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A few weeks back we asked our customers to send in their questions that they had for Dr. Shawna Silver, Paediatrician with Sick Kids hospital. Here are the responses.
1. What are the best first solid foods to introduce to your baby? There are
so many conflicting opinions out there - allergens, meat, cereal, etc. I prefer
NOT to feed my baby cereal because I like to stick with 'real' food, so I've
been making and pureeing things like beef stew, chicken, tilapia, eggs. How can
I ensure she's getting enough iron, and which foods are healthiest for her? Are
there any vegetables or fruits I should be avoiding at this point? I've only
given her a couple fruits because I want her to accept vegetables into her diet
first.
There are many considerations when
starting to introduce solid foods to your daughter. No matter what foods you introduce, you want
to make the experience enjoyable for her.
At six months or so, the purpose of solid foods is to get iron-rich
foods into the diet and to start introducing her to different tastes and
textures. She won’t be taking enough
solids for them to be a large proportion of her nutrition. Iron rich foods include meats, meat
alternatives (eggs, tofu and legumes) and iron-fortified infant cereals. All of these would be good options for your
daughter. Not only are fruits sweeter
but they also have a stronger flavor than vegetables. That is why some families choose to introduce
vegetables before fruits. The texture of
the food is also very important. New
feeders still have a strong gag reflex and can choke easily. Their first foods should be very smooth and
almost dribble off the spoon. As they
get more used to this texture, foods can be made thicker and then eventually
more lumpy. It will be very important
over time to get your daughter to try different textures, but only when she is
ready. No matter what you choose, have
fun and don’t sweat about the mess!
The AboutKidsHealth
website features a handy guide to introducing solid foods to your infant that
you can print and have in the kitchen to give you some ideas during meal
preparation.
2. When it comes to starting infants on
solid foods, I have been lead to believe there are two schools of thought. One
camp seems to feel that waiting until at least 6 mos of age and then gradually
introducing certain foods will help prevent common food allergies from
developing and the other which argues for an earlier introduction in order to
prevent the same issue.
Do you have an opinion on this topic
and can you discuss if from a medical standpoint there is a role for probiotics
in an infants diet?
You are correct – there were two schools
of thought. Initially, food introduction
guidelines created by the United States, Europe, Australia and Canada,
suggested delaying solid foods, especially highly allergenic foods, beyond six
months of age in order to prevent allergy.
However, recently, the United States, Europe and Australia have changed
their advice on food introduction in high-risk infants and dietary exposures
during pregnancy, lactation and early infancy.
A high-risk infant is considered an infant who has at least one parent
or sibling with an allergic condition such as eczema, food allergy, asthma or
allergic rhinitis. This new advice can
also be applied to infants not at high risk for food allergy.
In terms of maternal diet and
breastfeeding, avoiding allergenic foods such as milk, egg or peanut does not
prevent allergy and puts mom at risk of undernutrition. Breastfeeding duration
seems to have more of an impact on allergy reduction than exclusive
breastfeeding for the first six months.
Introducing solid foods at or around six months of age improves iron
stores and is associated with decreased rates of allergic conditions.
In terms of the introduction of solid
foods, preliminary evidence is suggesting that delaying certain foods does not
prevent allergy and may actually promote the development of food allergy and
other allergic conditions. Different
studies looking into early versus late introduction of wheat, eggs, fish and
peanuts have found that delaying introduction of these foods was associated
with a higher risk of allergic disease. However,
more research is needed on the early introduction (less than six months) of
specific foods to prevent allergy. Uncertainty
will remain about early introduction until additional studies are completed. Therefore, do not delay the introduction of
any specific solid food beyond six months of age.
Probiotics are live micro-organisms that
can be beneficial when consumed in adequate amounts and in specific situations. Probiotics can modify the gut microflora by
enhancing the gut barrier, producing anti-toxins and likely have a role in the
immune system. Different probiotic
strains have different biological activities.
