Sun and Water Safety: Don’t take risks. Follow these tips.

Memorial Day signifies the start of summer, the opening of pools and trips to the beach. Regardless of where you’ll be outside or around water, it’s always important to be safe. Make sun and water safety a priority! Bug safety will be covered separately in a future post.

Safe in the sun!

Keep kids safe in the sun with many methods, not just sunscreen.
Keep kids safe in the sun with many methods, not just sunscreen.

Protecting your child in the sun is very important. Make sure you understand how various sunscreens work, how they should be used, and what else you can do to protect your kids from the sun.

Infants under 6 months

Babies under 6 months of age should be kept out of the direct sunlight as much as possible.

Move your baby to the shade or under a tree, umbrella or the stroller canopy. Be careful near reflective surfaces, such as water. Shade may reduce UV exposure by only 50% if there’s reflected sun.

Dress them in lightweight but long sleeved clothing and wide brimmed hats to keep the sun off their skin.

It’s okay to apply sunscreen to small areas of the body that you cannot cover with clothing, such as face and hands.

Make sure infants stay hydrated in the heat. Do not give extra water to infants until they are on solid foods. Breastfeed more often or give extra formula to prevent dehydration.

Mineral vs chemical sunscreens

The sunscreen does not have to be baby specific, but chemical sunscreens are absorbed more than mineral sunscreens. One of the concerns of young infants using sunscreen is they absorb chemicals too much, so mineral sunscreens are preferred for them.

I think most things marketed for babies are really for parent’s piece of mind. They aren’t necessarily better for baby. And they can mark up the cost just because it says it’s for Baby. But one of my favorite sunscreen brands for babies – Blue Lizard – actually prices competitively for the baby product. I like this brand because it was developed in Australia to be used safely at all ages. All of their products are mineral based.

Mineral based products use zinc oxide and titanium dioxide to reflect sun rays. There is minimal absorption. The downsides are they are not as light on the skin and they can wash off when sweating or swimming.


Chemical sunscreens, on the other hand, are absorbed into the skin. They absorb the sun rays that enter the skin. These are best for older children who are exercising outdoors and swimmers since they do not wash off as easily.

What is SPF?

SPF= Sun Protection Factor

The SPF increases the time you can spend in the sun, depending on your skin type. If you would typically burn in 1 hour, an SPF of 15 will keep you from burning for 15 hours, if you reapply every 2 hours. If you would burn in 20 minutes, an SPF of 15 used every 2 hours would protect you 15 x 20 minutes, or 5 hours. This is why fairer skinned people need higher SPF levels.

The sun protection factor (SPF) should be at least 25 and should cover both UVA and UVB rays. The sooner your skin burns, the higher the SPF you should use.

How should sunscreen be used?

For all infants and children over 6 months, be generous with sunscreen. Apply sunscreen at least 30 minutes before going outside, reapply it every 1-2 hours if sweating or swimming (even if it states it is waterproof), and use sunscreen even on cloudy days. One full ounce should be used to cover an adult.

Reapply the sun screen every 1-2 hours.

Try to keep children out of the sun between 10:00 am and 4:00 pm, when the sun’s rays are strongest.

Clouds are not sufficiently protective against the sun. UV rays on cloudy days may be reduced by only 20% to 40%.

Does sunscreen cause cancer?

I don’t know why this is a popular question these days. Well, yes, I know why people question it. The rumor that chemicals in sunscreen are dangerous is commonly circulated online. That’s why it’s questioned, but I don’t know what started this rumor.

Sun causes cancer.

Sunscreens have been studied extensively and have been shown to be safe. Use them.

What about eyes?

We often neglect our eye health, but there are ways to prevent sun damage to our eyes. This sun damage can lead to cancer, cataracts, and growths in the eye.

Sunglasses should be used to protect the eyes from sun damage. Hats with wide brims also keep sun out of the eyes.

Be sure your sunglasses are rated to protect against UVA and UVB 100%. Darker glasses don’t offer more protection necessarily. They must be rated to protect against UVA/UVB.

Bigger frames are better. Especially the ones that wrap around the sides of the face.

Higher cost doesn’t mean better protection – look for the rating! Even inexpensive sunglasses can provide protection. This is good, since most of us need several pair due to them getting misplaced or broken – especially the ones for our kids!

For more on sunscreens:

SMART SUN PROTECTION: UNDERSTANDING THE BEST SUNSCREEN OPTIONS from Dr.Michelle Ramírez at Dream Vibrant Health.

Which Dermatologist-Approved Sunscreen You Should Use To Keep Your Skin Safe from Dr. Dhaval Bhanusali, a medical and cosmetic dermatologist

Sunscreen Safety: Is It Worth The Hassle? from Dr. Nidhi Kukreja at The Growing Parent.

Water

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How can I protect my child around water?

All parents should take a basic CPR course! Young children can drown in only a few inches of water, even if they’ve had swimming instruction.

Children who are swimming – even in a shallow toddler’s pool – should be watched closely. Even if there’s a lifeguard at the pool, there is too much to monitor when there’s a pool full of kids. You must watch your own kids until they’re strong swimmers.

It’s recommended that infants and toddlers have an adult within arm’s reach. For young children, you should continue to pay constant attention and be free from distractions. It’s easy to be distracted when talking to another person or checking your phone. Don’t consider it watching kids if you’re pool side reading a book.

Inflatable pools should be emptied and put away after each play session. (This also reduces unwanted mosquitoes!)

Enforce safety rules – no running near the pool and no pushing others underwater.

Water wings, tubes and other floating devices are not approved flotation devices and should be used only under direct and close supervision. Because they give a false sense of security, I don’t recommend them.

Be sure the deep and shallow ends of any pool your child swims in are clearly marked. Never allow your child to dive in the shallow end.

And then there are teens…

Talk to older kids and teens often about water safety. As they gain confidence in the water, they take more risks.

Teens are especially notorious for risk taking behaviors. Let them know your expectations. Teens might roll their eyes, but studies show they do best with rules and clear expectations from parents.

Of course they should not drink alcohol ever, but risks increase around water. They should never swim alone, even if they are captain of the swim team. If they are going to a river or lake, they need to be careful of inherit risks there, such as diving into shallow waters and boat safety.

As always, be sure you know where they’re going and when to expect them home. If they’re in water they won’t have a cell phone available at all times, so you might want to schedule “check in” times.

Drowning Risks

Drowning is a real risk. Dry drowning? Not so much.

Learn what distress in the water looks like. The movie depiction of drowning with a lot of yelling and thrashing around is not what usually happens.

If someone can verbalize that they’re okay, they probably are. Drowning victims can’t ask for help. There is a video linked to this page of what to look for with drowning that shows an actual rescue. From this site, signs of drowning:

  • Head low in the water, mouth at water level
  • Head tilted back with mouth open
  • Eyes glassy and empty, unable to focus
  • Eyes closed
  • Hair over forehead or eyes
  • Not using legs – Vertical
  • Hyperventilating or gasping
  • Trying to swim in a particular direction but not making headway
  • Trying to roll over on the back
  • Appear to be climbing an invisible ladder

What about swimming lessons?

The American Academy of Pediatrics does not recommend swimming lessons for children under one year of age because they cannot really learn skills to keep them safe.

Even young children who have had swimming lessons should not be unattended at the pool because they are not able to always make safe choices.

How can I protect my child around the backyard pool?

Inflatable pools should be emptied and put away after each play session. (This also reduces unwanted mosquitoes! Who wants mosquitoes in their backyard?)

If you have a swimming pool at home, it should be completely surrounded on 4 sides with a tall fence that has a self-locking gate. The house cannot serve as one side of the barrier. Keep the gate closed and locked at all times. Be sure your child cannot manipulate the lock or climb the fence.

If your pool has a cover, remove it completely before swimming. Never allow anyone to walk on the pool cover. Your child could fall through it and become trapped underneath.

Keep a safety ring with a rope beside the pool at all times. If possible, have a phone in the pool area with emergency numbers clearly marked.

Spas and hot tubs are dangerous for young children. They can easily drown or become overheated in them. Don’t allow young children to use them at all due to these risks. If older children use them, they should be supervised. Be sure they are well hydrated. After using a hot tub, be sure everyone showers. You don’t want hot tub folliculitis!

What about at the ocean or lake?

Talk to kids about the pull of undertow if you’re wading into the ocean. (If you don’t know what this is, walk into the water without your kids first.)

Use coast guard approved life preservers correctly whenever needed. All people should wear a life preserver when riding in a boat unless they are inside a cabin. Children should wear a life preserver when they are near the water’s edge or on a dock, even if the law doesn’t require it.

A life preserver fits properly if you can’t lift it off over your child’s head after he’s been fastened into it. For the child under age five, particularly the non-swimmer, it also should have a flotation collar to keep the head upright and the face out of the water.

Adults should not drink alcohol when they are swimming or boating. They are not only at risk of dehydration from the alcohol, but they also risk lives. It presents a danger for them as well as for any children they might be supervising. Don’t ruin a fun time with a tragedy.

Keep it fun in the sun!

Sun and water safety are not only important, but if you’re not careful, it can ruin a vacation. Practice sun and water safety every day!

 

Swollen eyelid causes and treatments

There are many causes of swollen eyelids in kids (and adults). The good news is that the most common ones are usually not serious. Some swellings herald warning though and should be properly evaluated and treated by a doctor.

Warning signs include vision changes, pain, protrusion of the eye, fever, difficulty breathing, abnormal eye movements (or loss of movement), foreign body that cannot be removed, or signs of anaphylaxis (swollen tongue or throat, difficulty breathing, hives). Any warning signs deserve prompt medical attention.

Allergies

Allergies can make the eyelids puffy due to the histamine reaction. This is usually accompanied by itching, red eyes that are watery. There can be circles under the eyes.

Treatment involves either oral allergy medicines, topical allergy medicine (eye drops) or a combination of both. Washing the face, hair, and eyes after exposure to allergen can also be an important part of treatment.

Anaphylaxis

Anaphylaxis is a more serious allergic reaction. It involves swelling of the eyelids, throat, and airways.

This is a medical emergency. If epinephrine is available, don’t hesitate to use it. Call 911.

Blepharitis

Blepharitis is an inflammation of the eyelids that can cause swollen lids. It often includes flaky eyelid skin and loss of the lashes.

