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	ask the experts linda folden palmer

Linda Folden Palmer, DC
Healthy Parenting and Nutrition

• Trisomy 21 restless sleeper
• Vegetarian prenatal vitamins
• Child heartburn
• Skim milk versus whole milk
• Omega-3 Fatty Acids in Toddlers
• Meat for Babies
• Baby Showing Interest in Solids
• Honey for Babies
• Raw Milk While Breastfeeding
• Protein Needs During Pregnancy
• Wheat Intolerance
• Asthma: Nutritional Advice
• Colic
• Chronic Constipation
• Supplementing with Formula
• Fluoride for Children
• Improving Immunity
• Iron Supplements for Breastfed Babies
• Growth Charts for Breastfed Babies
• Pacifiers
• Attachment Parenting and Baby's Health
• Picky Eater
• Cow's Milk for a Toddler
• First Foods for Baby
• Hyperactivity
• Burping a Baby
• Goat's Milk

My son Braden was diagnosed with trisomy 21 from birth and is an extremely restless sleeper. Is this normal, and is there anything my wife and I can do to help him and ourselves get a good night 's sleep?

Yes, this seems to be pretty common with Down syndrome. You will want to be sure your baby's doctor has checked that an enlarged tongue or large adenoids are not partially obstructing his airway while lying down. Be sure he is not reacting to foods in mom's breastfeeding diet, such as animal milk or soy; eliminate potential allergens and see if he improves.

Reflux is way over-diagnosed and is usually caused by food intolerance, but in the case of your child's challenge, it is more likely that an extra-weak gastroesophageal sphincter is allowing excessive acid reflux. You can pretty much determine this by seeing whether he's happier eating and napping when partially upright—as opposed to lying flat—and by providing much shorter and more frequent nursing sessions.

Find out whether or not he sleeps better when snuggled up with a parent. Down syndrome children tend to be highly receptive to affection, though some neurological challenges may cause restlessness; he may find contact too stimulating. I know one neurologically challenged child who slept best in an electric vibrator chair (no, it's not very green) as he seemed to just have too much neurological input going on to be able to settle. Vibration sense reaches the brain faster than many pain and other nerve impulses, dampening their impact. Parents are finding all kinds of ways to improve the development of their trisomy 21 children. I'm sure you have found your way into some support group by now, but do look specifically for those who are seeking, experimenting with, and finding optimal dietary and neurological input answers.

I have been doing research on vegetarian prenatal vitamins and looking for more natural whole food vitamins. I found one that I like called New Chapter Organics - Perfect Prenatal. Is it safe to have fermented soy and dandelion in your vitamin?

You sure found a delightful product. I wish there were choices like these when it was my turn.

I don't see any concern with dandelion; it is among the herbs commonly recommended for pregnant women.

Concerns about soy are hyped. Fermenting soy eliminates most of these [concerns], and the amount of soy in this supplement is very small anyway. It’s a good food for the great bacteria and fungi in this product. (Saccharomyces cerevisiae is a valuable fungus while most probiotics are bacteria.)

In this supplement, other valuable foods are fermented, which makes their nutrients highly available as well as provides a wide spectrum of probiotics and antioxidants. On the other hand, I’ve never heard of fermenting herbs that are normally sought for their actions in their whole forms. I imagine that culturing could neutralize some of their herbal actions (I may be wrong), [but] this would not be harmful.

Let's look into the key nutrients thought to be in a prenatal supplement today. The spectrum and levels of vitamins and minerals look great overall. There's lecithin for choline. There's plenty of folate, which is the natural form of the synthetic folic acid we hear so much about in terms of preventing neural tube defects.

You can see clearly that the vitamins are not a source of calcium and magnesium, but this is appropriate. For one reason, iron is more difficult to absorb when taken along with calcium. A second reason is that the recommended amounts of these minerals are so much larger than other nutrients that, when included in multivitamins, they make for very large tablets or doses.

If you are eating a diet that's high in green vegetables, beans, and maybe some molasses, [then] you’re getting plenty of calcium and magnesium. To be sure [you are getting enough], you may want to [take] a separate supplement for these while you are pregnant and nursing, just as you take prenatal vitamins to "be sure" about other nutrients. When one is not consuming dairy products, sodas, or high amounts of salt or meat, then the daily amount of calcium required is actually much less than the constantly rising US recommendations, which are far higher than World Health Organization recommendations.

Prenatals often have double the iron found in the product you've selected. I disagree with this high provision; the New Chapter product has a much more reasonable, still ample dose. Nearly every healthy food you eat is going to provide some iron. There are negative consequences to consuming too much iron. Studies show that these effects are pronounced in infants, so I would be concerned about a fetus as well.

In addition to this product, you will want to take DHA/EPA, omega-3 fatty acids. Good vegan sources are available. Studies on brain development in babies born to mothers on various diets and supplement plans show measurable benefits for good DHA consumption levels but not when just the precursors, found in flax and walnut oil, are consumed.

I’d give the product you found two thumbs up.

My five-year old seems to suffer from heartburn. He's also a picky eater. Any common issues that might be causing his heartburn? He was not a fussy baby, by the way. What strategies do you recommend to manage heartburn in children?

I'm going to assume that your son's problem is not smoking, excess caffeine, excess stress nor pregnancy. That leaves what is the most common cause of acid reflux: food intolerance. Your son's picky eating is a good clue too. Obesity is often another link to heartburn, while food allergy can be the cause of both of these.

It sounds as though your son was not food allergic as a baby—but a child can develop food intolerances at any age. Sometimes extended antibiotic usage or gastrointestinal illnesses can cause food intolerance to begin. Sometimes it's the maturing immune system or just plain genetics. Sometimes the pain is in the stomach or duodenum and is not actually reflux into the esophagus, but the cause is the same.

Cow's milk is the most common agent while other possible food reactions need to be looked for as well. Lactose intolerance leads to gas and some discomfort but not usually burning discomfort and other symptoms. It's the proteins in cow's milk that the stomach and small intestine react to; sometimes leading to acid reflux, other times diarrhea, rashes or behavioral reactions. You need to watch out for the ingredients casein and whey when reading labels. Many are fooled because these are usually added to "non-dairy" products and vegetarian cheeses (look for vegan). Usually one who is intolerant of cow's milk proteins will eventually develop the same difficulty if switching to goat's milk.

A child will instinctively try to avoid foods that cause irritation or reaction, but when foods are mixed and various ingredients are hidden in foods, it's difficult for the body to know what to avoid. You'll probably find that he's more comfortable when avoiding citrus fruits, strawberries, spicy foods and onion and garlic (especially when raw). These healthy foods can lead to discomfort in a digestive system that's already irritated by food allergy or other cause, as can soda. White flour and sugar neutralize acid on contact and tend to reduce the gastrointestinal burning sensation for a while. Other times a child will simply not want to eat because of digestive discomfort. It's easy to see how a picky eater can be created by intestinal food reactions. A poor diet often results, probably intensifying the body's tendency to react to foods.

Be sure your son is receiving fish oil supplements or another good source of DHA and EPA, and not just the omega-3 precursors. These may help reduce his tendency to react to foods. Strong antioxidants are often anti-inflammatory as well and may also help limit food reactions. Grapeseed extract is a good one to try. Regular use of probiotics can help reduce food reactions as well.

The marketing of newly developed acid reducing drugs (proton pump inhibitors such as Prilosec), has created a lot of hype about gastroesophageal reflux. The word "disease" has been added to the phrase and GERD is the new mantra, leading to an incredible number of prescriptions for babies, children and adults. Even when a hiatal hernia or such is found, it still doesn't necessarily cause this GERD. There's usually a reason the reflux is occurring and it's usually the diet.

Should you try these drugs? Well, a study of proton pump inhibitor use in babies reports that while the drug reduces the acidity of the stomach, it does not reduce any of the symptoms: the vomiting, colic, signs of pain, slowed heart rate or impaired breathing episodes associated with the diagnosis of GERD in infants. Another study suggests that GERD diagnoses are very random; that the symptoms do not correlate well among those diagnosed. A review of multiple studies over ten years concludes that GERD drugs are no better than placebo, and finally there's a study showing that these GERD drugs increase intestinal infections and pneumonia. Without even getting to the side effects, I'm hoping I've convinced you that modern reflux drugs may not be the best answer. Still, a short-term usage of these helps some to heal when their damage is very progressed.

The older acid reducing drugs, H2 blockers like Zantac, actually block part of the biochemical food reaction process and some people who believe they are getting ulcer or reflux relief with these are actually enjoying reduced immune reactions to milk and other foods. So, some children do find help with H2 blocker drugs, but remember that removing the cause (diet or other) makes much more sense.

Allergists will test for IgE reactions to foods and may tell you that your child has no food allergies. Even IgG blood studies have a large number of false positives and false negatives. Those who study food allergies know that IgM, T-cells, TGFb, TNFa and many other immune system components and peptide residues are involved in various reactions. Removing suspected and commonly offending foods from the diet and then challenging the child with these foods again is the only way to really know what your child reacts to and to thus know how to help him.