Probiotics have been studied for the prevention of atopic and allergic
diseases.
One theory suggests that increased
permeability in the gut barrier may contribute to higher rates of food
allergies. Lower counts of specific
‘good’ bacteria have been found in the guts of children with eczema than
children without eczema. In some
studies, treating children with eczema with lactobacilli has improved their gut
barrier. However, while the gut barrier
improves, these studies and others have failed to show that giving probiotics
prevents allergic disease or food hypersensitivity.
If you are considering using probiotics,
ensure that you are using the appropriate strain studied for the specific
disease.
3. My son is 22 months old - turning 2 in June. At 15 months of age we
stopped giving him homogenized milk from a bottle after learning it was bad for
his teeth. He used to love drinking milkfrom a bottle, but since we've switched
to cup, he won't drink it at all. We've tried all different types of cups. I'm
concerned he's not getting enough calcium. He does like milk in cereal, yogurt,
and cheese. What can I do to get him to start drinking milk? Should I be
concerned?
According to the Canada Food Guide,
children 2-3 years of age need 2 servings of milk and alternatives every day in
order to get their required calcium. A
serving would be a cup of yogurt or an ounce of cheese (one adult finger). You can offer a serving in a smoothie or milk
popsicles. You can try adding milk,
fortified soy beverages or skim milk powder to other foods you are making such
as cereals, soups or casseroles. It
sounds like he is getting enough through the other foods he is eating.
If you are still concerned, you can try
changing the temperature of the milk in the cup. Perhaps he prefers it warmer or cooler. You can also try using a cup with a straw. Will he drink other fluids with a cup? Cup skills are essential so it will be very
important that he learns how to do this over time.
4. My 21 month old son was always been a wonderful eater. Suddenly the last
couple of weeks he has become a very picky eater. He has been refusing meals
without taking any bites (just looks at it & shakes his head), refusing
past favourites items & even refusing snacks that he used to love. I'm at a
total lost! I've run out of ideas to get him to eat. He's basically living only
on whole milk right now for all three meals. Help!
As an infant grows into a toddler, their
weight gain slows down and there is a decrease in appetite. At the same time, toddlers are trying to
develop a sense of autonomy. They prefer
self-feeding and become more ‘selective’ (or picky!) in their choice of foods. If they feel too much pressure, they may
resist eating as their way of trying to assert their need for autonomy. Food intake may fluctuate considerably from
day to day. As long as they are able to
maintain stable growth, then you should not be concerned.
Toddler’s food preferences are
unpredictable. Their favourite food one
day will end up being thrown on the floor the next day. It is not uncommon for toddlers to eat the
same 1 or 2 favourite foods and nothing else for a few weeks and then switch to
totally different foods. The important
part is for you to continue offering healthy food choices and accept that his
appetite and food preferences change considerably over time. If healthy food choices are always being
offered, he will make sure that he is getting enough nutrients over time, even
if it does not feel that way for you on a day to day basis.
Mealtime should be an enjoyable and
pleasurable experience. Toddlers value
the company of their family at mealtimes and a family meal gives the toddler
the opportunity to learn through imitation.
According to the Canadian Pediatric Society, “A toddler’s time at the
table should generally be limited to 20 minutes. When mealtime is over, all food should be
removed and only be offered again at the next planned meal or snack. It is unlikely that the subsequent meal will
be refused”. Your son may have learned
that if he refuses his food, he will get milk which tastes good and fills him
up quickly. Too much milk may suppress
his appetite which may impact the next snack or meal. I would suggest no longer offering him milk
after he has refused a meal or snack.
This is much harder to do at the moment but as long as your son is
growing well, he is getting enough to eat.
Here is some more information from the
AboutKidsHealth website on appetite slumps in toddlers. http://www.aboutkidshealth.ca/En/HealthAZ/HealthandWellness/Nutrition/Pages/Appetite-Slump-in-Toddlers.aspx.
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