This chronic condition should be managed by an eye care specialist.

Bug Bites

Bug bites are the most common cause of swollen eyelids we see in our office. Usually there is a known exposure to insects and there may be other bug bites on the body.

Bug bites on the eyelid tend to itch rather than hurt despite the significant swelling they produce. There should be no fever or other signs of illness. The eyeball should move freely in the socket. (See “orbital cellulitis” below.)

Treatment of bug bites involves cool compresses and oral antihistamines. Occasionally oral steroids are required for significant swelling, but they require a prescription.

If the swelling is concerning to you or your child, bring him in to be seen.

Conjunctivitis

Conjunctivitis, also known as pink eye, causes inflammation of the surface of the eye ball and sometimes a puffy appearance to the eye lids. It can be from bacteria, virus, or allergies.

Bacterial conjunctivitis causes the whites of the eyes to look red and includes a yellow discharge from the eye. This is usually treated with antibiotic eye drops.

Viral conjunctivitis causes the white of the eye to look red, but there is no yellow discharge. This does not require antibiotic eye drops.

Allergic conjunctivitis is described above under “allergies.” Treatment of allergies is recommended.

If unsure which type your child has, or if it is probably bacterial, see your doctor.

Contact Lenses

Contact lenses can contribute to swollen eyes if they are dirty or damaged.

If you suspect problems with your contacts or your eyes continue to bother you and you wear contacts, see your eye doctor.

Crying

Crying can cause the eyelids to become puffy. The lacrimal glands produce an overflow of tears, so the fine tissues around the eyes absorb the fluid, causing them to appear swollen. This is compounded by the autonomic nervous system increasing blood flow to the face during times of strong emotion and rubbing the eyes to wipe away the tears. This cause of swelling is short lived.

Cool compresses and avoidance of rubbing can help decrease the swelling.

Graves’ Disease (Thyroid)

Graves’ disease can cause the appearance of swollen eyelids and protruding eyes. Sometimes a drooping eyelid or double vision occurs. It is caused by thyroid problems, which also can cause problems with appetite, fatigue, heat intolerance, and more.

These symptoms should be evaluated by a doctor.

Kidney Problems

Kidney problems can lead to fluid retention. If the eyes are puffy along with puffiness of the ankles or swelling of the abdomen, then kidney problems should be considered. Children can develop this suddenly from infections, like certain diarrheal illnesses or Strep throat. The urine may look tea colored or like it has blood in it.

This is a medical emergency and you should seek care immediately.

Sinus Infections

Sinus infections can cause puffy, swollen eyelids. Congestion, runny nose, headache, postnasal drip, and cough are typical symptoms. It must be present for a minimum of 10 days, but sometimes these symptoms happen with a viral upper respiratory tract infection.

See your doctor if you suspect sinusitis.

Styes and chalazion

Styes look like a swelling at the edge of the eyelid, often red or pink with a small white central area. It is caused by a blockage in one of the small glands in the eyelid. They can be painful or tender.

Another swelling from blockage of oil glands of the eyelid is a chalazion. These do not typically hurt but they can cause the whole eyelid to swell significantly.

Applying warm packs to the area several times per day often helps treat styes. Chalazions more often need to see an ophthalmologist for treatment.

If a stye persists beyond a few months or the lid swells to cover the pupil, see your doctor.

Trauma

Trauma of the eye or nose, like any trauma, can cause swelling. A broken nose can cause swelling and bruising to the eyelids.

Any significant trauma to the eye or nose should be seen by a doctor. Symptoms may include vision changes, chemical exposure, foreign body in the eye, blood in the eye, severe pain, or nausea or vomiting after injury.

Ocular Herpes

Ocular herpes is an infection of the eye by the herpes virus. (Not all herpes infections are sexually transmitted!) It can appear initially like a blister or cluster of blisters near the eye.

It can lead to permanent damage to the eye, so prompt care by an ophthalmologist is important.

Orbital Cellulitis

Orbital cellulitis is a potentially serious infection of the eyelids. The infection can extend behind the eyes, causing meningitis.
It is suspected when there is painful swelling of the upper and lower eyelids, fever, bulging eyes, vision problems, and pain with eye movement.  Inability to move the eyes is a serious symptom.
This is a medical emergency and if suspected, prompt medical attention is warranted. Treatment involves iv antibiotics. To assess the extent of swelling, imaging is often done.

Ptosis

Ptosis, or drooping of the eyelid, can look like a swollen lid. There are many causes and this should be evaluated by an eye specialist.

Be Prepared! Season 2 of “13 Reasons Why” Starts Soon.

The Netflix series “13 Reasons Why” came in like a whirlwind last year. With it came increased thoughts and attempts of suicide. I’m worried that Season 2 will have a similar contagion effect this year. I’ve already heard from many teens that they plan on watching it. Last year I saw many teens significantly affected by Season 1, so it was on my radar to watch “some time soon.”

When my 15 year old said she wanted to watch it but needed me to unlock her Netflix restrictions to be able to view all maturity levels, I knew I had to watch it sooner rather than later.

It hit me hard.

The Netflix series "13 Reasons Why" came in like a whirlwind last year. I'm worried that Season 2 will have a similar effect this year. Last year I saw many teens significantly affected by Season 1, and I'm hoping we can all be prepared more this year.
I’m hoping we can all be more prepared this year to talk to our kids and teens about watching “13 Reasons Why” responsibly.

The show did a great job of getting me hooked. I binge watched most of the episodes over one weekend. I put off grocery shopping and other necessities. It was hard to stop watching despite the fact that it was hard to watch.

There was a lot of debate about whether or not Netflix was responsible in showing this series. The producers claimed they wanted to bring the issues to the forefront. Mental health experts argued that it sensationalized suicide. I can see both sides. It does bring the conversation to the forefront, but can also lead to increased feelings of depression and post traumatic stress.

I couldn’t stop thinking about it for several weeks. There was so much to process! And I’m a 40-something year old pediatrician mother of teens who has a lot of life experiences to help with the processing. I can’t imagine processing this as a teen. And for those who have a history of abuse, rape, or other traumatic life events, this series could really be traumatic to watch.

This blog was first attempted a year ago, but it was too fresh and I could not finish it. I went to it many times, but never could finish it. It’s been a year and now Season 2 is coming, so I thought I’d finally finish it it in anticipation of all the kids who will see the upcoming season.

What’s it about?

Season One was about a girl who committed suicide and left tapes to explain the 13 reasons why she did it. It left a number of issues unresolved, such as a victim dealing with rape, a shooting, a counselor who failed to help on an at-risk child, and more. Season Two is expected to tackle these issues based on the previews.

It doesn’t sound any less traumatizing to watch than the first season. They do have a website dedicated to helping people who are struggling and supposedly will have warnings and helpful resources with each episode.

No more hiding the subject.

Depression is a significant problem. We do need to discuss it.

Between 10-15% of teenagers have some symptoms of depression at any given time. We need to recognize and address it better than we do. Less than a third of teens with depression get help, yet 80% of teens with depression can be successfully treated.

It is recommended that all teens be screened for depression yearly. If your teen hasn’t been screened, schedule a yearly physical with his or her physician, and be sure they are screened at that visit with a standardized questionnaire.

Schedule a visit that is dedicated to discuss depression if you’re worried about depression. If your teen has significant risks for suicide, take action immediately.

Again and again in Season 1 there are opportunities for the teens to talk to an adult, but they don’t, which is too often the case in real life. It’s not that parents don’t ask. They do.

In real life and in the show, parents offer to listen, but kids don’t talk. You can argue that parents should push harder, but that usually tunes teens out even more. Having teens fill out a standardized questionnaire can help identify problems that might be missed at home and school.

Open the conversation.

Conversation is desperately needed. Our kids are exposed to much more than we were.

The internet allows them to research just about anything – and they can find inappropriate things intentionally or accidentally.

Rumors spread much faster than they did when we were kids due to social media.

Our kids are at risk of being photographed in compromising situations more than we were in the days of bulky film cameras and when video recorders were not in everyone’s phone.

This show could be a great eye-opener for parents of teens. The first season depicted teens getting drunk, struggling with relationships, drug abuse, abusive relationships among family and friends, sexuality, bullying, and rape. Maybe parents already know these things happen, but don’t realize how it affects their kids. Watching shows like this with your teens can help to start the conversation.

Teens hear about and see this stuff so we as parents cannot shy away from it. Whether they go to public schools, private schools or religious affiliated schools, they are not in bubbles. These situations and topics affect them in real life.

Watching shows that tackle controversial topics together (or watching separately but discussing) helps open a needed conversation. They need help processing all the “stuff” they encounter at school and online.

Warning!

It might be risky for people who have been sexually assaulted or have experienced trauma of any sort to watch this series and shows like it. I have seen some teens who suffered from post traumatic stress reactions after watching Season 1.

If you struggle with a history of assault or abuse, cautiously watch it with someone you trust. Stop if viewing becomes uncomfortable.

Things to discuss.

Of course I haven’t watched Season 2 yet so I can’t comment specifically on it. Common Sense Media has a short video on things to know and once the shows are available online, they will have more.

Some things that can be discussed from Season 1:

Social Media

Social media is a theme throughout the series. Kids send messages that spread to everyone at school several times. Cyberbullying is real. It doesn’t go away when kids go home, which is historically a safe zone, but there are no longer safe zones for kids due to the internet.

In the first season, a picture that can easily be mistaken for something it isn’t is shown to friends to brag (inappropriately) about a sexual experience (that didn’t happen) is shared by a friend (with minimal resistance). This of course causes the girl in the picture to be thought of as a slut and the guy as cool. This slut label lasts for months despite the fact that it isn’t true. There are several discussion points here:

Talk to your kids about never sharing pictures or words online that could be hurtful or embarrassing to anyone. Ever.

talking to adults

There is a consistent theme in season 1 of teens not wanting to talk to adults. I have teens of my own so I know this is an issue regardless of how often parents try to connect.

It is a normal phase of life, but kids need to know that it’s important to talk to a parent or another trusted adult if any significant issues arise. I always remind teens that their brains aren’t mature until the mid 20s, so if they need advice, they need to ask an adult. Even very smart and kind teens can give bad advice because they just don’t know yet what the best advice is.