Some good years of avoiding the foods that cause intestinal reactions, improving the diet and sticking with certain supplements may result in a child "growing out" of some of his food allergies.

I have read that the American Heart Association now recommends not giving children older than two whole milk, but rather skim milk. My daughter is three and healthy and we do not give her juices, candy, desserts or other sweets/junk food. Isn't the fat in the milk still healthy for her development? Is there any reason we should consider changing the type of milk we give her, from whole to skim?

The standard dogma about cholesterol, saturated fats and heart disease has been debunked by science for some time now, but it takes a long time for various factions to catch-up. I don't know what the motive is for the AHA advice to remain so behind the evidence, but I imagine there are political reasons or financial ties of some kind.

The evidence is growing that animal milks are likely healthiest when closest to their natural forms, and there are valuable nutrients in milk fat. Many cancer and heart disease studies examining milk consumption find skim milk to be the most-implicated in any possible links to these diseases (while yogurt, cheeses, and other fermented milk products show no links to these diseases). Very little research exists on raw milks yet, but it appears they are more healthy than processed. The fat is the portion of milk where toxins are stored so you want to look to organic sources when possible.

Fats to avoid? Avoid hydrogenated vegetable oils like the plague. Reduce the use of omega-6 fatty acids some, including corn, soy, safflower and sunflower oils. Monosaturated oils found in olive oil, nuts and avocados are great. Increase omega-3 fatty acids from sources like walnuts, flax and salmon and maybe provide fish oil or algae-derived DHA and EPA supplements.

Dietary induced vascular damage can be found at very early ages. Restricting trans fats and feeding plenty of vegetables will reduce heart disease risks, regardless of the amount of saturated (non-trans) fat and cholesterol consumed.

I well understand the benefits of EPA and DHA for children and adults, but how about toddlers? Our daughter has been breastfed up until about 13 months, and is now on solid foods. If they are a good idea, how may we best introduce our toddler to these supplements? Do you have any recommendations for what types and how much supplementation of these types of oils such as flax, DHA and EPA?

Yes, it is a good idea to consider these omega-3 fatty acids in toddlers. The neurological, anti-inflammatory and heart-health benefits of these are shown from infancy through old age.

As you know, flax oil and other vegetable sources do not contain DHA or EPA, only their precursor, alpha linolenic acid (ALA). ALA can convert to DHA and then EPA. While this conversion is about 20 to 30% efficient in healthy adults, the conversion is not very efficient in babies. Breastfeeding babies will get DHA and EPA from mother's milk, depending upon the quality of the fatty acids in mother's diet. When breastmilk consumption has gone down or ended you can depend partly on an ALA source but it's healthiest to have a direct source for DHA in a young child's diet. The only good direct sources for these are marine sources or flax-fed hen eggs.

There are some concerns that too much EPA in infants can prevent DHA from being incorporated well into developing nerve tissues. Some infant nutrition studies are using DHA only. Since EPA occurs in breastmilk and definite value is found for EPA in adults, I would still want to see some EPA supplemented to young children. Breastmilk is 4:1 DHA to EPA. I would take this as a good ball-park indicator of toddler needs.

While fish oils are a great source for DHA and EPA, most have twice as much EPA as DHA (fine for an adult). It's probably not that easy to get a young child to swallow a fish oil capsule anyway. Cod liver oil has slightly more DHA than EPA and may be a better source for part of their supplementation.

Where can you find DHA only? Most of the new flax-fed hen eggs contain DHA only and are easier to get down a child than cod liver oil. An infant under 12 months (where allergy can be a concern) can be given only egg yolk. There are a few child foods now, such as a couple brands of yogurt, that are supplementing DHA. Also, some of the newer algae-derived vegan omega-3 supplements are DHA only.

So how much? Studies on the DHA and EPA benefits to breastfed babies in fish oil supplemented mothers find measurable improvements as those children grow, when babies receive a dosage of up to about .6 grams (600 milligrams) per day of these combined omega-3 fatty acids. Many experts recommend .25 to .5 grams per day for babies and children. Supplemented infant formulas provide .1 grams DHA daily with limited results at this lower amount. I think the .5 grams of combined DHA and EPA is a great target amount, and a little added source of ALA would be a bonus. You're only looking for an average daily amount. It's fine to have more one day and less the next, so if it's eggs one day and fish-sticks another, you can average out the totals.

One half teaspoon of cod liver oil provides .5 grams of combined DHA and EPA. (CLO also has high levels of vitamins A and D.) A high-concentration fish oil supplement provides .6 grams. Three ounces of pollock or tuna provide around .5 grams and 3 ounces of salmon provide around 1 gram. Two omega-3 supplemented eggs will provide .25 grams. Remember that other DHA supplements, such as the algae-derived or certain fortified foods are available.

If you wish to depend in part on dietary sources of ALA, the precursor to DHA, one half teaspoon per day of flax oil can provide enough ALA to convert to about half the amount of DHA and EPA wanted (assuming that a toddler has better conversion than a younger baby).

We've all heard that walnuts are a great source of omega-3's. While they're a very healthy raw food and good source of all the essential fatty acids, they have five times the omega-6 fatty acids as omega-3's so they don't go far in helping you to increase your percentage of omega-3's over omega-6's. Other nuts have only omega-6's.

It's easy to give oils by spoon or gel-cap in a child who will swallow these but this can be very challenging with many young children. Eggs work well in many families for part of the daily goal, but it'd take four eggs per day to reach the target amount. Fish sticks go over well in many children. Many of the grocery store brands are now made without hydrogenated vegetable oils but they concern me a little because they all seem to have various forms of msg in them. Seek out natural versions or make your own fish sticks at home (baked or fried) as better options. Some toddlers will eat tuna salad, but don't serve more than once a week, due to mercury concerns. You'll have to experiment with all of the choices to determine what sources will work best for your child.

We're not vegetarians, but choose meat carefully and eat it in moderation. When should we introduce our baby to meat and how? What kinds and prepared in what manner?

I'm no fan of grains as first foods. Veggies should predominate and meat is great as an early food. A breastfed baby has some risk for developing iron deficiency during their early transition to solid foods. Once any iron-containing foods are introduced, mom's delivery system of bound iron is hindered and new iron-hungry flora begin to grow. Hence, first foods should be high in iron, and meat fits the bill nicely.

You can feed meat as soon as you are committed to solid foods. Allergies to meats are very rare and meat provides some nutrients that are more difficult to obtain from a vegan diet. Meat should be moist and well ground until baby is a very good chewer. Low- mercury varieties of fish may be the most delicate and healthiest meat to feed. Be wary that seafood allergies are more common.

Just as for the rest of the family, the first choice for meats would be organic, grass-fed (for beef) and unprocessed. Avoid nitrates and don't allow high temperatures when cooking. While today's meat eating focuses on the flesh only, boiling bones and ox tails to obtain the gelatin broth provides very important nutrients for joint development and repair among other benefits. Organs are power packed with nutrients.

How much protein for baby overall? While your own diet may be around 20% of calories from protein, children should have under half of that percentage. Human milk has six to 11% of calories from protein and babies do their greatest amount of growth and development on this diet alone. Experiments in increasing protein in infant formulas have led to many problems. A current study shows that toddlers receiving more than 14% of their calories from protein have a greater chance of becoming obese later in life. Optimal protein would be in the ballpark of 16 to 25 grams per day depending on your child's size and appetite. A jar of babyfood meat has 10 grams of protein. Protein also comes from legumes, nuts, grains, eggs and milk.

My five month old is showing interest in our food, and tries to put it in his mouth. I have been thinking about starting him on food, but frankly I want him to continue breastfeeding for as long as possible. Will solid food decrease his interest in nursing? Does he need to have solid food by a certain age?

Once any foods or formula (or iron supplements) are added to the breastmilk diet, baby's immune protection is reduced. Of course this change is inevitable but it's usually preferable to delay the event. Still, baby knows best. Some are very eager for other foods early and handle them well. More often, the apparent interest in foods at five months is just curiosity about the things in his environment. Baby's mouth is his favorite tool of exploration.

No, solid food shouldn't decrease his interest in nursing. Many nurse for years in addition to solids. His milk intake will gradually reduce with increased caloric intake from other foods.

Does he need to have solid foods by a certain age? The recommendation used to be four to six months, but when it was discovered that breastfed babies fare better when solid foods are delayed to six months, that became the recommendation. Some will say that breastmilk is no longer complete nutrition after that age but I've never been able to discern just what nutrient it is that they think baby needs. Some say protein, but the recommended portion of protein intake for babies on solids is the same as in breastmilk. Nearly all studies on nutritional status with delayed solids are performed in populations where mothers themselves are malnourished. In this case, deficiencies arise.

Potential for iron deficiency is suggested to be one reason for needing solids at six months, however studies show that term infants exclusively breastfed to nine months usually continue to have good blood iron (hemoglobin) levels; often better than those who've begun solids. Iron deficiency anemia is more common in breastfed infants after solids have begun. For this reason, first foods need to be high in iron. Iron levels can always be tested if there is concern. On average, those who breastfeed exclusively for longer continue to have better iron levels than those beginning solids sooner.

