesn’t know the difference between all of those added sugars.  Whether it’s honey, cane sugar, or plain old white granulated, your child’s body will use each source for energy, and store the excess as fat.  There are some specific medical situations when a child’s body can’t tolerate a certain kind of sugar (fructose or lactose intolerances), but most often, the body won’t differentiate the rest.
  2. Know your sugar terminology.  All of the following are added sugars that can be found in the ingredient list.  Remember, no one is particularly better (or worse) for your child:  Corn syrup, Cane sugar, fruit juice concentrate, honey, agave, sucrose, molasses, maple sugar, brown sugar, and raw sugar. 
  3. Other than sweetened beverages, breakfast is one of meals highest in added sugar.  Sweetened breakfast cereals, breakfast pastries, muffins, jelly, syrup…all are common sources of sugar in a child’s diet.  If one of these items is on the menu, consider making some adjustments in the snacks and other meals for the day to balance the diet.  
  4. The food label does not distinguish between added and naturally occurring sugars.  In order to get an idea about how much added sugar the product contains, look at the ingredient list.  Ingredients are listed by weight, so the earliest items in the list are the major components of the product. If sugar or a sweetening product is one of the first three ingredients, leave it on the shelf.
  5. Don’t be fooled by manufacturer’s labels. Recently, companies have started to make their own claims on product packages, but these claims are not often regulated.  Just because the manufacturer tells you it’s a good choice, doesn’t mean it would meet your requirements for a healthy item. Always check the ingredients.
A child’s consumption of sugar sweetened foods and beverages is particularly concerning because these foods may take the place of more healthy foods needed for growth and development. Trying to limit the added sugar in your child’s diet to zero may be impossible, but this is  one true instance where moderation is the golden rule.

POSTED: Wednesday, April 2, 2014, 5:30 AM

In my clinical practice, I specialize in treating children with selective eating disorder (aka Avoidant/Restrictive Food Intake Disorder).  In a recent post, I addressed the question of whether picky eating is harmful.  The short answer was “yes:” prolonged picky eating compromises a child’s nutrition, inhibits their ability to eat like their peers at social and school events, and generally makes mealtimes a battleground (harmful to family harmony, not to mention parental sanity).

The following are my recommendations to help your picky eater.  They are probably most appropriate for kids aged 5 to 10, the age group that I generally treat. The list assumes that you have already seen a physician to rule out any medical cause for the picky eating, such as swallowing difficulties or gastro-intestinal problems.

  1. Believe that your child is capable of eating just about any food.  That extreme distress he displays whenever there’s pressure to try a new or nonpreferred food?  It is not the result of a physical or psychological incapability. Rather, it is the result of years of avoidance. A basic rule of the brain is this: The longer something is avoided, the more distressing and impossible it seems. This goes for just about anything, from completing a big homework assignment, to starting a complicated project at work, to calling someone up and asking for a date.  It’s also true for a food.
  2. What’s needed, then, is repeated exposure to foods until your child habituates to them.  Habituation is just a fancy word for “learned safety” or “the brain gets used to it.”  Research has shown that young children need an average of 8 to 15 exposures to habituate to and accept a new food.  Unfortunately, how many times do most parents offer a food before deciding their child will never like it? Just 3-5
  3. For the picky eater, exposure means tasting and swallowing the food.  It does not, in this case, mean merely having the food on the plate, looking at it, touching it, or smelling it.
  4. You are no doubt wondering, “But how do I get my kid to swallow it?”  Answer: By making it worth his while. Plenty of research confirms that kids will eat nonpreferred foods for rewards.  In my experience, the easiest and most motivating reward is access to screen time after a meal.
  5. Establish a consistent pattern, such as requiring your child to taste and swallow a new or nonpreferred food each night at dinner. Start with very small bites and then work up to larger and larger amounts as your child gets over the initial days of distress and comes to accept that a nightly “challenge food” is just another dreary fact of daily life.  
  6. Many desperate parents have tried telling their children that they can’t leave the table until they have eaten a nonpreferred food. In my experience, this leads to a child who sits at the table for hours, whining loudly and often.  My recommendation is to require that he eats that nightly challenge food within the first 5 minutes of a meal. Go ahead and set a timer. The 5-minute rule means he gets it over with right at the start of the meal and then everybody can relax.
  7. Reward successes and mostly ignore failures. He eats the nightly challenge food = lots of praise and access to rewards/privileges. He doesn’t = “No screentime for the rest of the night, but I know you can do it tomorrow” said once, with sincerity and optimism.
  8. Don’t worry about rewarding or restricting privileges based on eating: There are no credible, converging lines of scientific evidence that doing so causes eating disorders or self-esteem problems.  Think about it: parents require their children do things they don’t want to do for their own good all the time (teeth brushing, taking a bath, getting homework done).  That’s called good parenting. Why should it be any different when it comes to insisting your child eat a varied and healthful diet?
  9. Remember, this will not happen overnight.  It will not happen over many nights. It will happen over many months – so be patient.  With enough successful exposures, your child will eventually habituate to enough foods that his diet is greatly expanded and mealtimes are a peaceful experience for everyone.