Alcohol and drugs

Each party these characters attend has what appears to be every teen drinking alcohol. This normalizes the use of alcohol. There is talk of not drinking and driving, but it is still not responsible (or legal) use.

Talk about how Jessica goes from occasional use of alcohol to regular use, even at school, as a means to deal with her emotions. As she becomes more depressed, she attempts to self medicate with alcohol and marijuana. This is not a healthy way to treat depression.

Teens need to know there are many healthier options to have fun at a party and more effective ways to address any depressed feelings. I have written more on teens and alcohol previously.

Accepting responsibility

Use some of the show’s examples to highlight how individual choices and actions make a difference.

Jessica’s actions restrict her from cheerleading. She blames the coach, but it is her behaviors that are causing the coach to make consequences.

When a minor accident caused a stop sign to be knocked down, it led to a more serious accident. By not calling the police when the stop sign was knocked down, they indirectly lead to the death of a friend. It didn’t seem like such a big deal but actions have consequences.

Guilt

After suicide, many friends and family members feel guilty, but people who are suffering from depression and suicidal thoughts need professional help. Friends and family members should show love and support, but they are not capable or trained to help sufficiently.

Put a suicide hotline number in every phone.

Learn warning signs so you can help a friend if needed.

Rape and sexual harassment

There is a general theme of girls being objectified and sexually harassed at school. There are few students who seem to realize the seriousness of this.

We need to open the discussion of how to treat others with respect, not objects.

sexual consent

Sexual assault and consent is an often misunderstood topic. While rape can result in physical trauma, it does not always cause physical injury or involve brutality. Victims do not always have bruises or obvious physical symptoms.

In Season 1 we learn that Jessica was raped and didn’t even know it due to alcohol. There are many instances of rape where victims blame themselves for not saying no firmly enough or because they lead someone on.

Victims are often blamed for dressing suggestively or flirting too much. 

People who have experienced sexual assault but have no physical trauma are less likely to report the incident to the authorities or to get proper healthcare related to the encounter. People who have had sexual assault are more likely to have symptoms that seem unrelated, such as headaches, chronic pain, difficulty sleeping, poor physical health, depression, and anxiety.

Discuss sexual consent with your kids and teens.

Resources

National Suicide Prevention Lifeline – 1-800-273-8255

National Sexual Assault Hotline. RAINN. Free. Confidential. 24/7.

Stop Bullying. Resources to help prevent bullying and cyberbullying.

Alcohol Addiction Center. Resources for alcohol misuse and addiction.

Suicide Awareness Voices of Education (SAVE) Toolkit on 13 Reasons Why.

Home alone? Is your child ready?

Parents often wonder when it’s okay to let their kids stay home alone. There is no easy answer to this question. Many states, including Kansas, do not have a specific age allowable by law. The Department for Children and Families suggests that children under 6 years never be left alone, children 6-9 years should only be alone for short periods if they are mature enough, and children over 10 years may be left alone if they are mature enough. (For state specific rules, check your state’s Child Protection Services agency.)

Growing up

Is your child ready to stay home alone?
Is your child ready to stay home alone?

Staying home alone is an important part of growing up. If a child is supervised at all times throughout childhood and the teen years, he won’t be able to move out on his own.

This might be the case if there is a developmental delay or behavioral problems that make it not safe for that person to be alone.

The age at which kids are able to be alone varies on the child and the situation. Parents must take many things into account when considering leaving a child alone.

Maturity of the child.

Age does not define when kids are ready to stay home alone. You must consider how responsible and independent they are.

Does your child know what to do if someone knocks at the door? Can they prepare a simple meal? Do they follow general safety rules, such as not wrestling with a sibling or jumping on the trampoline unsupervised? Will your child be scared alone? Do they know how to call you (or 911) in case of problems or a true emergency? Are they capable of understanding activities that are dangerous and need to be avoided when unsupervised?

Readiness.

Is your child asking for the privilege of being left alone or are they afraid to be alone?

Forcing a child who is afraid to stay alone can be very damaging. Only allow kids to stay alone if they want to and are capable of the responsibility.

Behavior.

Some kids are typically rule followers. Others are not. If your child has problems following rules while supervised, he is not ready to be left alone.

Dangers are more likely to come if kids are risk takers and cannot control their behaviors. House fires, hurt pets, physical fights among siblings, kids wandering the neighborhood, and online behaviors that put kids at risk are but a few ways kids who don’t follow rules can get hurt.

Even if kids used to be able to be unsupervised, things change. If you think a child or teen is depressed, using drugs or there are other concerns, it might not be safe any longer to leave them unsupervised.

Number of children and their ages.

Kids can supervise younger siblings as long as they are mature enough and the dynamics between the two allow for it.

Two kids of similar ages can keep each other company if they are able to be responsible alone and not fight.

Some children can stay alone, but are not yet ready to take care of younger siblings. If they can do it when parents are home, they might be ready for unsupervised babysitting.

In Kansas kids must be 11 years of age to watch non-siblings, but there is no law for siblings. Leaving an 11 year old alone with a baby is much different than leaving the 11 year old in charge of a school aged child!

You must know your kids and their limitations.

Left alone or coming home to an empty house?

When you leave kids home, you can first be sure doors are locked and kids are prepared.

If they will be coming home to an empty house (such as after school), there are a few more things to consider. Will they be responsible to keep a house key? Is there an alternate way in (such as a garage code)? Do they know how to turn off the house alarm if needed? How will you know they made it home safely?

Pets.

If there are pets in the home, is your child responsible to help care for them? Can they let the dog out? Will they be allowed to take the dog for a walk? Do they have to remember to feed the pets?

It’s not just your child’s abilities when there are pets involved. Your pet’s temperament makes a difference. Does your pet have a good nature around the kids?

Neighborhood.

Where you live makes a difference. Do you live on a quiet cul-de-sac or a busy street? In a single family home or an apartment building? Do you have a trusted neighbor that your child can call in case of emergency? Is there a neighbor that your child seems to be afraid of? Are there troublemaker kids down the street?

If you don’t know neighbors what can your child do if there is a problem?

Will they go outside?

You’ll have to set ground rules about leaving the house, which will vary depending on the situation.

Is your child allowed to go outside when you’re not home and under what conditions ~ with a group of kids, with your big dog, on foot only or on a bike, daylight/dark, etc?

If they can go outside who do they tell where they are going and when they will return? Are there area limitations of where they can go? Run through scenarios of what to do if someone they don’t know (or feel comfortable with) tries to talk to them.

Do all the kids play outside after school with a stay at home mom supervising? If you will allow your child to go out expecting that the other parent will be there, be sure to talk with that other parent first to be sure it is okay — the parent might not want that responsibility.

Baby Steps.

Gradual increases in time alone are helpful.

Start by doing things in the home where you tell kids you don’t want to be disturbed for 30 minutes unless there’s an emergency. Let them know it is practice for staying home alone to show responsibility. When they do well with that, try going to a neighbor’s house briefly. If they do fine with that short time alone with you in close proximity, take a quick run to the store. Gradually make the time away a bit longer.

Time of day.

Start with trips during daylight hours when they don’t need to make any meals.

Only leave kids alone when dark outside if they are not scared and they know what to do if the power goes out, such as use flashlights, not candles.

Overnight stays alone are generally not recommended except for the very mature older teen. And then you must think about parties or dates visiting…

List of important things.

Make sure kids have a list of important phone numbers. They should have an idea of where you are and when you’ll be back. What should they do if they have a problem? List expectations of what should be done before you get back home.

Are there any no’s?

While it is impossible to list every thing your child should not do when you’re not home, make sure they know ones that are important to you. Having general house rules that are followed are helpful to avoid the “I didn’t know I couldn’t…” Think about how much screen time they can have, internet use, going outside, cooking, etc. Are they allowed to have friends over? Can they go to a friend’s house if their parents are home? What if those parents aren’t home? Some kids might be ready for unsupervised time at these activities, others not.

Emergencies.

Go over specifics of what to do if …

  • fire
  • electricity goes out
  • someone calls the house
  • a friend wants to come over
  • they are hungry
  • there’s a storm outside
  • they spill food or drink

Quiz them on these type of topics.

Do they know what the tornado alarm sounds like and what to do if it goes off? And do they know the testing times so they aren’t afraid unnecessarily?

Can they do simple first aid in case of injuries? Discuss the types of things they can call you about– if they call several times during a short stay alone, they aren’t ready!

Supervise from afar.

When kids are first home alone, you can call to check in on them frequently. Tell a trusted neighbor that you will be starting to leave your child home alone and ask if it is okay for kids to call them if needed.

Ask how things went while you were gone. Did any problems arise? What can be done to prevent those next time?

Internet.

Internet safety deserves several posts on its own since there are so many risks inherit to kids online.

Be sure you know how to set parental controls if your kids have internet access. Review all devices (computers, smart phones, tablets, etc) for sites visited on a regular basis.

Talk to your kids about what to do if they land on a site that scares them or if someone they don’t know tries to chat or play with them online. Be sure they know to never give personal information (including school name, team name, game location and time, etc) to anyone on line.

If they play games online, remind them to only play with people they know in real life. Do your kids know how to change settings so that the location of photos cannot be tracked through GPS?

home alone.

At some point kids will need to be independent, so work on helping them master skills that they need for life. This includes learning to stay home alone.

 

Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease is a very common illness, but there is a lot of confusion about it. It is caused by several different viruses in the enterovirus group. It can make kids (and some adults) miserable, but like most viruses we don’t have a specific treatment to fix it. There are things we can do to help kids stay more comfortable and to decrease spread.

Daycares in my area often make unreasonable demands of when to let kids return, which makes me aware that they aren’t aware of how it’s spread and how to control the spread as much as possible. Do they realize that many adults can have the virus and spread the disease without having any symptoms themselves?

How can you recognize hand, foot, and mouth?

Hand, foot, and mouth disease can look different in different people.

Of course the name gives a clue: there’s often a rash on the hands and feet, and in the mouth. If there is  a classic rash, you’ll know what you’re dealing with. The rash can look like red spots or blisters, classically on the palms and soles, but it can extend up the arms and legs. I often call it hand, foot, mouth, and butt disease because bumps in the diaper region are common. You might not recognize the blisters unless you can get a good look in their mouth to see blisters on the gums, tongue, or throat.

