NUTRITION AND FITNESS Iron Deficiency
Adequate dietary iron is necessary to produce red blood cells (which carry oxygen) in our circulatory system. We can tell if the red blood cell count is sufficient by checking your child's hemoglobin with a finger prick. When the count is too low, the consequence is anemia (low red cell count) and is usually caused by a lack of iron. Mild iron deficiency anemia may have no symptoms. More severe levels of anemia may cause fatigue, headache, irritability, pallor, shortness of breath, poor exercise tolerance and decreased appetite. In some cases, reduced attention span and alertness occurs and contributes to poor school performance. In the most severe cases, unusual food cravings, a symptom known as pica, may occur as well. The table below shows the best sources of iron.

Calcium & Vitamin D
Vitamin D is created in the body by sun exposure. As the importance of sun protection has been increasingly recommended, vitamin D synthesis through sun exposure has decreased. Vitamin D is vitally important to the absorption of dietary calcium into the bones, to prevent skeletal deformities and osteoporosis in both sexes. Low vitamin D levels also appear to increase the chance of developing multiple sclerosis, cancer of many types, rheumatoid arthritis and heart disease, as well as impaired glucose metabolism in overweight children.

Recent studies show that Vitamin D deficiency affects children of all ages. Breastfed infants who did not receive vitamin D supplementation in winter were deficient. Vegetarians are particularly vulnerable. Since very few foods in nature contain vitamin D (egg yolk, fish, fish oil, some cheese, beef liver and some grains are foods naturally high in vitamin D), significant deficiency is widespread worldwide, even in healthy older children. Dark-skinned children have a markedly reduced ability to produce vitamin D and should take a supplement. The current recommendation for vitamin D supplementation is 400 IU units daily for most infants, children and adolescents.

Calcium intake is particularly important in pre-adolescents and adolescents. The peak requirement occurs between 9 and 18 years of age, when 40 % of total lifetime bone mass accumulates. Adolescents, especially females, often do not meet this need, which would require 4 servings of dairy products per day.

Only 500 mg. of calcium can be absorbed at one time, so it must be consumed throughout the day to reach the necessary 1300 mgs daily. Many teens opt for soft drinks and juices which replace milk intake. Caffeine and alcohol interfere with calcium retention. To allay concerns about weight gain, remind teens that low-fat dairy products do not contain less calcium. Alternatives to dairy products as good sources of calcium include cereals, calcium-fortified juices, soybeans, tofu, spinach, broccoli and almonds.

NUTRITION AND FITNESS Introducing Baby to Solid Foods
Breast milk or formula is the only food your baby needs until 4 to 6 months of age. At that time you may begin to slowly introduce solid food. Always begin new foods in the morning and offer only one new food every 2-3 days. Observe for allergic reactions such as skin rash, vomiting, diarrhea, irritability or in rare instances, wheezing.

Begin with one tablespoon of iron-fortified rice cereal (Stage I) mixed with 2-3 tablespoons of breast milk or formula once a day. The cereal should be thin and runny initially, but gradually thickened as the baby learns to eat. You may work up to 4-5 tablespoons of rice cereal per serving over a 2-3 week period, and can then try oatmeal or barley.

Once your baby is eating cereal without incident, introduce single ingredient fruits and vegetables. Begin with one tablespoon of each new food and advance to 3 or 4 tablespoons per serving as the baby’s appetite increases. You may mix this with the cereal or give separately. Each feeding should end with breast or bottle feeding, although the amount of milk may decrease as the amount of solid food increases. By 6 months of age, most babies will advance to 2 meals per day: cereal plus fruit and vegetable plus fruit.

By 6 to 7 months of age, begin a third meal and add single ingredient meats. Foods should still be smooth in consistency. Once all single ingredient (Stage I) foods have been introduced, Stage 2 foods are appropriate to start. Avoid desserts and cobblers which are full of sugar. If you would like to prepare your own baby food, we recommend: “Feed Me, I’m Yours” by Bruce Lansky.

By 9 months of age, most babies are ready for more texture (Stage 3), lumpier foods and soft finger foods such as small pieces of ripe fruit or cooked-to-very-tender vegetables. You may begin yogurt, small cubes or shreds of cheese, pastina and scrambled or hardboiled eggs (yolk first, then whole egg). Most babies can also handle teething biscuits, crackers, rice cakes and Cheerios by this age.

Between 9-12 months, you may gradually transition to table foods (even if no teeth yet!). These should be minced or mashed and should dissolve easily in the baby’s mouth. Avoid foods like popcorn, nuts, raisins, grapes, hard raw vegetables and hot dogs as these may easily cause choking. If there is no family history of food allergy, you may introduce fish, dairy products, berries and citrus products after nine months. Otherwise, wait until one year of age to try the more allergenic foods. The latest recommendation is to avoid peanut butter and peanut products until age three.

One important aside: once your child is tolerating dairy products, and you are ready to try whole milk, remember to offer small quantities in a cup (any type of cup is okay). This early practice will help to ease the transition from bottle to cup at 12-15 months of age.

Every baby is different and will set his/her own course of feeding. If s/he seems fussy or turns away, end the feeding and try again at the next feeding time. You may have to offer certain foods many times before a baby accepts each one. Always feed your baby sitting up in an infant seat, highchair or your lap-never lying down!

Allow your baby to partake in the feeding process by leaving his hands free to “help” and push the spoon and food into his mouth. Expect a mess but also a delighted baby!