Zinc is the other fret. Deficiency is uncommon with well nourished mothers. Some studies find zinc to be "low" in a portion of infants exclusively breastfed longer than six months but no symptoms are found, so the definition of low is questionable. Still, zinc testing is not easy so any slowing of growth may suggest a need for zinc supplementation or introduction of solids.

A baby who was born prematurely or small for gestation will have lower stores of zinc and iron to depend on and is much more likely to need these minerals added to his diet early. Frequent diarrhea can also lead to zinc and iron deficiencies.

Iron supplements to mom do not increase the iron in her milk. Zinc supplements might lead to a slight and gradual increase.

Let breastfed baby take the lead when it comes to solids but don't confuse exploration or teething with hunger.

So, what's the full scoop on honey? Last night my ten month old was begging as I was preparing a soothing cup of Sleepy Time tea with honey. Without even thinking I let him lick the end of the spoon. My husband asked me aghast. I then recalled hearing honey was a no-no for babies, but didn't know why. I didn't know who to call, poison control seemed a little extreme. So far there has been no visible reaction. Please tell me more about the effects of honey and if it's so dangerous for the younger population why there isn't a warning label?

The concern over honey is botulism. Clostridium botulinum bacteria are found in about 10% of honeys in the U.S. Consumption of these bacteria almost never affects an older child or adult, but the immature infant intestine seems susceptible to colonization of this bacterium. As the bacteria multiply, it releases a potent toxin, (have you heard of Botox?). This botulism toxin affects the nerve endings in the body, causing paralysis, and can lead to death. Not only in honey, the botulinum spores are very commonly found in soil as well as in the dust in vacuum cleaner bags. The greatest risk factor for infant botulism is not honey, but living on or near a farm. The chief risk is in the first 6 months of life. Of course, the incidence of botulism in infants is low and most babies exposed to honey or dirt will not develop clinical signs of botulism.

Studies suggest that the incidence of botulism may be greater in breastfed babies, although their cases prove to be milder and cases of sudden death from botulism are found chiefly in formula-fed infants. Some small percentage of SIDS is thought to be related to botulism. It is possible that the friendly breastfed infant flora may not compete well with botulinum bacteria, although the rate of growth must be kept in check by breastmilk. The iron in formulas causes a very vulnerable intestinal environment and may be the cause of the more-overwhelming cases in formula-fed or formula-supplemented infants.

Constipation, although a common finding in babies, can be an early symptom of botulism. If a baby develops constipation along with some weakness such as reduced ability to hold his head up or to suck, these symptoms should be brought to the attention of a doctor.

References:
S.S. Arnon et al., Protective role of human milk against sudden death from infant botulism, J Pediatr 100, no. 4 (Apr 1982): 568-73.

S.S. Arnon, Breast feeding and toxigenic intestinal infections: missing links in crib death Rev Infect Dis 6, suppl. 1 (Mar-Apr 1984): S193-201.

P. McMaster et al., Instructive case: A taste of Honey, J Paediatr Child Health 36, no. 6 (Dec 2000): 596.

J.S. Spika et al., Risk factors for infant botulism in the United States, Am J Dis Child 143, no. 7 (Jul 1990): 828-32.

I am a new mother of a 2 month old baby girl. I am exclusively breast feeding. Recently I have been doing some research about the benefits of drinking unpasteurized raw cows' milk. I was just wondering if there are any risks to my daughter if I choose to drink raw milk.

There is evidence that when a nursing mother consumes more good bacteria in her diet — the kinds found in yogurt — and some is found in raw milk — benefits to baby are measurable. Illness from infected raw milk is rare, and your breastmilk should provide good defense to any deleterious bacteria that possibly get through to your milk. I would probably exercise extra caution here in a small, premature, or otherwise weakened baby. One of the most worrisome bacteria from milk, Mycobacterium paratuberculosis (linked to Crohn's disease), is found even in pasteurized milk and it's possible that producers of raw milk would be more conscientious about eliminating this infection in their herds. You should know about the herd and producers of the raw milk you choose, as leukemia can also exist in raw milk.

The fats in homogenized milk are suggested to be unnaturally small and pass through the intestinal wall improperly. these could end up in breastmilk and would not exist in raw milk. After what we've learned about artificially hydrogenated fats I'm more suspect of homogenized fats. Unpasteurized milk is usually organic so there should be less drug and toxin exposure to pass on to baby. The excess calcium and phosphorous in all cow's milks are two components that are suggested as to blame for the increased incidence of osteoporosis among those who consume more than a serving per day of dairy products. Luckily, consuming greater quantities of these minerals will not alter the good balance of minerals in your breastmilk.

Bovine insulin is still equally present in raw milk. Exposure and reaction to this foreign, but very human-like form of insulin during early infancy is linked to the later development of diabetes. Some of the confusing diabetes studies comparing infants fed milk-based formulas to those fed breastmilk do not take into account the amount of dairy the breastfeeding mothers consume. I personally would avoid any diary products in the first couple of months of breastfeeding, for many reasons.

Soft raw milk cheeses can be dangerous and it's best to avoid these during pregnancy and early lactation. Brucellosis, listeria, salmonella and tuberculosis are all potential dangers here.

I feel overwhelmed and confused about all the conflicting info out there regarding optimal nutrition during pregnancy. I want to make sure I get enough protein, and yet feel concerned about the alarm about eating fish during pregnancy b/c of Mercury....(I eat only Salmon) and about eating too many eggs. I don't eat red meat or poultry. What is your advice on the best pregnancy diet?

Protein is important during pregnancy. Aim for 75 to 100 grams most days. Just calculate a few days' worth of menus and see if you are in the ball-park. There's no need to count protein daily when your diet is a healthy one.

Even though it's a bit out of vogue, I would work a little at combining complimentary amino acids (protein combining; like joining grains with beans) during pregnancy if you are depending chiefly on vegetable sources for your protein.

It is certainly easier to acquire all of the important nutrients when consuming some kinds of animal products, such as eggs and fish, during pregnancy and early lactation.

Let's look at eggs first. The chances of Salmonella infection are nearly null if the eggs are properly cooked. The various fats and fatty acids in eggs are beneficial for you and your fetus or nursling. The cholesterol in eggs is not going to contribute to heart disease. Artificially hydrogenated oils are the fats to avoid. Your concern may be for the suggestions that egg allergy in an infant may be reduced if eggs are avoided during pregnancy. If there is a prevalence of allergy in your family or the father's family this might be a consideration, but the results are very minimal and may not be worth the effort. Avoidance of potential allergens during breastfeeding has better results, but still may not be valuable unless the child is highly suspect or is already demonstrating intolerance symptoms. While dairy protein is the number one offender in food intolerance, there are so many potential allergens that it is difficult to predict what the child may react to if he is destined to react to foods.

Eggs are certainly a valuable protein source, as well as B12, choline, iron, and other important vitamins and minerals. As long as you're eating eggs, you may as well select those produced with enhanced omega-3 fatty acid levels.

Salmon is considered to have among the lower levels of mercury amid fish normally consumed. It's a good protein source and is extremely valuable for its omega-3 fatty acids (especially DHA and EPA).

So what about the mercury? Many studies have documented the levels of mercury being passed on to fetuses from fish in maternal diets and studies demonstrate adverse effects of high doses of mercury on small laboratory animal offspring. There is certainly evidence of human fetal damage when accidental high mercury poisoning of waters has occurred. The real question however is whether there are negative effects on human children from the usual levels found in ocean fish. Ocean mercury comes from natural sources as well as human pollutants.

A large study performed in England showed that when pregnant mothers consumed one to 4 servings of fish per week, their children performed slightly higher in language and social development than those of mothers who consumed less or no fish. While mercury levels measured in cord tissue correlated to levels of fish consumption, they did not correlate with developmental measurements. No association was found between mercury levels and birth defects.

A series of studies performed in the Seychelles found no association between maternal mercury exposure from fish and neurodevelopmental risks in children. Here the mercury levels in fish are similar to those in the U.S. and the average mother consumed 12 meals with fish per week. A similar study performed in the Faroe Islands, where marine animal consumption is also high but is chiefly whale (mammals), did find reductions in language and memory skills associated with mercury exposure. Some smaller, earlier studies have also found correlations.The most recent studies attempt to compensate for factors that were criticized as complicating the results in earlier studies. I feel comforted by the most recent findings in terms of mercury exposure from fish likely not posing measurable harm; or the benefits of the fatty acids outweighing any harm.

There are also laboratory studies showing that when mercury exposure comes from eating fish, the amount of mercury held in the consumer's body is much lower than when it comes from other sources. It seems apparent that the fish's own detoxification efforts influence the form of mercury exposure to the consumer of the fish.