Some kids will be fussy and eat less than normal.

Many, but not all, will have a fever. Don’t fear fever.

This photo shows typical blister-type lesions around the mouth of a toddler. Notice the drool at the chin. Many kids have these blisters on their throat, which makes it painful to swallow. They often refuse to eat or drink – or even swallow their saliva!

Hand Foot Mouth Disease

Are there any serious complications?

Most kids recover completely within a week or so, but some can have a more significant illness.

Some kids refuse to eat or drink and may require hospitalization for dehydration.

A rare complication is viral meningitis, an inflammation around the brain. Symptoms can include fever, headache, stiff neck, and irritability. Viral meningitis might require hospitalization to help with comfort measures or to treat with antibiotics while ruling out bacterial meningitis.

Even less commonly children can get encephalitis or a polio-like paralysis. Encephalitis is an inflammation of the brain. Symptoms include fever, seizures, change in behavior, confusion and disorientation, and related neurological signs depending on which part of the brain is affected.

One consequence I tend to see every few years is fingernails and/or toenails falling off weeks after recovery from hand, foot, and mouth disease. While this is not serious and the nails eventually grow back normally, it can be distressing to parents. Simply knowing that this might happen can hopefully stop your worry before it starts!

How is it spread?

Most enterovirus infections in the US are during the summer and fall. Enterovirus infections are common worldwide. Most kids have been infected by the time they’re school aged. Pets do not get infected with enteroviruses.

The virus easily spreads from person to person. This happens through contact with saliva, nose and throat secretions, fluid in blisters, or stool of an infected person. The virus can spread from mother to infant prenatally and in the newborn period.

Enteroviruses may survive on environmental surfaces for periods long enough to allow transmission from fomites.

Respiratory tract shedding usually only occurs for 1-3 weeks, but the virus can exist in the stool for months after infection. Careful hand washing after all diaper changes is essential. In most cases it is not possible to keep kids home from daycare until they are “no longer contagious.”

Infection and viral shedding can occur without signs of clinical illness, especially in adults. This means many parents and daycare providers can unknowingly spread the virus to susceptible infants and children.

The incubation period (time from infection until symptoms show) for enterovirus infections is typically 3 to 6 days.

What treatment can be given?

Because this is caused by a virus, there is no specific medicine that is needed to make it go away.

Fluids are very important. Some kids refuse to swallow due to pain, so they are at risk of dehydration. Giving pain relievers, such as acetaminophen or ibuprofen, can help to decrease the pain and improve how well they will drink. Offer cold drinks, smoothies, and popsicles if age appropriate.

Older children and adults can use throat lozenges or mouth sprays that numb the pain.

Magic Mouthwash

A mixture of liquid diphenhydramine (a common antihistamine) and a liquid antacid, such as Maalox, in a one-to-one ratio can help alleviate pain. Give the amount that equals the diphenhydramine dose per weight.

For example, if a child’s dose is 2.5 ml of diphenhydramine, mix 2.5 ml diphenhydramine with 2.5 ml of the liquid antacid. If a child can swish, gargle, and spit the mixture, it can help numb the sores. When younger children swallow the mixture, it may also help if it coats the sores in the mouth adequately.

Control measures to prevent hand, foot, and mouth disease

Hand washing, especially after diaper changing, is important in decreasing the spread of enteroviruses.

Don’t share foods or drinks. Avoid contaminated utensils.

Wash toys and disinfect surfaces regularly.

Chlorination treatment of drinking water and swimming pools may help prevent transmission.

Can kids get this more than once?

Since there are several different viruses that cause hand, foot, and mouth disease, it is possible to get it more than once. Keep washing those hands, toys, and surfaces!

Body Safety and Sexual Consent – Start Younger than You’d Think!

We hear about child molestation and rape far too often these days. While we can’t anticipate all the situations our kids will be exposed to throughout their lives, we can teach them how to protect themselves in all situations and if there’s trouble to speak up. Teach them to respect themselves, to respect others, and to never keep secrets. Talk about consent often, starting in the toddler and preschool years!

Start in the toddler years?

What about their innocence?

It’s never too soon to talk about body safety. You don’t need to cover all the specifics at young ages, but there are many age appropriate things to talk about at each stage.

The message and words change over the years as your child grows, but start young!

Teach proper body part names.

We call eyes “eyes.”

An elbow is an elbow.

Why should we call a vagina a “hoo hoo” or a penis a “wee wee”?

If kids ever need to talk about those body parts and the other person doesn’t know the slang, it’s more difficult to get the point across.

Wouldn’t you feel awful if your preschooler tried to tell a teacher that another adult touched her inappropriately, but the teacher thought “hoo hoo” was just a fun term, so didn’t act on the issue?

Teaching kids about private body parts is important.  Let them know that their swim suit area is private. No one should be able to look or touch there without permission from Mom or Dad and from the child himself.

Teach respect of personal space.

Many kids love to hug and kiss everyone they see.

Other kids hate to be hugged or kissed.

Sometimes they just don’t feel like it, but other times they’re okay with a big bear hug.

All of these feelings are okay, but we must be mindful of how these interactions are approached and consented.

Ask permission.

Teach your kids to always ask permission before entering someone’s personal space.

They can say something as simple as, “Can I give you a hug and kiss goodbye or should we high-five or blow kisses?”

Encourage kids to demand permission before being touched. You can model this kind of expectation by asking before touching.

~ Can I be a tickle monster and get you?

~ It’s time to wash your back. Should I do it or do you want to do it yourself? Now it’s time to wash your penis, do you want help?

~ Do you want me to rub your back to help you fall to sleep?

Be sure others ask similar questions of your child.

Talk to family members about this when the child isn’t present. You don’t want it to be an ordeal in front of everyone, so a little discussion ahead of time can help the adult understand and follow your expectations.

If adults continue to enforce a hug or kiss, it’s a red flag that they don’t appreciate boundaries. I would not recommend allowing your kids to be alone with them. They might simply be innocently wanting a hug from a cute kid, but they also might be testing to see how the child reacts in preparation for more intimate touches.

Don’t force your kids to be kissed or hugged by anyone, even family members. If they don’t want Grandma or Uncle Buddy to get too close, they shouldn’t be forced to give a hug or kiss.

Think about the message that sends.

They should not have to submit to being touched. Ever.

Teach proper hygiene.

Once kids are potty trained, they can start learning to wash their own genitals. It will take practice before they can do an adequate job, but if you don’t start teaching them, how will they ever know what to do?

If they still need help toileting or bathing, be sure they know that only adults who have permission are allowed to help. This means you must tell them that it’s okay for any specific person to help.

Wipe properly.

Many girls wipe inadequately after urinating. Some rub too hard, which irritates the genitals. They often miss some of the urine and the inner labia stays moist, which leads to redness and pain.

Teach them to wiggle the toilet paper between the skin folds.

Many kids will need help wiping after a bowel movement for many years, but you can show them how to wipe until the toilet paper no longer has streaks on it. Using a flushable wet wipe is often helpful.

At bath time teach them to wash their genitals.

For girls this means using a mild soap and rinsing between all the skin folds with water well. Soap residue can really irritate the sensitive labial skin.

For boys, washing the genitals and between the buttocks is important too. If he is uncircumcised, teach him to gently pull back on the foreskin to rinse the head of the penis. If it does not yet retract, do not force it.

Encourage questions.

As kids get older, they have lots of questions about their body. You want them to ask you or another trusted adult for answers, rather than going to the internet to find answers.

Answer questions as truthfully as you can. Don’t feel like you have to answer more than what’s asked.

Where do babies come from?

Of course when they ask how babies are made, you need to answer it to a level they can understand.

Young kids don’t need to know that a penis goes into the vagina to release sperm and fertilize an egg. They can’t comprehend that.

Think about what they’re asking and answer that question truthfully without going into details they won’t yet understand.

If you’re not ready to answer the question when it’s asked, buy yourself time. Tell them that it’s a great question and you want to think about it. Be sure to give a specific time that you’ll be able to answer the question. Think about it, prepare what you’ll say, and discuss it at the chosen time.

Model healthy relationships.

When kids see healthy relationships, they learn that that is what is appropriate and acceptable in a relationship. Show respect in what you do and say to all people around you. Demand respect in how others treat you.

If you’re in an unhealthy relationship, work with a counselor so you both can learn to work together to improve the relationship. If that’s not possible, especially if the relationship isn’t safe, think about how to safely separate. It isn’t easy, but if your kids grow up watching an abusive relationship, they are more likely to end up in the same situation.

Teach kids to ask for help.

It can be really hard for kids to learn when it’s best to work out problems and when to ask for help. No one likes a tattle tale, but there are times kids need help from adults.

When safety’s an issue, an adult should be part of the solution. If a friend is doing something dangerous, such as running into the street, it’s best to tell an adult.

If kids are simply frustrated that another child won’t share a toy or play the game your child wants to play, that is something that kids can at least start working out on their own.

Praise kids when they make smart choices about asking for help when needed and when they solve their own conflicts appropriately.

No means no. Stop means stop.

Teach kids that we always need to respect others when they say no or stop.

For example, if Sissy says to stop tickling her, stop.

When friends or adults don’t listen if they’re told no or stop, kids need to think about if they feel safe and if they still want to be around their friend. If they don’t feel safe, they need to talk to you or another trusted adult.

Books can help talk about these difficult topics. Some suggestions for saying “no” appropriately and “stop” when needed:


For teens, I love this Cup of Tea video. It explains so well that no means no!

No secrets!

Remind kids that they’ll never be in trouble for telling you things. There are never secrets in families. We might keep surprises, but never secrets.

You might need to change your wording at times… If you’re buying or making a gift for someone, it’s a surprise, not a secret. Surprises are fun. We can build up suspense for the fun by not telling. But secrets make us feel bad because we can’t share them.

Remind your kids that if anyone asks them to keep a secret, it’s best to tell their parent.

A great book on this subject is Some Secrets Should Never Be Kept!

Believe kids.

Sometimes it’s hard to believe what our kids tell us. But if we don’t believe them or we discount their stories, they will stop telling us things.

I know that I’ve been challenged to believe many things my kids tell me, but instead of downplaying the story or telling them to stop lying, I try to ask more questions.