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POSTED: Monday, March 17, 2014, 5:30 AM
Filed Under: Nutrition

Today's guest blogger is George Matysik, the director of governmental affairs and public policy for Philabundance.

At Philabundance, the Delaware Valley’s largest hunger relief organization, we see the reality of hunger every day. Between the severe economic recession and the recent cuts to SNAP (Supplemental Nutrition Assistance Program, also known as Food Stamp), it’s harder than ever for many Philadelphia families to put food on the table.

When hunger strikes, children are among the hardest hit. 

American youth are facing a hunger crisis. In 2011, 22.3 percent of Philadelphia children were food insecure, according to statistics from Feeding America, the nation’s largest domestic hunger relief charity. That’s more than 1 out of every 5 kids. In other words, in a classroom of 25 students, five of them may not have had breakfast that morning and may not have a nutritious meal waiting for them when they get home.
POSTED: Thursday, February 20, 2014, 5:30 AM
Picky eating can be inconvenient, annoying, and worrisome, but is it actually harmful to your child?  That depends on how long it lasts and its severity. Most children tend to go through a vexing icky-picky phase when they are toddlers – that’s developmentally normal. What’s also developmentally normal is that children gradually come out of this phase and expand their diet beginning in the late preschool/early kindergarten years and then continue to diversify the range of foods they eat comfortably and enthusiastically into adulthood. 

By contrast, long-term picky eaters continue to eat food similar to the color of bride dresses, favoring variations on the theme of white, cream and beige (e.g., cereal, bagels, chicken nuggets, and plain buttered noodles). They are highly reluctant to try new foods, rigidly brand loyal, and uncommonly (often hysterically) sensitive to changes in the appearance, quality, or quantity of a preferred food.

Prolonged picky eating becomes unsafe in several ways.  First, a diet of soft, carbohydrate-based finger foods is naturally lacking in the vitamins and minerals that derive from a diverse diet, which leads to nutritional compromise even if the child remains normal weight

POSTED: Monday, February 10, 2014, 1:00 AM
Filed Under: Beth Wallace | Nutrition

I will be honest with you. I’m not a really productive member of society until I’ve had 16 ounces of coffee. As adults, some of us have a caffeine fix the morning. But should we be concerned that kids are trending towards a serious caffeine addiction with a Starbucks on every corner and a convenience store full of energy drinks?

A new study from Pediatrics released online today evaluated the trends on caffeine intake in American children and adolescents.  Surprisingly, the average caffeine intake hasn’t increased in the last decade. The study found that 63 percent of toddlers and preschool children, and almost 75 percent of older children consumed caffeine daily.  While the overall amount of caffeine intake didn’t change significantly, the sources of caffeine did.  The study reported that the intake of caffeine in children’s diets has decreased from soda, but increased through energy drinks and coffee drinks.  Intake from tea remains the second highest source of caffeine. 