Your body also has the power to partly detoxify mercury consumed. The bacteria in your intestines are valuable detoxifiers and when you keep a healthier flora, including regular consumption of pro-biotic bacteria such as acidophilus and bifidus as well as ample fiber, you will provide a better ground for detoxification. Vitamin B12 is necessary in this process. Highly nutritious spirulina (a blue-green algae) is shown to likely provide detoxification benefits. Anti-oxidants in your diet are helpful in this task as well. When you take antibiotics, your detoxification powers are greatly limited and you will absorb and retain more mercury in your body, allowing for greater exposure to the fetus.If your animal product consumption is low, vitamin B12 is your greatest nutrient concern. Yeast or yeast extract is an excellent choice, or you can take supplements. There is controversy over whether B12 is attainable from spirulina or not. Fortified products such as soy milk or breakfast cereals are helpful.

If you choose to consume dairy products, cheeses and yogurt are healthier forms compared to whole or low-fat milks. Non-pasteurized soft cheeses can contain dangerous bacteria.

Beyond your protein concerns, a high amount of dark colored vegetables and fruits will guarantee good nutrition. Although many studies show greater benefits from diet-supplied omegas than from supplements, take extra omega-3 supplements on days you don't eat fish (or flax or walnuts) to bring your total omega-3 intake to close to 2 grams per day.

Resources:
M.H. Berntssen et al., Higher faecal exretion and lower tissue accumulation of mercury in Wistar rats from contaminated fish than from methylmercury chloride added to fish, Food Chem Toxicol 42, no. 8 (Aug 2004): 1359-66.

T.W. Clarkson and J.J. Strain, Nutritional factors may modify the toxic action of methyl mercury in fish-eating populations, J Nutr 133, no. 5; suppl. 1 (May 2003): 1539S-43S.

J.L. Daniels et al., Fish intake during pregnancy and early cognitive development of offspring, Epidemiology 15, no. 4 (Jul 2004): 394-402.

A? G.J. Myers et al., Prenatal methylmercury exposure from ocean fish consumption in the Seychelles child development study," Lancet 361, no. 9370 (May 17, 2003): 1686-92.

H.S. Pan-Hou and N. Imura, "Involvement of mercury methylation in microbial mercury detoxication, Arch Microbiol 131, no. 2 (Mar 1982): 176-7.

I.R. Rowland et al., Effects of diet on mercury metabolism and excretion in mice fiben methylmercury: role of gut flora, Arch Environ Health 39, no. 6 (Nov-Dec 1984): 401-8.

My 6 year old daughter has a wheat intolerance that causes behavior changes and skin reactions. The reactions occur within a few hours and are generally gone in a day or two. Would you expect her to outgrow this condition?

The longer a child has held on to their food allergy or intolerance, the less likely it is that they will be out-growing the condition. At age 6, there is still a fair chance that she'll lose the sensitivity. She may be challenged by wheat consumption throughout her life though.

There are many positive studies about the regular use of probiotics, (acidophilus and other bacteria), and regular consumption of omega-3 fatty acids, (as in fish, walnuts, and flaxseed), for reducing the reactions in food-allergic individuals. these are definitely worth exploring if you haven't already. There is some evidence that total avoidance for a good long time will improve one's chances of losing a sensitivity.

It may be important for you to characterize your daughter's reactions as well as you can. You may wish to determine, on one hand, whether there is any intestinal involvement, and on the other hand, whether any breathing difficulty could occur with exposure; possibly when coupled with exercise.

There is one study, (Sazanova, Pediatriia,1992;3), that keeps me very concerned about food reactions that seem to be only in the skin and other upper-body areas. This study found that in 100% of children who were thought to have only skin reactions (eczema), there was inflammation and damage in the intestinal linings as well. I have yet to find another study that attempts to confirm or deny this finding, although many studies report stunting of growth and other types of symptoms occurring in children with eczema. Intestinal damage and malabsorption would be the best explanation for these findings.

The delay in reacting and the behavior changes that you observe lead me to think more in the direction of a gastrointestinal involvement in your daughter. If she has loose or irregular stools with greater wheat exposures, this picture is even more likely. While some may decide to put up with a little rash now and then in order to experience a special treat, there may be greater health ramifications to that decision if the intestines are involved.

There are many different proteins in wheat that one can react to, and various means of reacting. Current tests available are not adequate in diagnosing many wheat reactors. If the child has been avoiding wheat by nearly 100 percent for quite some time, expect any tests to be negative.

Gluten sensitivity is under-recognized and is my chief concern. Gluten protein is found in wheat, rye, barley, spelt, and kamut. At some level of this sensitivity the condition is called celiac disease. Sufferers can experience reduced absorption of important nutrients and consequential health problems. The medical community recognizes full-blown celiac disease through various tests when one is quite ill and not avoiding gluten. At the other end of the spectrum, they easily acknowledge anaphylactic wheat allergies (where breathing becomes restricted). There is an entire gamut between these that are not well recognized medically and for which there are not reliable tests; so the real testing is up to you.

The first step is to determine whether your daughter tolerates barley and rye well by feeding her these in increasing dosages. It may take many introductions before a reaction is recognized. Oats fit into this category as well, but are more-weakly reacting. Watch for your child's usual reactions and also watch her stools for any changes from her normal. If your daughter is found to be reactive in any way to these other gluten-containing grains then she most likely falls into the gluten-sensitive picture. Intestinal involvement is pretty certain here, and avoidance of all gluten is very important for optimal health. There are many potential health problems associated with allowing regular gastrointestinal reactions to occur. Gluten sensitivity is more-often lifelong.

If your daughter seems to be totally fine with the other gluten grains, and you do not notice any hints of intestinal involvement, and you've never noticed any swelling in or around the mouth or alteration in her breathing, the outlook for her future ability to consume wheat may be much brighter, especially when coupled with other health-promoting efforts that may help to reduce her body's decision to react.

My 2 1/2 year old son has Asthma. Do you have any nutrition advice for a?child with Asthma?

A significant portion of asthmatics have allergies, either airborne, food-related, or both. these allergies can trigger their attacks, often with the added stressors of physical exertion, smoke, or otherwise poor air quality. It can be very valuable to determine whether the asthmatic child is being affected by food allergies or food intolerances, as some of their need for dangerous drugs can then be removed by simple food avoidances.

Generally if food reactions are involved in a child, there will be some other symptom as well. Frequent presence of rashes (even mild ones), diarrhea, constipation, bedwetting, sleeplessness, or abdominal pains can be indicators that should alert one to investigate food links. Ulcers (flat spots) on the tongue or an "allergy ring" around the anus are two other signs. The most commonly offending foods are dairy, wheat, egg, soy, corn, and peanuts, but any food could be a trigger in any given child.

Laboratory blood or scratch tests for reactions to foods are only mildly diagnostic. All tests can be negative in a child who has definite food reactions. Elimination dieting is the optimal means to finding reactive foods in the diet. This process is somewhat more complicated in an asthmatic child, as he needs to be protected during the process from possible airborne reactions, and from excess activity. If the child is also allergic to dust mites, animal dander, mold, pollen, or the like, his symptoms from these reactions can greatly confuse the food testing procedure. Providing antihistamines to remove these factors may also remove the food reactions you are trying to discover. You also want to eliminate sulfites, FD&C Yellow no. 5 food dye, BHA, and BHT in your dietary trials.

The next important key is to provide elevated levels of antioxidants to your child. It has been demonstrated that Vitamin C with bioflavonoids, and vitamin E can reduce the inflammatory process involved in asthma. Other antioxidants that are likely helpful as well are found in deeply colored fruits and vegetables.

Magnesium supplementation is purported to reduce the muscle contractions in the lungs that are involved in the actual asthma attack. This effect appears to be mostly because many asthmatic children are deficient in magnesium. Many asthma drugs reduce magnesium levels in the body, as do diets high in dairy products, and food intolerance reactions.

Studies have shown less asthma in children whose diets contain low amounts of meat or dairy. Additionally, the newest dietary discoveries pertain to the fats in the asthmatic's diet. Trans-fats have been shown to increase asthmatic reactions. these should be avoided as much as possible. Animal fats are in this category also, but are appearing to be a little less damaging than the artificially hydrogenated oils. Raising the proportion of omega-3 fatty acids has been shown to reduce asthmatic episodes. Sunflower, corn, and safflower oils are healthy oils, high in omega-6 fatty acids, but the goal is to replace many of these with omega-3 containing oils, such as fatty fish or fish oil supplements, walnuts (the only nut), and canola or olive oils. A spray of oil with a sprinkle of salt on bread is a simple substitute for margarine. Dairy butter is shown to be less bad than typical margarine in regards to inflammation reduction, but I recommend focusing on other choices. Cook with canola or olive oil. Use walnuts everywhere. Spread walnut butter on his whole grain bread or add a bit to whatever you bake. Use raw walnuts mixed with deeply colored dried fruits for snacks and even throw some walnuts in the blender with your child's rice or soy drink. Walnuts are a great source of protein, folate, and magnesium as well.

I have a 4 week old baby who presents a lot of the colic symptoms. I am wondering if I can help him through my nutrition. Are there things I should add or stay away from? I am a vegetarian who eats dairy.