Once my daughter told me about an accident the bus had while she was on a field trip. I didn’t believe her (surely the school would have alerted parents) and asked more about what she was saying without outright saying she was lying or telling stories. I asked for more clarification, thinking she’d contradict what she had said, but she kept to the same story. It wasn’t too much later that the school sent out a message that the bus had been in an accident and there were no injuries. I told her that I got the message and she just beamed. She knew I didn’t believe her! But it was an opportunity to let her know that sometimes I might not believe stories initially, but I was proud that she told me and continued to try to show me the truth.

If your kids ever tell you they don’t want to visit or stay with a certain person, find out why. If they say they’re scared, don’t discount it. Even if you trust the person, believe your child. Molesters are adept at grooming families to gain trust. Kids generally don’t make abuse up.

Men and women are different.

When kids are young, teach in general terms about males and females.

You can talk to young kids about why men and women look different than kids. Many will question why men have facial hair, women have breasts, or how a baby will get out of mom’s tummy. They might want to know why you have feminine hygiene products in the bathroom or what they’re for. Answer the questions to their level of understanding.

Talk about puberty before changes happen. Younger kids are more open to learning new things. Once changes start, kids are confused and more self conscious. Puberty starts in girls around 8-12 years of age and in boys about 2 years later. When you notice changes, reassure your kids that it’s normal and they’re just growing up!

For more on menstruation specifically, check out my Q&A about periods.

Some of my favorite books on puberty:

 

Online activities.

The internet has opened the doors to a lot of knowledge and sharing of information. It can be used to better ourselves, but it can also leave kids open and vulnerable. It can lead to bullying. Sometimes it encourages feelings of inadequacy. Online predators can take advantage of our kids.

This is a huge topic and cannot be covered here, but in short: teach kids to never share anything online that they wouldn’t want the public to see. It is okay for parents to monitor online activities, it’s not threatening their privacy. It’s helping them stay safe.

Think of supervising online activities like supervising learning to drive.

You would never just give the car keys to your teen and expect them to safely drive. You first have them learn the rules of the road and pass a written test to get a learner’s permit. The learner’s permit allows them to drive while being supervised. After many hours of supervised driving, they may get a license that allows them to drive alone, but you probably wouldn’t let them take a long road trip alone yet. They start out with quick trips around town, then onto highways, and finally longer trips. The specific timeline of that depends on the teen. Some need longer times at each stage, others show maturity and responsibility more quickly.

Common Sense Media has a number of helpful articles about online safety.

Our actions impact others.

Kids can learn how their actions affect others and that they can’t alter anyone else’s behavior without first changing their behavior.

While this doesn’t seem initially to impact sexual consent, it does. What happens if we all do what we want when we want, without caring what others think or feel? We take advantage of others and hurt people. We don’t want our kids to grow up without empathy or social conscience. It also helps kids to identify their own feelings in response to other people’s actions, which might help them avoid people who make poor choices.

Talk to kids when you see opportunities to talk about the impact of behaviors. Find examples they can identify with.

For example, if a child was being noisy at the library, what kind of impression did they make? How did the noise affect everyone else’s experience at the library? What situations can they think of that they were noisy when they should have been more quiet? How can we be more mindful of our own noise level?

What can kids do if they see a bully? Is it hard to recognize the significance of bullying when everyone’s laughing at another child? Should they join in the laughter when someone’s being teased? Can they stand up for the person being bullied? When should they talk to an adult?

rewind

A fun game to play that can help kids learn how to change their behavior to get a better outcome I call Rewind. You roll play and rewind a situation and play it out differently. When kids complain about the outcome of an event, have them role play it to try to get to a better ending. The trick is they have to be the first to change what they say or do. In the real world we can’t just expect someone else to change a behavior.

For example, if your son is upset that no one would play hop scotch at recess, he can’t simply expect that someone will join him the next day. Other kids might not realize that he wants to play. Maybe he can ask kids to play with him. Roll play what to say if he’s turned down. Think about why other kids don’t want to play hop scotch. Are they all busy playing basketball? Talk about being open to taking turns: maybe another child will play hop scotch with him if he plays basketball with the other child first. The trick is that he just can’t expect others to change their behaviors unless he changes his first.

Respect

One word that summarizes most of the above is respect.

Respect Yourself

Respect yourself enough to eat right, sleep adequately, and exercise. Take care of your body and mind. Be the best you can be. Don’t do things that you know could harm your body or cause you to get into trouble.

Respect Others

Respect others and their wishes. If you’re kind and respectful towards others, they will appreciate it.

This does not mean that kids have to do everything other people ask them to do. They should never do anything that makes them feel uncomfortable or that they know is wrong. See the last respect point…

Demand that others respect you

Just like you should respect others, they should respect you. If everyone respects other’s thoughts and feelings, we would have no abuse or bullying in our lives.

We can’t change other people’s actions all the time, but we can leave situations where people are not kind and respectful. Kids need to know that they should talk to an adult if someone is not being respectful to them.

We hear about child molestation and rape far too often. Teach kids to respect themselves, respect others, and to never keep secrets. 
We hear about child molestation and rape far too often. Teach kids to respect themselves, respect others, and to never keep secrets.

Kids to Parks Day

Each year Kids to Parks Day is celebrated on the 3rd Saturday of May. It’s a day we can help kids and families connect with their local, state, and national parks and have fun! This year it’s Saturday, May 19th.

Why should we have a national day to celebrate taking kids to a park?

Because anything that encourages families and friends to explore the outdoors together is a great thing!

Where should you go?

If you’re wondering where to go, check out this great page from the National Park Trust called Explore Parks Near You. You can click on the state you want to explore to find parks.

Of course if there’s no national park near you, you can visit any nearby park or trail. The point is to get outside and enjoy nature.

What can you do?

Parks may offer a number of activities. You can investigate if they have hiking or biking trails, water activities such as swimming or fishing, camping, or more.

Check out these Boredom Busters and the ideas in this Park Adventure Booklet for your next park trip. You can also try to do all thirty of these 30 Things. If your kids are into creative games, you can have them go on a scavenger hunt.

What should you bring?

Always make sure you’re prepared when you’re going into nature.

Sunscreen and sun protection from hats and clothing is a must when outdoors. Use at least an SPF of 25 and reapply sunscreen every 2 hours until evening hours.

Sunglasses might also be appreciated and help protect the eyes from damaging rays. Be sure your sunglasses provide 100% UV protection from both UVA and UVB rays. Don’t forget the kids! We get 75-80% of our UV exposure before we turn 18.

Use bug sprays and sunscreens appropriately. Don't buy a combination product. Use the sunscreen first, and then spray bug spray over it if needed.
Use bug sprays and sunscreens appropriately. Don’t buy a combination product. Use the sunscreen first, and then spray bug spray over it if needed.

Bug sprays can help prevent bug bites. If you’re in an area with ticks, still do daily tick checks even if you use insect repellant. You can use this handy online tool to find the best bug spray for your needs.

Be sure to bring water bottles for everyone. Dehydration is a risk when you’re active, especially if it’s warm outside. Caffeinated (and for adults, alcoholic) beverages don’t rehydrate as well as water.

Wear appropriate shoes. Many kids want to wear their favorite sandals, but if you’ll be outdoors walking, they will need a more sturdy shoe. If you’ll be around water you might even pack a second pair in case they get wet. Walking in wet shoes is begging for blisters.

Bring a camera to take memories, but don’t spend the day trying to get the perfect picture. Snap a few pictures, but make the day about enjoying the outdoors, not about taking pictures.

If you’ll be hiking, bird watching, or looking for wildlife, it might be helpful to have binoculars.

Bring healthy snacks or pack a lunch if you’ll be out during typical snack or meal times. When kids are hungry, they get angry. You don’t want hanger to ruin a fun day!

If there are areas appropriate for sporty activities, bring some balls or frisbees.

What should you not bring?

Leave the electronics at home. This is a great day to unplug!

If you have allergies in the family…

If someone (or many) in your family suffer from allergies, be prepared! I have many tips in a previous blog that covers allergies.

#KidstoParks

Get your kids outdoors on Kids to Park Day!
Get out and into nature!

Food Strike! What can I do when my child won’t eat anything anymore?

“What can I do to help little Sally eat? She used to eat everything, but now she hardly eats anything at all.” I call this a food strike, and it’s very common. But kids are smart, they won’t let themselves starve. The way you handle it as a parent can either encourage unhealthy eating or healthy eating.

Eat it or wear it.

This question always reminds me of the Judy Blume book, Tales of a Fourth Grade Nothing, one of my favorite books growing up.

The younger brother in the book, Fudge, refuses to eat. After many failed trials of bribing and forcing food, his father finally loses patience and says “eat it or wear it.”

Needless to say, Fudge ends up with the bowl of cereal on his head and goes around for days saying “eat it or wear it!”

I would not advise this approach.

When is a food strike a real concern?

Most of the time picky eating is a normal phase. Sometimes it’s simply that toddlers and young children don’t need as many calories because they’re not growing as fast as during infancy. Or it could be that they’re filling up with empty calories due to inappropriate snacking.

Of course there are some instances that are cause for concern.

Red Flags include:
  • Recurrent or persistent illness
  • Frequent vomiting or diarrhea
  • Food allergies
  • Very limited food types over an extended period of time
  • Problems swallowing or choking
  • Falling off growth curve
  • Sensory issues (trouble with textures, tastes, smells, and more)
  • Anxiety about eating or around foods
  • Body image problems

There is a great series of posts covering picky eating on a dietitian’s blog. Some articles are authored by a nutrition therapist. I will include some of my favorites below, but you can find them all on the site.

If you notice one or more of the red flags above, be sure to talk with your child’s pediatrician.

Encouraging healthy eating

If hungry, kids will eat. Don’t let them fill up on things that aren’t giving a nutritious balance. Even just milk all day can be harmful because it lacks many vitamins and minerals. A little milk with other foods is better!

Healthy food choices

Offer veggies, fruits, cheese, nuts, etc at scheduled snack times. Think of snacks as mini-meals. If kids are offered healthy foods at meals and snacks, they will eat them when they’re hungry.

Limit pre-packaged foods

Many prepackaged foods are preferred over fruits, vegetables, dairy products, nuts, and other healthier options.

If kids have a choice between cucumbers and hummus or a bag of chips, what do you think they’ll pick?