So the big question…is caffeine safe for kids?  Caffeine is a drug found naturally in some plants (think coffee beans and tea leaves), and added to many other drinks (those neon-colored energy drinks).  The myths were dispelled about caffeine intake stunting growth, but the experts still say the answer is a big “no.”  The American Academy of Pediatrics discourages the consumption of caffeine for all children in adolescents, and the United States has no guidance on the amount of caffeine that is safe for children. 

POSTED: Thursday, January 30, 2014, 5:30 AM
Filed Under: Beth Wallace | Nutrition | Tips

Doesn’t it seem like one of the fastest growing nutrition product markets has been the “milk” industry in the past five years? I am 100 percent confident that in my childhood, I never saw a commercial for almond milk.

No longer do parents walk into the grocery store and choose between skim and 2 percent milks. Now there are so many options ranging from organic and lactose free to non-animal derived sources like almond or rice milk. The variety has become slightly overwhelming. With growing concerns about allergies and the safety of our food sources, parents are left staring at the refrigerated section wondering which milk is best for their families. 

It is important to be an informed consumer when choosing a milk product in order to maximize the vitamins and minerals in your child’s diet.  First things first, you should know what nutrients are important to compare in each of these items.  Historically, traditional cow’s milk has been a major source of protein, calcium, and vitamin D for children over the age of 1, and the American Academy of Pediatrics continues to recommend transition to whole milk (and in some cases 2 percent) for children between the ages of 1 and 2 years old.

POSTED: Wednesday, January 8, 2014, 5:30 AM

There has been a great deal of news lately about the need, or lack thereof, for vitamin supplements. The latest research tells us that most dietary supplements don’t show benefit and in high doses, could be harmful.  Bear in mind that this recent information pertains to adults, who are advised to get the vitamins and nutrients that they need from the foods they eat.

Growing children may benefit from vitamin supplements if they don’t get the recommended daily allowances (RDA) of nutrients from their food. Vitamin D is important for bone health because it aids in the absorption of calcium. You can find it abundantly in foods such as fish, eggs and milk. When kids eat the right foods and get some daily exposure to sunlight, they shouldn’t be deficient in Vitamin D. (It’s a complex process, but basically, sunlight is a catalyst that stimulates the syntheses of Vitamin D from cholesterol in the body.)

The current guidelines from the American Academy of Pediatrics for Vitamin D call for a minimum of:

  • Ages 1-7: 600 IUs daily (IU = International Unit)
  • Age 7 and up:  800 IUs daily
POSTED: Tuesday, January 7, 2014, 5:30 AM
Filed Under: Beth Wallace | Nutrition
A quarter for a carrot? (iStockphoto)

Parents have tried it all when it comes to getting their children to eat vegetables, and it seems that there is no end to their creativity. After making them into fries, hiding them in desserts, and sometimes begging for their consumption, it seems like there is no consistent way to ensure that your children are eating the recommended 1 to 3 cups of fresh vegetables daily to provide the necessary nutrients for their growing bodies.

A recent study from Brigham Young University and Cornell in Public Health Nutrition took a bit of a creative risk in finding a solution to the lack of veggie consumption by paying children to eat their vegetables. Yes, literally paying children. The study, aimed to determine if children would be motivated to eat more of the vegetables designated by the new federal school lunch regulations, offered children a nickel, quarter, or a raffle ticket towards a larger prize if they consumed the vegetables served to them.

Research suggests that a new federal rule has prompted the nation’s schools to serve an extra $5.4 million worth of fruits and vegetables each day, but it's also been found that about $3.8 million of that ends up in the garbage daily. The authors found that the small rewards induced big results: it increased vegetable consumption by 80 percent, and reduced waste by 33 percent. 

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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