While not usually a nutrient problem, diet is the number one cause of colic, whether it's breastfeeding mother's diet or baby's formula. You do want to be sure baby has been examined and had other possibilities ruled-out. A dietary trial is simple and safe and could bring some wonderful relief to your family. Foods that can cause gassy discomfort in general are hot spices, onions, garlic, and the cruciferous vegetables, which include broccoli, cabbage, and cauliflower. Some babies become colicky from caffeine or chocolate in mom's diet. You may wish to try a few days of eliminating these foods to see how your baby responds.

Beyond these generally irritating foods, some babies have food intolerances that will likely also be seen in their solid-food consumption later on. More often this baby will have rashes or abnormal stools as well as sleeplessness and crying. The most common offender by far is dairy protein. While many babies are intolerant of a few or several foods, it may be an easy starting place to have a trial elimination of dairy products in your diet. Please heed that if you aren't strict in elimination, your answers won't be clear. Read your cereal and bread packages for whey, look for casein in "non-dairy" products, and watch for butter and lactose too, as they can contain traces of the allergenic proteins. If dairy elimination doesn't do the trick, a more comprehensive elimination trial would be the next step.

If you or baby have any signs of thrush or yeast infection, efforts to eliminate yeast overgrowth in both of you may relieve the colic. While the white-coated tongue is rather common in babies, Candida is strongly related to intestinal upset and the perpetuation of food intolerances. In any case, a few drops of liquid acidophilus in baby's mouth daily may help with whatever is going on.

Deglycyrrhizinated licorice (DGL) may be too harsh for a baby to receive directly, but it might pass through your milk if you take it yourself. This herbal extract can sooth the tummy and also help to eliminate any possible H. pylori presence. You can also try drinking chamomile and peppermint teas throughout the day.

My two-and-a-half year old daughter has chronic constipation. it'started when she was 10 months old. She responds well to prescription?laxatives (Lactulose for one year and now Miralax) but continues to be?fearful of having a bowel movement. Without the laxatives, she would?withhold her stool for days. I feed her a great diet (lots of fruit, fiber, water) and am very loving when she expresses her fear. My question is when will she get over this? Is there a certain age when this type of fear fades away? Is there any way I can help her change this behavior?

"Lots of fruit, fiber, and water" sounds great. It's not that unusual for preschoolers to be resistant to having bowel movements. Your daughter's has gone on from such a very young age however that I believe constipation is causing her fear, more than the other way around. Beyond dietary trials (that I'm compelled to bring up below), and wondering how it all began, bowel training is the key now. (That's bowel training, not baby training.) The bowel needs to be allowed to re-learn and resume its normal patterns. Normally, peristaltic waves heighten in the bowel with the first introduction of food or drink in the morning, and with every introduction of substantial food or water throughout the day. Eventually, if allowed, the body develops a cycle with this pattern, sometimes moving the bowels at the expected time without even having the meal or drink.

Your daughter may be too young to want to try this technique with the toilet, although that would be the preferred choice if she's up to the challenge. Some children even prefer to urinate in the potty but produce stool in their diapers for many months longer. You can modify this technique for diaper or toilet use. Right after the first morning meal is the most important time to attempt bowel training. It should be tried again after most meals and larger liquid intakes throughout the day. Try to end a meal with a few extra sips of water, and then encourage your child to sit on the potty right after her meal. Let her know that you are not expecting her to produce stool. She only needs to sit there (or squat in her diaper) for maybe a minute or two. If she will, have her just try to think a little bit about her stools moving inside her, or have her try to make the "pushing them out" action just a little bit, so that her body can begin thinking about it.

If she will just sit on the toilet or squat in her diaper for a bit after a meal, then she has been successful and your delight at her success will encourage her. If she'll try to think about moving her stools or pushing a little, then she's been really successful. With a few successes every day, her body will hopefully ramp up its schedule of peristaltic waves and begin producing stool with her efforts. Remind her in your loving way how proud you are of her for trying to "heal" her body this way. Remind her also that when it heals, moving her bowels will not hurt or be difficult any more. If it works for your family style, try to go through the same bowel-training process along with her and let her see that it sometimes produces the end goal for you, and that you feel better then.

Some may disagree, but I believe that using sweet friendly language about little poopies wanting out and encouraging Mrs. Poopy machine inside her tummy will produce less fear than talk about bowel movements with an anxious child. Some even more creative stories might help.

Excess calcium in the diet can cause constipation. The calcium needs to be balanced out with magnesium, at 1/3rd the dosage as the calcium. Magnesium is barely present in dairy products, and this is one reason why some children on high dairy diets become constipated. Sometimes a magnesium supplement is all that is needed to relieve constipation. Sienna is an herbal laxitive, but can create dependence the same as prescription laxitives can. Slippery elm may be a helpful herb. Psyllium is the great regulator. It can be added to a healthy shake or made into a gel treat with gelatin and fruit juice. It also comes in crackers. I highly recommend using psyllium daily. I believe it should work as well as the Lactulose, but a little more naturally. I'm sure you have been told that the Miralax is more apt to cause dependence, but I know she needs it when she needs it. I recommend warm water enemas for babies, instead of drugs, but it may add to the fear at your daughter's age.

?I'm imagining that your baby's diet changed somehow at the age of 10 months, as this is a little young for a child to be choosing to hold her bowel movements on purpose. If one were to choose to withhold at that age, it would be because it is hard and painful already for some other reason. I have seen babies whose dairy intolerance (to dairy proteins not lactose), or other food intolerance has caused chronic constipation that ended when this food was removed from the diet. There are usually other signs as well when food intolerance is involved however, such as rashes or fussiness or alternating diarrhea. Some other foods can be constipating in some people. You may want to try some dietary experimentation.

Do I have to supplement with formula before a child turns 1? My 10 month old weaned herself from breastfeeding 2 weeks ago. She was exclusively breastfed for 7 months. She eats a well rounded organic diet and drinks enriched rice milk and water.

Your daughter certainly had a great start! Now that she's weaned, formula is a better choice than milk for at least 18 months. Not going with milk at all is a great choice. At 10 months, your daughter still has high nutritional needs. She's rather on the border for an age where I'd say yes, definitely use formula. Enriched rice drink is an OK drink, but it's not densely nutritious for the amount of carbohydrate provided. It should not be a major part of her diet. If it is, then replace it with formula. Water is great, because it does not replace more-nutritious calories. Herbal teas are nice too.

If your daughter chose to wean herself, she must have known inside that her present diet was very healthy for her. If her diet is high in deeply colored vegetables, some deep colored fruits, and beans and nuts (like almond butter), she's on a good course. Formula supplementation is a good means of providing her with nutrition-dense snacks, and a way of knowing that she's getting a good balance of nutrients. With good diligence, and a cooperative baby, you can go without at this age. If not using formula, I would feel more comfortable to see her receiving a daily multi-vitamin and mineral supplement. If her dark colored vegetable/legume/nut diet is very high, and she's receiving some animal products, then you could forgo this.

I have some concern, getting the impression that yours may be a more vegan diet (which I'm all for). Breastmilk is an "animal product" and baby is truly designed to require animal products for at least her first couple of years for optimal development. Balanced protein requirements are high at her age, and animal products have certain enzymes that promote digestion and absorption of various nutrients more important in infancy. Fatty acids are a very important concern at her young age. ARA (an omega-6 fatty acid) and DHA (an omega-3 fatty acid) are under the spotlight today, as researchers realize that the lack of these two fatty acids in non-breastmilk infant diets may be responsible for some of the slight neurological and visual deficits seen in formula-fed children. these fatty acids, found in fish, meats, and eggs, as well as breastmilk, are also indicated in reducing the risks for obesity, diabetes, and heart disease later on. I would strongly consider giving baby a daily egg-yolk for these important fatty acids, as well as proteins, B12, selenium, cobalt, and sulfur — all difficult nutrients to attain in a non-breastmilk vegan toddler diet. Egg whites are common allergens and you may wish to avoid these. If she' is not getting formula, meat, or egg yolk, do remember to provide a source of B12.

Give baby a source of Lactobacillus acidophilus and Bifidobacterium. these will help to keep her intestinal flora healthier, in the absence of breastmilk.

Is fluoride bad for my children? If so, where can I get toothpaste and?mouthwash without fluoride?

Like many micronutrients, fluoride exists in natural drinking water, and trace amounts are important to human health. Yes, supplemental fluoride is bad for children. Local fluoride treatment of the teeth, as with use of fluoridated toothpaste, is not harmful, as long as none is swallowed. It may even be a little helpful to the teeth. If the kids are swallowing any toothpaste, you likely want to buy a fluoride-free product. You can purchase toothpaste and mouthwash without fluoride at most healthfood stores.

Excess fluoride replaces some of the magnesium in bones, making them harder. The evidence is weak, but this might provide some advantage to teeth in small doses. This "hardness is detrimental however to the rest of the bones in the body. The important structural and limb bones become hard, as in brittle, losing their tensile or flexing strength. Bones containing extra fluoride look very dense on X-ray, but they fracture easily --- that's osteoporosis. With higher doses of fluoride, as in the child who swallows some toothpaste or receives fluoride supplements, and who drinks sodas and juices constituted from fluoridated water sources, dark staining and cavities appear in the teeth, and bones can become misshapen.