Healthy drinks

Limit drinks other than water and milk.

Drinks fill kids up and don’t offer balanced nutrition.

Limit milk to no more than 24 ounces per 24 hours.

Too much is overwhelming

Put only a small amount of each food on the plate. It might be overwhelming to have a full plate.

Different personality types can even respond differently to different plate sizes. See Children’s Personalities & Bowl Bias: Extravert and Introvert Children Are Not Equally Influenced by Plate Size!

Turn off the tv and put down the screens

Have a dinner conversation with the family. This not only sets up healthy eating habits, but also healthy family dynamics. Teens who eat with their families are less likely to have risky behaviors!

Set a good example!

Talk about how much you are enjoying the healthy foods at the table. (Not how healthy they are, but rather how good they taste.)

Keep foods separate on the plate

Kids might eat a food if it’s not touching another but refuse it if it’s contaminated.

Scheduled eating

Set a time for meals and stick to it. If your child doesn’t eat, clear the table.

When they complain of being hungry, don’t be condescending. Simply say, “I know how you feel. I’m hungry too when I don’t eat. Dinner is coming up soon. I’m sure you’ll be ready!” Don’t offer filler foods. Keep the discussion calm and without blame or judgement.

Kids are smart, they’ll pick up on the fact that they need to eat at meal time or be hungry.  They won’t starve to death!

Hide healthy foods

Puree a can of beets into spaghetti sauce. It makes a cool color without changing the flavor much at all.

Blend carrots, spinach, kale, or cauliflower into smoothies. I’ve even used frozen peas when there was nothing else. Strawberries, bananas, kiwi, and other fruits are much more flavorful than many veggies and kids tend to like their tastes. If your kids balk at the color, try to match the fruit and vegetable colors to hide the vegetable.

Puree onions, carrots, zucchini, spinach, and other vegetables in recipes rather than chopping them… kids won’t pick them out!

With all of these hidden foods, chances are they won’t even know they’re there.

Try foods in different forms

Frozen peas are crunchy– maybe they don’t like the squishy texture of cooked peas.

Raw broccoli is much different in taste and texture than cooked broccoli.

Many kids love cheese over vegetables or foods dunked in ketchup or yogurt.

It’s fun to eat with fingers for a change. Let them get messy!

Try cutting things into pieces and serve with toothpicks. Everything’s more fun on a stick!

Cut sandwiches with a large cookie cutter for fun shapes.

Use small cookie cutters for bite sized sandwiches or fruit pieces.

Take a look at Pinterest to find ideas on how to make foods fun if you really have a lot of time on your hands.

Rewards?

Try not to use food as a reward. This can set up unhealthy eating habits.

Don’t reward for eating. Most kids will get the intrinsic reward of satiety. They don’t need stickers or dessert for eating a meal.

Praise small steps

If kids try a new food (whether they like it or not) praise the fact that they tried!

Set realistic expectations 

Don’t expect kids to eat as much as infants/toddlers or teens/adults. Calorie needs go down when not in growth spurts. Just make the nutrition needs balance.

Don’t worry as much about volume as variety of healthy foods! Parents can decide what kids eat, but kids should decide how much to eat.

Most kids don’t need supplemental meals in a can (Pediasure and other brands) ~ they are getting the nutrition and calories they need, there is just an imbalance of perception of what they need.

I always prefer a healthy, active, thin child over a child who is overweight and not active (and often undernourished due to poor quality foods).

Will they get enough vitamins?

Vitamin supplement use and need is debated. It’s very difficult to study vitamin supplements. Baseline diet variations could make a big difference as to whether or not the supplement is needed. The time that needs to be studied is very long, because many health issues develop over many years. This means we need to wait a long time to see results and there’s a bigger potential that study participants are lost to follow up.

Vitamin D is one vitamin that I believe should be supplemented by all. Very few foods have vitamin D. Milk and a few other foods have been supplemented, but that alone will not give sufficient levels. Sunlight is a great way to raise vitamin D levels. But sunlight availability is unreliable and amounts needed vary based on skin type and quality of the light. Not to mention that sunlight can damage our skin.

In general I think it’s a good idea to give a multivitamin with iron if kids aren’t eating well. I prefer for them to get nutrients from foods, but if they refuse, then there’s no need for them to become deficient in nutrients. Iron deficiency actually causes anorexia, which increases the problem by not eating well!

If your family uses vitamins, be sure to lock them up as if they’re medications so kids don’t accidentally ingest too much.

Last thoughts

Most kids grow well during their picky eating and food strike phases. Just be patient and aware of any red flags that need to be evaluated.

If you are concerned, schedule an appointment to discuss foods, growth, nutrition, and concerns. Bring a typical food log of foods and drinks (with approximate volumes) for at least one week. Your physician can either identify a concern and develop a plan of action or reassure you that your child is normal!

Food strike! What do you do when your child stops eating?Resources:

How much food should I eat? (KidsHealth.org)

Choose My Plate 

How to Handle Picky Eaters (Zero to Three)

Picking Produce: Organic or Conventional- Does it matter?

Social media is great for making connections. I’ve followed Dr. Nicole Keller, a pediatrician who is passionate about sharing information about farming and food production. After several “conversations” I asked if she’d be willing to write a post for this blog to explain organic versus conventionally grown foods and she agreed. I learn a lot from her and others who share the science behind the foods. I hope you do too! ~ DrS

Raising kids is hard. There are so many decisions all the time. One of those daily choices comes in the form of what to feed your kids – and that happens 3 times every day (if not more)! Food choices are very personal decisions and with all the information (and misinformation) out there about food, picking the right options seems impossible.

As a pediatrician, I have a vested interest in kids’ health. But when I’m not a pediatrician, I’m also a farmer’s wife. My connections to agriculture and medicine have helped me navigate the food labels craze and I would like to help you do the same. I’m writing here to help you feel good about what you feed your kids based on sound evidence – no matter what the labels may say.

Organic versus conventionally grown foods. Does it matter?
Is organic food really healthier?

What type of produce should you buy?

Eating plenty of fresh produce is an important part of our diets – fruits and veggies should make up a large portion of our diets if we want to stay healthy.

The short answer to what type of produce you should buy is whatever you can afford and what looks good to you and your family – no matter how they were grown.

Lists like the Environmental Working Group’s “Dirty dozen” take data and skew results to unnecessarily and wrongly  scare consumers away from healthy produce options. There is no need to avoid any produce even if it makes one of these highly publicized lists.

For example, organic produce can only use certain growing methods and certain chemicals to be approved as organic (yes, organic can use pesticides – read on to learn more!).  Even so, a food can still qualify as organic if it has less than 5% of the EPA’s tolerance level for that pesticide (ie. if the tolerance level is 100, a level of 5 can be acceptable). In 2016, the EWG’s #1 dirtiest conventional produce (strawberries) met this 5% rule in 76% of samples where residues were detected. So 3/4 of the samples they claimed as “dirty” actually met measures to be considered organic.

The point here is that skipping produce because you fear its safety is much more harmful than eating even the “dirtiest” of these produce options on a regular basis.

Even so, it is hard to not to go to the store and look at the options and wonder if something that has a healthier looking label or a higher price tag is better.

So, do higher cost, fancy labeling or buzz words (i.e. “all-natural”, “organic”, etc) equate to more nutrition or safety? Read on to find out.

“What is organic? What is non-organic or conventional?”

Organic and conventional (non-organic) foods tell you how a product was grown.

Each type of farming has to meet standards for safety of their own.

Both organic and conventional farmers can use chemicals to help control pests. Pests come in the form of bugs, weeds, disease, or other things that negatively affect a crop.

Organic has their own list of approved pesticides as does conventional farming. Traditionally, conventional farming is allowed to use synthetic (lab created) chemicals where most organic pesticides are classified as natural (naturally occurring).

“Aren’t natural pesticides healthier because they already occur naturally?”

Not necessarily.  This “appeal to nature” or the “naturalistic fallacy” assumes if something is natural it is good. If it is unnatural it is bad. This is a common misconception.

Many natural things in our world can be dangerous: belladonna, poison mushrooms, cyanide, etc. These naturally occurring substances can cause great harm (or death) even though they have not been made in a lab.

What makes the difference is the dose.

With any chemical, natural or synthetic, dose makes the poison. Water can be deadly in the right amounts, yet it is necessary for life as well.

Additionally, pesticides created in a lab may be more fine-tuned – they can be made potent for the appropriate purpose but safe in other aspects.

We don’t get to dictate that with naturally occurring chemicals.

Less pesticide in organics

“Organic products have less pesticide though, right? And less pesticide residue must be better, right?”

Again, not necessarily.

In truth, 99% of the pesticides we consume in our diet are made by plants themselves! This means we consume a HUGE amount of naturally occurring pesticides made by plants on a regular basis.

Additionally, these naturally occurring compounds show similar (and sometimes worse) potential for toxicity when consumed.

Testing for all pesticides wouldn’t be helpful as plants make them as part of their typical life cycle and they can’t be avoided no matter how the plant was grown.

In regards to pesticide residue testing done by the USDA, traditionally, organic produce has shown to have less pesticide residue compared to conventional. The catch here is that those results only account for what the food was actually tested for.

At this time, many organic pesticides aren’t tested for the same way synthetic ones are tested for because they are assumed to be safe.

So does this mean synthetic occurring chemicals are assumed to be unsafe then because they are not natural? No, but, because of their synthetic creation they are held more accountable when testing is done. This increased accountability makes sure the synthetic pesticides created are being applied safely and leaving safe levels (if any) of residue.

Why use synthetic pesticides at all?

“If plants produce their own pest control naturally why can’t we just rely on that and not use synthetic pesticides at all?”

Sometimes the plant’s natural defenses just aren’t enough to combat certain pests.

When you have millions of people to feed around the world that is a big gamble to take.

One of the ways to help achieve a better guarantee of good crop yields is use of synthetic pesticides that were created to deal with specific crop-destroying pests.

How do we know the chemicals are safe?
How do we know the chemicals are safe?

This is where many consumers get nervous – “how do we know the chemicals we are creating won’t harm us somehow?”

Well, remember above we talked about being able to fine-tune chemicals by creating them in the lab?

This refinement is done with the help of expert scientists testing how the synthetic chemical works on the plant, breaks down, and what happens when ingested (by humans and even by other species like insects and pets).