There is also evidence as to other toxic effects from fluoride, when it comes to the levels and the synthetic forms used today. No other health benefits of supplemental fluoride have been purported. Do make sure your drinking water isn't fluoridated.

My 5 mo. old daughter has been ill almost all her short life. She has had thrush since about 6 weeks, has gotten a stomach flu twice, and has had too many respiratory viruses to mention. Meanwhile, she is solely nursed, we do not use anti-bacterial soaps, eat primarily organic foods, and overall take care in our nutrition. What more can I do to increase/improve her immunity? I have heard conflicting reports regarding giving supplements to babies.

It sounds as though your daughter has a great diet and very healthy environment. Caution is certainly warranted in giving supplements to babies. For starters, supplementation of various vitamins and minerals can cause imbalance in absorption of other nutrients. An exclusive breastmilk diet from a well-nourished mother should provide her with a perfect balance of nutrients. A multi-vitamin supplement for mom may not be needed, but wouldn't hurt.

Do make sure baby is getting plenty of Vitamin D, either through mom's or baby's good sun exposure, or through mother's supplementation or fortified foods.

Some popularly recommended supplements could be harmful to baby's immune system. If you are giving iron to baby, stop as soon as her iron level returns to low-normal. Iron supplements or iron-containing baby foods block much of the immune protection provided by mother's milk. On the other hand, if you haven't had her iron level checked, maybe you'd want to. Anemia can cause frequent illness. The two most common causes of anemia in breastfed babies are immediate cord clamping at birth and irritated intestines from cow's milk proteins. Fluoride supplements will reduce her immunity as well and are unneeded.

You do want to be giving baby acidophilus for the thrush and the weaknesses that it creates. It can be purchased in liquid form. Choose one that has multiple kinds of flora and is non-dairy. You might find your daughter staying healthier if you try eliminating dairy from mom's diet and making sure no other foods in mother's milk are bothering baby.

Echinacea is a wonderful illness-fighting herb, but it's considered to be an oxidant and should only be used for treatment, not daily. Goldenseal can be given regularly for immune boosting. A liquid Vitamin C supplement with bioflavonoids for baby may be useful and won't interfere with baby's breastmilk-only diet as long as there is not dextrose or corn-syrup in it.

Garlic is a wonderful immune supporter that mom can consume regularly, as it passes nicely in the breastmilk. Make sure it's not disturbing baby, as some babies don't tolerate "large doses" of garlic.

Mold in discrete areas of the house is another possibility to consider, as is reaction to dust mites. Consider a major cleaning-out & drying-out, or try using a HEPA filter.

More immune boosters: Provide your daughter with lots of holding and skin-to-skin contact to encourage her natural immune system and reduce any stress in her tiny life, and try to avoid prolonged crying that goes unanswered.

My pediatrician has recommended an iron supplement including ?Vitamin A, C, and D, for my 4 month old who is exclusively breast fed. We did not do a blood test, but I was told that at 4 months of age, iron stores are low in breastmilk.A? I do not eat dairy since he is allergic to the cow's milk protein so I amA? worried about his nutrition.A? Do I supplement or not??

Exclusive breastfeeding, without supplements, is the best means of assuring good iron levels in baby. Studies on exclusively breastfed babies through 9 months of age show them to usually have superior iron levels.1-4 Once iron supplements or iron-containing foods are introduced, the picture becomes more complicated.

Unless you, the mother, are quite anemic, iron levels in your breastmilk are exactly where they are meant to be for the optimal health of your baby. Neither iron supplements nor iron-fortified cereals are indicated for a breastfed baby, unless a blood test demonstrates anemia. Symptoms that should evoke a blood test are paleness of skin or mucous membranes, frequent illness, increasing irritability, decreased attentiveness, or a decrease in appetite.

If a blood test demonstrates anemia, then baby should receive moderate iron supplementation. Insufficient iron can affect neurological development. Two causes of anemia in a breastfed baby are blood-loss associated with intolerance to cow's milk proteins in mother's diet, and early cutting of the umbilical cord. Breastfed babies may have low iron stores, by design, but the actual level of available iron circulating in the blood (hemoglobin level) is the measure that counts at this age. Some doctors become misinformed about the two parameters and suggest supplementation for breastfed babies when only stores are low.

It has been shown that iron supplements for breastfed babies who are not anemic can stunt growth and cause diarrhea.5 Additionally, if you give iron supplements to your exclusively breastfed baby then he will be losing many of the benefits of his exclusive breastfeeding. Breastmilk has a special iron delivery system called lactoferrin. This component provides highly absorbable iron to baby without making it accessible to various gut bacteria that can cause illness in baby. Supplemental iron in baby's diet feeds and encourages potentially dangerous gut bacteria and the child loses the protective intestinal flora balance that young babies are meant to enjoy.

Excess iron has other detrimental effects for people of all ages. Behaving as an oxidant, it has been linked to heart disease and may lead to an increased risk of cancer. Excess iron also binds with zinc and other minerals, causing relative deficiencies of these other important nutrients.

Once iron is added to the diet, (with supplements, or when starting green vegetables, fortified cereals, or meats), you will notice baby's stools becoming more odiferous. This represents the transition to a more adult and less protective intestinal environment. Lactoferrin becomes somewhat overwhelmed and iron from mother's milk becomes less accessible to baby. The dietary iron feeds gut bacteria and is poorly absorbed by baby. The introductory months of iron-containing foods in baby's diet actually represent the highestt risk period for development of anemia in breastfed babies. Once iron-containing foods are being regularly introduced, baby's diet should include plenty of high iron foods. Vitamin C containing foods then help with iron absorption.

Vitamin D supplementation during breastfeeding is not needed if either mother or baby receives good sun exposure. The more sunscreen worn, the darker the skin color, and the closer to the Earth's poles, the greater the consideration for supplemental D.

I'm not sure what your concern is over not having dairy yourself. Dairy consumption would only lower the iron levels you have available to your baby. Milk is artificially supplemented with Vitamins A and D, but these supplements can easily be attained elsewhere. A diet high in dairy is one that is low in Vitamin C and many cancer-preventing antioxidants that you could share with baby.

The best nutritional protection for breastfed baby is for mother to be adding a moderate multivitamin-mineral supplement to her own healthy diet. This will ensure that mother's body has optimal nutrient availability so that it can balance the nutrient levels in her milk to be healthiest for baby. Once baby discovers white flours, juices, and sugars, it may be time to consider a multivitamin-mineral supplement for him.

References:
1. R.A. Pastel, et al., "Iron sufficiency with prolonged exclusive breast-feeding in Peruvian infants, Clinical Pediatrics 20, no. 10 (Oct 1981): 625-6.

2. A. Pisacane et al., Iron status in breast-fed infants, Journal of Pediatrics 127, no. 3 (Sep 1995): 429-31.

3. L. Salmenpera et al., "Folate nutrition is optimal in exclusively breast-fed infants but inadequate in some of their mothers and in formula-fed infants," Journal of Pediatric Gastroenterology and Nutrition 5, no. 2 (Mar-Apr 1986): 283-9.

4. M.A. Siimes, et al., Exclusive breast-feeding for 9 months: risk of iron deficiency, Journal of Pediatrics 104, no. 2 (Feb 1984): 196-9.

5. K.G. Dewey, et al., Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras, Journal of Nutrition 132, no. 2 (Nov 2002): 3249-55.

My son is 16 months and still breastfeeding. His doctor told me he is below average weight according to the percentile chart. He is a very healthy boy who eats a healthy diet of solids and snacks. How much stock should I put in those growth charts? Are they made for breastfed babies?

Your doctor said he's "below average?" Something funny about averages. — 50 percent are below average and 50% are above. If he were in the bottom 10 percentile, that would mean that 10 out of every 100, or 1 out of every 10 children are the same weight or less. One certainly couldn't say that one or two in every ten children is malnourished (and then one or two obese). Even if he were at 1 in 100, it wouldn't mean he was unhealthy, but a very low or high ranking could be a signal to just take a look at things.

There are charts being developed for breastfed children, and your child will rank considerably higher in those at his age. The CDC has developed new charts that lump breastfed and formula-fed infants together, but I'm not so sure these will be very practical for anyone. This useful link shows the difference between the rankings in the formula and breastfed averages: www.kellymom.com

Formula-fed babies are shown to consume 20 percent more formula than usual breastmilk consumptions, even though formula and breastmilk are similar in calories.[1] It is assumed from studies that formula-fed infants need to take in more in order to get the amounts of certain nutrients that their bodies know they require.[2] The bovine protein in formula is more difficult to absorb. Certain fatty acids in formula are unusable and simply combine with calcium to be lost in the stool. The milk sugars are easily absorbed, and the excess amounts are turned into body fat, making the average formula-fed baby overweight, in comparison to natural, intended infant weights. This higher weight is more rightfully considered a result of malnutrition.

Crafty promotion during the last decade still leaves doctors and families thinking that after 6 months breastmilk has little nutrition. They are bent on wanting to see fat, formula-supplemented babies, although the former statement is incredibly untrue and there are no studies that demonstrate any advantage to baby fat. There are studies that demonstrate a greater likelihood of obesity[3] and a greater difficulty in maintaining healthy blood pressure in adults [4] for those who were well "above average" weight as babies. Among breastfed infants, even those with the slowest growth rates show no differences in their average rates of neurological development or of illness.[5]

Through the invention of refined sugars, fatty fast-foods and the like, most adults have lost their inborn abilities to maintain optimal weight easily. Babies, on the other hand, know much better than you or I or your doctor just what weight is right for them, as long as good foods are available to them

If your baby is alert and active, and achieving developmental milestones well, some a little ahead of his peers and some a little behind, then he's likely doing just super!

NOTES:

1. B. Lnnerdal, Effects of milk and milk components on calcium, magnesium, and trace element absorption during infancy, Physiol Rev 77 (1997): 643-669.

2. S.J. Fomon et al., "Infant formula with protein-energy ratio of 1.7 g/100 kcal is adequate but may not be safe, J Pediatr Gastroenterol Nutr 28, no. 5 (May 1999): 495-501.

3. M. Prokopec and F. Bellisle, Adiposity in Czech children followed from 1 month of age to adulthood: analysis of individual BMI patterns, Ann Hum Biol (Czech Republic) 20, no. 6 (Nov-Dec 1993): 517-25.

4. B.S. Simic, Childhood obesity as a risk factor in adulthood and its prevention, Prev Med 12, no. 1 (Jan 1983): 47-51.

5. K.G. Dewey et al., Adequacy of energy intake among breast-fed infants in the DARLING study: relationships to growth velocity, morbidity, and activity levels. Davis Area Research on Lactation, Infant Nutrition and Growth, J Pediatr 119, no. 4 (Oct 1991): 538-47.

Do you know of any negative effects of introducing a pacifier? I had one as a child and found it hard to part from, but as a potential parent have not found any research on the effect of pacifier use.

How can attachment parenting improve the health of my baby?

In the mid-1900s, psychologists were demonstrating many undesirable results from the standard "hands-off" parenting promoted during that century. Sadly, their voices were not loudly heard. Today's science has brought hormonal testing, mapping of brain receptors, and many more studies to the table that re-prove what was shown in the 60's (and many parents around the world already knew). It is now well established that withholding of affection and attention more-often produces children with psychological disorders, as well as lifelong elevations in their stress responses. By contrast, responsive parenting is more-often linked to lifelong lower blood pressure, (meaning less heart disease), and greater emotional security.

Many valuable studies performed chiefly on premature babies, (because these new beings are available in the hospitals for study), demonstrate how providing just one component of natural parenting, such as extended sucking, rocking, skin-to-skin contact, or holding, increases the growth and success of babies. Preemies provided with human milk show a strong developmental edge as well. Clearly, parents who put many of these practices together have a great chance of creating healthy rewards.

Various reports over the last decade about cosleeping families have spiked research into the consequences of this worldwide behavior. While the actual research findings are not sensational enough to gain media publicity, the truth is now documented that room-sharing and cosleeping (with non-smoking parents) drastically reduce the incidence of SIDS [check-out Mothering's Sept/Oct. 2002 issue]. Beyond increasing infant survival, many believe that the gained physical cues and emotional security provide lasting mental and physical benefits.

It has been established that exclusive breastfeeding in itself significantly reduces hospital visits, diabetes, childhood cancers, and other health challenges, and increases infant survival. Parents and lactation assistants have been learning on their own, however, that breastfeeding on-cue provides greater success in the feeding relationship and less-stressed babies and parents, and can protect against failure-to-thrive.

Our nation's "modern" practices don't provide all the answers. While we rank number 1 in medical expenditures, we rank 28th in the world for infant survival, and 35th for child survival. Those nations who beat us out by far are ones who widely practice extended breastfeeding, cosleeping, baby carrying, and reduced interventions in birthing and parenting.

Parents who have chosen to follow their own hearts, or who have set-out deliberately to pursue the new attachment parenting models, can be comforted in knowing that increased success can come from honoring babyhood, smothering their babies with unrestrained love and affection, and rejoicing in all the special cozy comforts parents are designed to provide.

Your toddler does not require any certain amount of foods other than breastmilk. Eventually, of course, he will be living entirely on "solids," and the transition time is here. Make it the best you can. It's OK to let your child take the lead as far as how much supplementary food he's interested in eating. Left alone, he'll listen to his body's needs.

The ideal foods, those that bring high nutritional compliments, are vegetables - the deeper-colored the better. The protein foods that have the most other nutritional benefits are beans and nuts. All of these foods provide calcium, iron, and other minerals, good vitamins, fiber, and cancer-blocking antioxidants. Eggs and lean meats are protein-dense with other good nutrients, if you choose these. It's safest to provide some supplemental B12 if meats or dairy are not consumed. Fruits are delightful healthy treats - again, the deeper colors are generally most nutritious. Children love grains, and the whole grains are always more nutritious than refined.

Vitamin D is being missed here, and needs to be considered once the child's diet is more than 20% non-breastmilk. The closer to winter, the farther from the equator, the less outdoor time, the more clothing and sunscreen used, and the darker the natural skin color, the greater the need for supplemental vitamin D. This may need to come from a fortified food, such as a white liquid or commercial cereal, or from a chewable vitamin.

If this were your child's entire supplemental diet, you would have nothing to worry about. All the bases would be covered. This is the ideal. The second part of your question pertains to the "real."

Humans have been designed with a strong drive to seek and eat foods, in order to promote their survival. To accomplish this, we have been given strong affinities for the tastes of fats and sweets, and for the site of colorful foods. Today we have learned to extract those "flavors" and pack foods full of them, and to chemically color these food-imitations. If our children were never introduced to beautifully packaged concentrated sugars and hydrogenated fats, they would not demand them. Of course today it is nearly impossible to protect our children for long from images and offers of candies and cakes, and foods full of artificially hydrogenated (trans) oils.

When it comes to feeding picky eaters, what works for one just doesn't work for another. Finger foods are widely popular. Be creative. Combine colors, wrap this in that, or make it into a creature. Keep lots of healthy options on hand wherever you go. While some may enjoy wide variety, don't worry about variety if that's not his preference, as long as there is a vegetable or two and a protein food in there.

Water or weak herbal teas are the best drinks. Fiber-void juices promote sweet preferences and should only be served diluted and occasionally. Many feel a need for some kind of white liquid, but there really is no necessity, while there are many healthy options if these are desired. There is no need to begin certain habits that I call starvation behaviors, such as spreading fats on bread or covering vegetables with fatty products.

The most negative foods are your refined grains packed with refined sugars and hydrogenated oils - in other words, those that are offered daily from outside sources. We all know he'll be eating some of these, but your best opportunity for success is to pay attention to what foods your child sees others eating. Adventurous visits to the organic foods market with lots of praise and information are very helpful. Gardening, messy baking projects, helping in vegetable preparations, and colorful food art projects can develop bonds to healthy foods. Avoid bringing them to the grocery store during pre-Easter and Halloween times and fill them up before a cupcake and soda birthday party. Develop relationships for your child with other healthy eaters and begin early education about the causes of heart disease, diabetes, obesity, and cancer.

A diet emphasizing cow's milk can cause anemia in children. Such a diet is also low in cancer-fighting antioxidants and phytochemicals. Cow's milk protein intolerance is common in children and sometimes goes unrecognized, causing behavior problems, malabsorption, chronic infections, or other problems. Growth hormones and steroid hormones naturally found in cow's milk, and added through BGH and pesticides, are a possible cancer concern. Developing a strong emphasis on dairy for a child can also lead to large lifetime consumption and the problems associated with it.

There are strong links between dairy consumption and diabetes. While the highest risk period for dairy consumption here is in the first months of life (dairy formula and dairy in breastfeeding mother's diet), non-formula/non-dairy consuming nations have as low as 1/35th the rate of diabetes as the US, so the effect beyond infancy is worth considering as well. The natural cow hormones in milk, and the proteins, are both implicated in this disease process.

Since a major component of bones is calcium, it was once thought that high intake of calcium would create stronger bones, preventing osteoporosis. It has been shown however, that just as eating high amounts of protein does not make your muscles stronger, taking in high levels of calcium does not make your bones stronger. Exercise does, along with a balanced diet consisting of all the proper nutrients.

Studies show that high dairy intake in adults is associated with an increased rate of bone fractures -- that's osteoporosis. Worldwide, the nations that consume the most dairy are those with the most osteoporosis (and the most reproductive organ cancers and heart disease, by far), so clearly dairy is not the solution. It is this very weakness in the US that leads the government to continue to raise the RDA for calcium to amazingly high levels -- based upon education provided to them from links to the dairy industry.

Calcium loss may actually result from high dairy consumption as calcium is leached from the body by the high phosphorus and animal protein, and proportionally low magnesium levels in cow's milk. Calcium balance in the body is monitored by hormones, and regular high intakes of calcium may also weaken the balance of this system.