Fine-tuning of chemicals in the lab allows us to adjust a couple things: effectiveness, dose needed, and side effects.

By being able to refine all these aspects, the result is a very effective chemical that can be used in small quantities while also having low toxicity.

For example, when glyphosate is sprayed on a crop, it is effective at very low doses – a volume of less than 2 pop cans diluted in water are applied on an area the size of a football field. The chemical also breaks down very quickly into non-harmful components (it is less toxic than baking soda!) leaving no harm to the crop, the soil, and no harm when ingested.

In contrast, an organic (naturally occurring) pesticide many times needs several exposures to achieve effects because it is not as “finely-tuned” as the synthetic version. Additionally, they may have more side effects that are out of our control.

Think of it like a sharpened razor versus a dull knife. Both may eventually cut, but with the sharp razor you can achieve your goal with one swipe and have clean edges where the dull knife needs several strokes and may also leave you with tattered edges.

Reducing chemicals

“I still don’t like that conventional produce has more pesticide residues. I want to reduce my chemical intake, period.”

The question to really ask yourself here is, “What do those residues mean in regards to my health?” Especially since you now know you’ll be ingesting residues whether you eat organic or non-organic foods.

For example, there are more carcinogens in a cup of coffee than in a year’s worth of produce consumption. So what makes the chemicals in coffee acceptable but the chemicals in produce so scary?

“Why am I afraid of these chemicals in particular?”

After all, everything in our world is a chemical – water is dihydrogen monoxide. Add an extra oxygen to that formula and it becomes dihydrogen dimonoxide which is commonly known as hydrogen peroxide.

Small change in the above mentioned chemicals means big changes if you tried to drink a glass of each! Both sound scary when using their chemical names too, but, when used appropriately, both can be used safely no matter how scary their scientific formulations sound.

We need not fear chemicals outright.

We should of course be careful of what we put in or on our bodies. The residues found on all types of produce are tested for annually by the USDA. These levels have been repeatedly shown to be well below that would cause harm in short or in long term exposures in your diet.

Dose makes the poison

The presence of small chemical residues below margins of safety mean consumption is safe.

Think of it like taking Tylenol for a headache. If you take the appropriate dose, you can help your pain but not cause harm.

You may find Tylenol residues in your blood or urine but the presence of those residues don’t mean your dose was harmful. Your body breaks down the medication and leaves no residual harm in the body.

Again, dose makes the poison and the “dose” of pesticide residues we may ingest in our diets have consistently been shown to be well below levels that will cause any harm.

All produce should be washed before eating (no matter how it was grown) to remove dirt, bacteria and other contaminants. But in regards to chemical ingestion, our food supply has been repeatedly shown to be safe no matter the option you choose to buy at the store.

Care of land and animals

Taking care of our earth is important.
What about the earth?

Some consumers may believe that organic farmers respect their land and animals more than conventional farmers – they buy organic to ensure products were raised responsibly and respectfully.

The truth is, farmers of all types want the best for their land, their crops and their animals. Not only is it their livelihood, it is also what is feeding their own families!

Badly cared for land produces poor crops.

Unhealthy or unhappy animals do not produce good meat, eggs or milk.

Additionally, the large majority of farms (over 95%!) are family owned and family run – these are real people with real investments in their products and their work.

Organic and conventional farmers alike want what’s best for their farms and the products they raise.

Hormones in cattle
Hormones in cattle from bestfoodfacts.org

Health and safety

“But organic raised meat, eggs and milk have been shown to be healthier and safer, right?”

In regards to hormones, antibiotics and nutrient content, organic and conventionally raised animal products are equal.

The labels you see regarding hormone and antibiotic use in animals are fairly pointless.

These labels help sell a product.  The consumer assumes the non-labeled product is somehow lesser.

Truth is, it is illegal to use hormones in chickens and pork. Hormone use in beef is rarely done nowadays and even when given there are no residues of this added hormone in the products we eat.

Naturally occurring hormones will always be in certain foods – meats are one of them – but not because a farmer added hormones while the animal was being raised.

To put this into perspective, there’s thousands more hormones in a serving of nuts (over 45,000 nanograms) as compared to a hormone implanted steer (3 nanograms) – both being in ranges that are safe to consume regardless.

Antibiotics are allowed to be used in conventional farming but not in organic. Even so, when an antibiotic is used, it is used with the animal’s best interest in mind (to treat an illness) and only when needed (when confirmed illness is present that the medication can treat).

Antibiotics are expensive and using them needlessly would be of no benefit. Beyond this, once an animal is given an antibiotic, they must go through a withdrawal period and tested prior to using that animal again.

Additionally, many farmers feel it is unethical to not allow an animal to get a medication when it is sick. So if we’re talking about responsible treatment of animals, this is a big point to consider. Ultimately, appropriate use of antibiotics only when needed in humans and animals is important goal for doctors and farmers alike.

In the end, ignore the labels about antibiotics and hormones in animal products. They are all safe and healthy and all must pass the same standards to be able to be sold in stores.

“What about the environment – is one type of farming better for mother earth?”

Great question.

Turns out both types of farming have their merits and both have their pitfalls.

You see, farming in itself isn’t natural, but, it is necessary to feed our population. If we didn’t work the land, it would just go back to what it was prior (grasses and weeds).

But, since we have to work the land, it is important for all farmers to take care of their land.

And guess what, farmers do care for their land – it is in their best interest to do so! If they didn’t take good care of their land, they wouldn’t get good crops.

At this time, with typical methods of farming, there isn’t one clear winner in regards to the environment.

In conventional farming,  modern technology has made farming so much easier and better for the earth. The use of refined synthetic chemicals (remember this allows us to use less chemical with less side effects) along with GMO crops (see below for more on this) allow conventional farmers to have more yield for less – this is great for responsible use of resources and guaranteeing enough product to feed the masses. Also, since conventional farming uses no-till farming more, there is less soil loss and run-off (organic typically needs mechanical weed control requiring tillage).

Organic farming on the other hand does tend to take more land to achieve the same yields as conventional farming. It therefore use more resources as well – these facts put organic farming at a disadvantage in regards to environmental impact.

Both types of farming can use crop rotation and integrated pest management to be conscious of the environment.

“I’ve heard GMOs are bad. I should avoid them, right?”

This is a myth that is SO important to debunk.

GMO Lettuce? www.foodinsight.org
GMO Lettuce? www.foodinsight.org

GMOs (genetically modified organisms) are products grown that were altered in the lab in some way.

This process is done with the help of expert scientists and takes time to perfect and test before it is brought to the public.

What it has allowed is for is helping crops to resist disease on their own, use of less pesticides, and making crops more hearty to survive harsh growing conditions.

GMOs are an amazing advancement in food technology and have already saved certain foods from existence – look up the rainbow papaya if you’re curious.

Currently, certain foods are facing extinction secondary to disease – such as banana wilt in bananas – but, if we can find a way to alter the plant’s genetics in the lab to resist this disease, we may continue to save these crops – and our food supply.

Additionally, in countries around the world many conditions could be prevented or halted with certain nutrients that may be hard to come by.

By adding nutrients to foods with genetic engineering, we can prevent disease. An example of this is added vitamin A in golden rice to prevent blindness.

So, in reality, GMOs are something to be celebrated, not feared. So please ignore the scary headlines and pesky “made with non-GMO ingredients” labels – GMOs are safe and should be supported.

“Which is more nutritious: organic or non-organic (conventional) food?”

This is pretty easy to answer actually: they are equal!

There are no nutritional or health benefits to either type of food. Research has shown this.

Some foods that are genetically modified can have added nutrients into them but if you don’t count these, conventional and organic foods are equally healthy. An example of this GM type of crop would be golden rice that has added vitamin A to help prevent blindness from nutritional deficiency.

Why is organic more expensive?

“So you’re telling me that the organic label is no healthier, can still use chemicals, doesn’t mean something was raised more responsibly and isn’t better for the Earth – then why the higher price tag?”

Organic farming traditionally requires more land and resources – this costs more.

Additionally, the organic label is what people perceive as better so they can charge a higher premium for those products.

In the end, in regards to nutrition, safety, the environment and respectful farming, the label doesn’t mean anything other than how it was grown.

The bottom line:

The next time you’re at the store wondering whether it’s worth the extra 30% cost (or more) to pay for organic products, you can feel better knowing what the label means.

Make sure to keep your family healthy with multiple types of foods in moderation with a diet rich in fruits and vegetables that you can afford and that look good to you.

Skip the label worry and buy what is fresh and tasty!

Wash all your produce prior to consumption.

If you still are concerned, talk to your farmers about their products or ask your grocer who they buy from.

You’ll likely find a family farm behind the choices at your grocery store who wants what is best for their family and yours too.

Happy eating!

Learn more about GMO and organic versus conventionally grown foods:

General buying considerations

Safety of Pesticide Use and Regulations

Hormones

Environment

GMOs

Health

Starting Solids

Many parents are excited yet apprehensive about starting solids with their infants. So many questions… so many fears. Many food introduction guidelines have changed in recent years. What you did with your older kids might not be following current recommendations.

Back in time

I first published a version of this in 2011, and I still hear so much confusion.  It was actually Dr. Phil Boucher’s blog Why Is Introducing Baby Foods So Complicated?? that made me recall my blog and look to see when I wrote it.

Sadly, despite the time lapse of over 5 years, the American Academy of Pediatrics continues to have what I feel is a confusing message. On one line they say a baby may be ready at 4 months, then they say about 6 months. No wonder parents are still confused!

Starting solids
https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

Parenting is hard

Yes, there are things about parenting that are hard. Watching kids hurt. Letting kids make mistakes without coming to their rescue and knowing when it’s time to step in. Sleepless nights with crying infants and sick children.

But there are times that parents make it harder than it needs to be. Not only with feeding, but I think parental anxieties bring us to over think too much. (Yes, I’ve been guilty of this over the years too.)

The stay at home moms are made to feel guilty that they aren’t showing their kids an independent female role model. But the working moms have the guilt of missing milestones and other events.

We have the Mommy Wars about breastfeeding and formula. If you don’t breastfeed, you’re made to feel guilty. Unless you breastfeed too long, then you’re made to feel guilty. If you use formula… never mind. This isn’t really about the Mommy Wars.