People are also advised to provide dairy to children for its vitamins A and D. The Vitamin D is only there because it's added. It's typically not added to other dairy products. Vitamin D can be obtained naturally through sun exposure. If a child does not get enough sun, other fortified foods, certain fish, egg yolks, or chewable supplements can add to their Vitamin D levels. Vitamin A is in milk fat, as well as some other animal fats, and is also added to liquid lowfat milks, but not most other dairy products. Vegetable sources provide healthier, safer forms (precursors) of Vitamin A. Ample Vitamin A is easy to obtain when a diet emphasizes colorful fruits and vegetables, without the risks of high animal fat consumption.

Cow's milk is not a natural source of protein in human diets, and is a problematic protein for many. It's not hard to obtain adequate protein chiefly from beans, nuts, and grains, and certainly from lean meats or eggs, if you choose these.

OK, still everyone wants to know where to find calcium. Here are some common foods with good levels of calcium, listed in order of amount per calorie: molasses, dark salad greens, cabbage, broccoli, green beans, cucumber, peas, soy, squash, most other types of beans (including cocoa), figs, kiwi, almonds, real maple syrup, brown sugar, and tomatoes.

Breastfed babies become ready for solids at all different ages, and only they know when it's time, and what pace to take. Babies become very interested in exploring objects with their mouths around 4 to 6 months of age and some people confuse this with a desire or need to begin solid foods. This is an important window to take advantage of in formula-fed infants, but can be left as a taste and play activity for those breastfed infants who are not ready to eat. Teething also produces chewing desires that can be confused with needs to eat.

Your baby does sound as though she's thriving and does not sound ready for much beyond your milk. There's no need to encourage her. Let her be the guide. Also pay attention to her stools. If food comes out looking a lot like it did when it went in, it's not being digested and is only causing interference with immune properties of breastmilk and optimal flora maintenance in the intestines.

While exclusively breastfed children generally have good blood iron levels, those in the weaning process (beginning solids) are in a delicate phase. Iron-containing foods not only block a portion of the immune properties provided by breastmilk (from lactoferrin) and alter flora, but they reduce the availability of mother's iron to baby. For this reason, I suggest low-iron foods for playful eating (such as bananas, avocados, or non-fortified brown rice), and higher-iron foods for serious solid consumption (peas, squash, prunes, apricots, meats).

Iron-fortified cereals have high doses of iron and may stunt growth slightly if not needed. If baby has risk factors for developing anemia, (low iron stores from rapid cord cutting, smoking parent, food-intolerance reactions, lower birth weight), one might consider a blood test around 9 months (or sooner if recommended) to alleviate concerns.

Green beans and carrots are high in natural nitrates and commercially prepared versions are safer for young babies than are homemade. Grains are popular first foods, but not my favorite. Brown rice should be the first grain, moving then to oats and barley before wheat.

A reaction to a food may not be apparent until after 3 or 4 exposures. Watch for rashes, spitting up, stool changes, unusual fussiness, and sleeplessness as new foods are introduced.

Generally if food reactions are involved in a child, there will be some other symptom as well. Frequent presence of rashes (even mild ones), diarrhea, constipation, bedwetting, sleeplessness, or abdominal pains can be indicators that should alert one to investigate food links. Ulcers (flat spots) on the tongue or an "allergy ring" around the anus are two other signs. The most commonly offending foods are dairy, wheat, egg, soy, corn, and peanuts, but any food could be a trigger in any given child.

Laboratory blood or scratch tests for reactions to foods are only mildly diagnostic. All tests can be negative in a child who has definite food reactions. Elimination dieting is the optimal means to finding reactive foods in the diet. This process is somewhat more complicated in an asthmatic child, as he needs to be protected during the process from possible airborne reactions, and from excess activity. If the child is also allergic to dust mites, animal dander, mold, pollen, or the like, his symptoms from these reactions can greatly confuse the food testing procedure. Providing antihistamines to remove these factors may also remove the food reactions you are trying to discover. You also want to eliminate sulfites, FD&C Yellow no. 5 food dye, BHA, and BHT in your dietary trials.

The next important key is to provide elevated levels of antioxidants to your child. It has been demonstrated that Vitamin C with bioflavonoids, and vitamin E can reduce the inflammatory process involved in asthma. Other antioxidants that are likely helpful as well are found in deeply colored fruits and vegetables.

Magnesium supplementation is purported to reduce the muscle contractions in the lungs that are involved in the actual asthma attack. This effect appears to be mostly because many asthmatic children are deficient in magnesium. Many asthma drugs reduce magnesium levels in the body, as do diets high in dairy products, and food intolerance reactions.

Studies have shown less asthma in children whose diets contain low amounts of meat or dairy. Additionally, the newest dietary discoveries pertain to the fats in the asthmatic's diet. Trans-fats have been shown to increase asthmatic reactions. these should be avoided as much as possible. Animal fats are in this category also, but are appearing to be a little less damaging than the artificially hydrogenated oils. Raising the proportion of omega-3 fatty acids has been shown to reduce asthmatic episodes. Sunflower, corn, and safflower oils are healthy oils, high in omega-6 fatty acids, but the goal is to replace many of these with omega-3 containing oils, such as fatty fish or fish oil supplements, walnuts (the only nut), and canola or olive oils. A spray of oil with a sprinkle of salt on bread is a simple substitute for margarine. Dairy butter is shown to be less bad than typical margarine in regards to inflammation reduction, but I recommend focusing on other choices. Cook with canola or olive oil. Use walnuts everywhere. Spread walnut butter on his whole grain bread or add a bit to whatever you bake. Use raw walnuts mixed with deeply colored dried fruits for snacks and even throw some walnuts in the blender with your child's rice or soy drink. Walnuts are a great source of protein, folate, and magnesium as well.

Many a fussy breastfed baby is reacting to foods in their mother's diet. It's possible that nothing became widely apparent to you in starting solids if he were regularly reacting to his breastmilk diet anyway. Although 15 months is a very healthy age to begin solids, I wonder whether this was your choice or his? Many food-intolerant babies try to avoid solids after reacting to one or two, and finding the comfort and pain-reduction provided by nursing to appease their regular discomfort.

Generally, but not always, there would be other symptoms if your child were reacting to foods. Rashes, constipation, diarrhea, waking with screams, unexpected behavior bouts, or regularly runny nose are some of the more common symptoms.

You can try strictly eliminating some of the most popular allergens from your son's diet, such as dairy, corn, soy, and wheat. You'll have a much better chance for reward if you go ahead and try a very complete food-elimination diet. Choose from these foods: hazelnut, rice, poi, tapioca, maple syrup (for sweetener), dates, persimmon, pear, lettuce, asparagus, avocado, and lamb if you choose meat. You need to read ingredients well on everything you provide, as every ingredient on a label is a new food or additive to the diet. Whey, casein, cream, lactose, and butter are all words for added dairy. Corn-derived ingredients include dextrose, glucose, malt, caramel color, corn syrup, sorbitol, and hydrolyzed vegetable protein. Starch can be wheat or corn.

It's not worth undergoing this endeavor if you are not strict about the avoidances you've chosen, as your results will be unclear. See if there's any improvement in your son's demeanor after a few days on the diet. If so, you can begin adding foods one ingredient at a time, giving 3 separate doses of a new ingredient and observing results for a full day after the 3rd dose before starting another food.

The bottle itself isn't the only culprit.Scheduled feedings sometimes result in babies who have a long cry before eating. This may allow a buildup of stomach air that can cause discomfort if baby is fed much milk before they have had a chance to expel it. The larger, quicker meals that come from scheduling can also allow air to build up too quickly. Taking the time to attempt to burp a baby in the middle of a large meal may also bring relief in part because time is allowed for some stomach emptying.

Many think that if a baby cries after feeding, or has gas later, it is a result of not being properly burped. Some babies cry for the opposite reason: because air or liquid have come up the throat, bringing stomach acid along with it. Very little of the gas formed in the intestine ends up coming out of the mouth, thus a gassy baby is not a sign of inadequate burping. Excess gas is a result of a digestive problem, a floral imbalance (as from antibiotic usage), food intolerance, including foods in breastfeeding mother's milk, or a natural reaction to cruciferous vegetables in mother's diet. Jiggling and patting can also help a baby to pass gas, and this may be a great relief when needed, however gas production occurs one to a few hours after a meal.

Some breastfeeding babies may also pull in a little air while feeding, generally as a result of poor latch-on or very eager eating. Most on-request breastfed babies around the world are not intentionally burped and do just fine. On the other hand, most mothers around the world will naturally pat and bounce a fussy baby, likely releasing any extra tummy air or expelling some intestinal gas in the process.

Not all bottle-fed babies need to be burped. If any baby burps easily and seems to benefit from the process, and generally doesn't spit-up from it, there's no reason not to go for it. Some may really benefit. There is no reason to go through heroic acts in great determination to release a burp from a baby, and it could do more harm than good. Excess patting, jiggling, and other such efforts to bring up contents from the stomach often cause baby to spit-up or at least bring material into the throat. This can bring acid up from the stomach and slightly damage the esophagus. Unless baby seems to really benefit from forced burping, shaking and bouncing them during or after eating may only interfere with their feeding pleasure or interrupt their natural process of falling asleep during sucking.