We need to stop inventing things to be guilty about. Stop trying to perfect parenting and just enjoy the moments. (And for those moments you can’t enjoy yet, like the poop all over the wall… wait for it to become a funny story to embarrass the older version of your toddler.)

Feeding “Rules”

Old Rules for starting solids

The older “rules” for starting solids were so confusing… different sources will vary on these rules.

  • Don’t feed before 6 months
  • Don’t give nuts, eggs, and other “allergy” foods until ___ (2/3/5 years, varying by expert)
  • Don’t start more than one food every 3-5 days
  • Start with rice and other whole grain cereals, then add vegetables, then meat. Save fruit for last.

Variations of this were plenty, depending on the provider’s preferences.

No wonder there is so much confusion!!!!

New Rules for starting solids

New rules are much easier.  I like easier.

  • Start healthy new foods between 4 and 6 months, when your baby shows interest and is able to sit with minimal support and hold the head up.
  • Don’t give honey until 1 year of age.
  • Don’t give any textures your baby will choke on.

Done.

That’s it. Nothing fancy.

Any foods in any order.

Nothing too salted. Try nutritious foods, not junk.

Common sense (and your baby’s response) will hopefully guide types of foods.

Don't make starting solids with your baby too difficult. When they're ready give healthy foods and follow a few rules.

What about food allergies?

Research does not support the thought that starting foods earlier lead to allergies.

In fact, there is research to support that starting foods, specifically peanuts, earlier might prevent food allergies. A full 180 degree change!

Pregnant women and breastfeeding mothers no longer have to avoid nuts or other allergy foods in most cases.

If there is a close family member with a food allergy, it might still be beneficial to wait to introduce that food. There may be a risk to the person with the allergy if Baby shares saliva laden with the allergen, and Baby might be higher risk of having a reaction. Of course, early introduction might help to prevent your baby from developing an allergy, so it is complicated. Talk with your pediatrician and possibly an allergist if a close family relative is allergic to foods.

I admit that I was initially nervous about telling parents it was okay to give nut products in infancy. Not just the allergy aspect, but also choking risks. Nuts are hard and round– two no-nos. Peanut butter is thick and sticky– another choking risk. I have a blog devoted to introducing peanuts safely.

Any of the more allergy prone foods should first be offered in small amounts at home. These foods include nuts, egg, and fish. Do this only if there is no one in your house who is allergic to that food. Have diphenhydramine allergy syrup around just in case, but remember most kids are NOT allergic, and starting younger seems to prevent allergy.

What about saving the fruit for last so they don’t get a sweet tooth?

Babies who have had breast milk have had sweet all along! Breast milk is very sweet, yet babies who are graduating to foods often love the new flavors and textures with foods.

Formula babies haven’t had the sweet milk, but they can still develop a healthy appreciation of flavors with addition of new foods.

I tend to find that most babies prefer bland foods initially. Vegetables, meats, and whole grains are pretty bland. Babies are not used to strong flavors, so they don’t like fruits or fruit juices. (I don’t recommend juice.)

Saving fruit for last simply doesn’t seem to make a difference for long-term flavor preferences.

Fruits should be added after or along with other foods to give a balance of nutrition.

The more colors on our plates, the healthier the meal probably is!

I thought they couldn’t have cow’s milk until after a year…

Cow’s milk is not a meal in itself (like breast milk or formula). It’s missing many vitamins and minerals, so babies need to continue breast milk or formula until at least a year. If they change to regular milk (whole, 2%, skim, organic or regular) they are at risk of nutritional deficiencies.

Milk products, such as cheese and yogurt can be given to babies as part of an otherwise well-rounded diet as long as they don’t show any allergy risks to milk. If they have allergies to milk products, talk to your pediatrician.

Regardless of dairy intake, it is recommended for infants under 6 months to have 400 IU Vitamin D/day and those over 6 months to take 600 IU Vitamin D/day as a supplement.

I thought they should have cereal first…

Rice cereal has been the first food for generations, probably because grandma said so.

There has never been any research supporting giving it first. With white rice and other “white” carbohydrates under attack now, it is no wonder the “rice first” rule is being debated. Despite being fortified with vitamins and iron, it is relatively nutrient poor, so choosing a meat or vegetable as first foods will offer more nutrition.

Shouldn’t we wait on meat?

Waiting on meat due to protein load was once recommended, but no longer felt to be needed.

Pureed meats (preferably from your refrigerator… baby food meats are not very palatable) are a great source of nutrition for baby!

Some experts recommend meat as the first food due to its high nutritional value and low allergy risk.

How do we recognize symptoms of allergy?

I know so many parents who worry about allergies that they hesitate to start foods.

First, most kids are not allergic.

Second, introducing foods earlier helps prevent allergies, so when parents wait due to fear, they are increasing risk.

Allergy symptoms can vary and often are not specific
  • dry skin (eczema)
  • runny nose
  • hives
  • swelling of lips
  • difficulty breathing
  • vomiting
  • diarrhea
  • blood in the stool

If your child has one of these reactions we can test to see what the offender was. While testing is possible, it is not always recommended.

For possible food reactions that are mild, such as eczema or runny nose, schedule an appointment to discuss this with your doctor.

Significant reactions of anaphylaxis, such as lip swelling, extensive hives, or difficulty breathing are rare, but deserve immediate evaluation and treatment.

When’s the best time for starting solids?

This question has many variations… Will foods help baby sleep through the night? If we start foods before 6 months will it cause obesity or diabetes? Does starting wheat lead to gluten sensitivity?

It’s also one of the most difficult to answer because the American Academy of Pediatrics isn’t clear in their recommendation (as shown above). The American Academy of Allergy and Immunology is a bit more clear, but is not where pediatricians look for guidance primarily.

Your baby may be ready for starting solids if he/she:
  • is at least 4 months of age (in term babies, later in premature babies)
  • has the ability to sit with minimal support and hold their head up
  • shows interest in food by reaching for it and opening mouth as food approaches

You can wait until 6 months to start foods, but some studies show poor weight gain and nutritional balance as well as resistance to foods if started after 6 months.

Starting foods before 4 months is associated with obesity and diabetes. In formula fed babies the risk of obesity increases by 6 times at 3 years of age if foods are started before 4 months of age. That risk is not seen in exclusively breast-fed infants or those who begin foods after 4 months of age.

It is still an old wives’ tale that starting solids will help baby sleep through the night. Babies tend to sleep longer stretches at this age, so it is no wonder that this myth perpetuates. Start foods because you see signs that baby is ready, not because you want longer sleep patterns!

How do I know how much to feed my baby?

Babies will let you know when they are full by turning away, pursing their lips, spitting out food, or throwing foods.

As they eat more food, they will need less breast milk or formula.  In general a baby who is gaining weight normally will self regulate volumes.

What’s better: baby foods bought at the store or home-made foods?

This is a common question, but I think it’s the wrong question. Homemade and store-bought foods can be either nutritious or not nutritious. It’s more important that it’s a healthy food. In general healthy foods are fruits, vegetables, legumes, nuts, eggs, meats, and whole grains.

Marketing and ease of preparation has made pre-prepared foods for us all common place. It does not mean they are any better. They cost more than home-made foods and often contain unhealthy additions, such as sugar.

I didn’t make baby foods when my kids were babies because I thought it would be too hard. As my kids got older, they started limiting vegetable  intake despite loving them when they were younger. I began to puree foods to put into recipes. It really isn’t hard.

Take whatever you’re cooking for your family and put the items in a food processor or blender before adding a lot of salt and spices. Add a little water, breast milk or formula to get it to a texture baby can eat. Voila! Home made food. There are of course many baby food cookbooks and online recipes. You can freeze meal-sized portions so you can make multiple meals at one sitting.

There is help for parents who want to safely prepare baby food at home on How to Make Your Own Baby Food from What to Expect.

Baby led weaning

Common questions about finger foods include:

  • My baby only wants table foods. Is that okay?
  • Don’t they need pureed foods first?
  • He doesn’t have many teeth! How can he eat foods?
What is baby led weaning?

Baby led weaning is a process of starting solids that allows babies to start finger foods and self feed.

There are many benefits to finger feeding. Babies use and develop fine motor skills while finger feeding. They can learn what the foods look like as they associate flavors and textures of various foods. You can also name the foods, so they learn vocabulary as they eat.

Baby needs to be willing and able

Pureed foods are what most babies start with due to the easy texture, but some babies want to feed themselves. If they are able to get the food in their mouth, move it to the back safely with their tongue, and swallow without choking, they are ready to feed table foods… at least with some textures. Beware of chewy or hard foods as well as round foods ~ these all increase the risk of choking.

You don’t need to wait for teeth!

Most babies will be able to eat table foods between 6 and 12 months. They tend to not have molars until after 12 months, so they grind with their gums and use all their saliva to help break down food. They need foods broken into small enough pieces until they can bite off a safe bite themselves.

Minimize choking risks

Don’t put the whole meal on their tray at once… they will shove it all in and choke! Put a few bites down at a time and let them swallow before putting more down. Rotate food groups to give them a balance, or feed the least favorite first when they are most hungry, saving the best for last!

This is a great time for parents, sitters, and other caregivers to take a refresher course on CPR in case baby does choke. Infants and young children are more likely to choke on foods and small objects, so it is always good to be prepared!

Don’t overdo spices, sugar, and salt

Avoid giving the exact same foods as the rest of the family. Babies should have limited salt and spices. More on honey below…

Read labels to see how much sugar is in packaged foods. Don’t add extra sugar, honey, or agave to their foods. They don’t need things sweetened!

Let them enjoy the real flavors of foods.

Want more information?

For more on baby led weaning, check out Sarah Remmer, RD’s blog, Baby-Led Weaning: 5 Things You Need to Know Before You Start

How much juice should my baby drink?

I think babies don’t need juice at all. They can practice drinking from a cup with water.

Juice adds little nutritional value and a lot of sugar, even if there’s no added sugar. Eating fruit and drinking water is preferable.

See New Juice Guidelines for the current AAP juice recommendations.

What about organic? 

This is a fantastic question, but you’ll have to wait for the next post to see the answer. I have asked a fellow pediatrician, Dr. Nicole Keller, to help with this common question. Stay tuned. (It’s here!)

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