Our Blog

By contactus@allchildrenpeds.com
November 20, 2017
Category: Well Care
Tags: Nutrition  

Earlier this year my blog discussed various diets, their common characteristics and best current recommendations.  This month, I wanted to begin discussing the individual components and how much we need in our diets.

Protein

The first question onmivorous (eat everything) people ask vegetarians is "where do you get your protein?"  Most Hindus would beg to differ.  They are healthy and enjoy a vegetarian diet or a Lacto (milk products) vegetarian diet.  So maybe we don't have to eat meat protein; vegetables, dairy, legumes, eggs, grains and nuts can be rich sources of protein.  Humans need less than half a gram of protein per pound of their healthy weight daily or making it real, a 22 pound toddler needs about 8 grams of protein.  A single egg contains around 6, a piece of bread 2-4 or more, a 4 ounce glass of milk is 4 grams.  So that meal for breakfast would give the child all the protein or a minimum of 12 in that meal alone for the day. Recent studies have shown that children who eat an egg per day in the second year of life are taller generally (similar findings are out there about whole cow's milk vs. plant milks).  How should this information form our habits?  A typical 110 pound woman needs around 40 grams of protein per day.  If we take in about a third of that for breakfast, it will keep us satisfed until lunch compared to a similar breakfast in calories but without enough protein.

Some foods and their protein amounts:  Cooked meats and fish are about 7 grams per ounce, 1 egg is 6 grams, 8 ounce glass of milk is 8 grams, 1/2 ounce nuts is 6 grams, 1 tablespoon of peanut or other nut butter is 7 grams, 1/4 cup of cooked beans, peas or tofu is 7 grams, 1/3 cup of cottage or ricotta cheese is 10 grams, 1 cup of cooked oatmeal is 7 grams, 1 ounce of cheese (the harder tend to be higher) is 4-12 grams, breads or a bagel is 2.5 - 10 grams (variable), cerieals, cold per serving are very variable, pasta is 12.5 grams, Quinoa, teff, amaranth are variable but rich sources of protein.

I wrote about the toddler's breakfast; how about for grown ups?  If we try to get a quarter or a third of our protein for breakfast, how about a peanut butter sandwich on whole grain bread, an egg cheese and veggie omelet, greek yogurt with fruit, nuts or a quality granola topping, a breakfast burrito?  Cereals can be a good breakfast but many are short on protein.  Where are these gram amounts shown? On all food labels it's listed.  On another blog, I will discuss fats, carbohydrates, fiber and some of the micro nuturients we should get in a varied, balanced diet.  Remembering the 5-2-1-0 plan recommended for children (and adults) 5 servings of fruits and bvegetables per day, 2 hours max of screen time (except for school work), 1 hour of exercise and 0 sugared drinks, but getting a good breakfast with enough protein is an excellent start and enough protein the rest of the day is essential.

By contactus@allchildrenpeds.com
June 06, 2017
Category: Illness
Tags: Allergy  

Did you know Food and Allergy Awareness Week was May 14-20, 2017?  Well, it’s never too late to be aware of Peanut Allergies.

One of the most common food allergies in children is peanuts, and the prevalence in the United States is increasing. Food allergies most often begin in the first 2 years of life. In countries, including the United States, where peanut introduction is delayed, peanut allergies have more than doubled in young children. The Learning Early about Peanut Allergy (LEAP) trial was the first randomized trial to show the benefit of early introduction of peanut into a child’s diet resulting in a decreased risk of developing peanut allergy.

Children who are at increased risk for developing a peanut allergy include:

  • Family or personal history of atopic disease
  • Severe atopic dermatitis and/or egg allergy in young infants
  • Family history of peanut allergy

 

The American Academy of Pediatrics (AAP) recently introduced new guidelines for the introduction of peanuts.

  • In infants without eczema or food allergies, and who are not at increased risk of peanut allergy, recommendations suggest peanut introduction with other solid foods according to family preference or cultural practice.
  • In infants with mild to moderate eczema, or increased risk of peanut allergy, recommendations suggest peanut introduction around 6 months of age, following the start of other solid foods. Families may introduce peanuts at home.
  • In infants with severe eczema and/or egg allergy, recommendations advise introduction of peanut at 4-6 months of age, following the start of other solid foods. Allergy testing is strongly advised prior to peanut introduction in this group and possibly introducing peanuts under physician supervision

 

There are two methods for allergy testing: blood testing for peanut-specific IgE or skin prick testing.

When introducing peanuts to an infant, remember whole nuts and peanut butter can be a chocking hazard. We suggest adding water to smooth peanut butter and make a puree.  Put the puree on the tip of the spoon and feed your child. Wait and watch for any reactions. Allergic reactions to peanuts can include hives (raised, red areas of skin that are itchy), swelling of the tongue, trouble breathing/wheezing, vomiting or diarrhea.

For further information on food allergies visit

- FARE (Food Allergy Research and Education) foodallergy.org

- healthychildren.org

By Jenny Oberst, APRN, CLC
May 26, 2017
Category: Well Care
Tags: Physicals  

I have been a Family Nurse Practitioner for almost seventeen years.  I worked at Kosair Hospital (now known as Norton Children's Hospital) for six years, prior to that as an Onocology/Renal/Transplant nurse.  I also worked at Norton Hospital while attending nursing school at the University of Louisville.  I have spent all of my professional years working with children and families.  I cannot imagine doing anything else.  But the face of healthcare and insurance and its cost has changed dramatically in my years of practice.

The ever changing dilemma of health insurance coverage for ourselves and our family affects us all.  As a mother and wife keeping up with what is covered in my plan, annual deductibles, pharmacy benefits, co-pays and in and out of network providers is a huge undertaking.  Once you think you have it down a new enrollment period is upon you and it changes again.  One thing that I am certain of is you need to understand your plan and be an advocate for yourself.  Take advantage of the programs your insurance company has in place to keep costs down, ask questions, be friendly with your health insurance representatives and ASK QUESTIONS.  With the passage of "Obamacare" a few years back one of the most beneficial components is wellness benefits for all at no or minimal cost.  This is especially important for our children as they grow.  They need to be seen at each recommended and scheduled time for Well Baby-Child/Adolescent/College Age student visits.  The importance of seeing a trusted and well informed Pediatrician/Osteopath/Nurse Practitioner/Physician Assistant is imperative for health guidance and illness prevention in our next generation of adults.  The rise in healthcare costs and a US population that seems to get less fit each year should be a concern for us all.  Our children truly are our future and how we raise them and teach them will impact who they are as adults.  I believe healthcare is a basic right but the idea that it should come without financial responsibility and accountability is a reality we likely will not see again in our lifetime.  So plan and prepare, realize that health insurance is part of a famly budget.  Here are some websites to help you begin to get informed.  A healthy mind and body is essential for us all.

http://www.aap.org/en-us/advocacy-and-policy/Documents/

MAP/KY.pdf

http://www.heathcare.gov

http://www. kyvoicesforhealth.org

votesmart.org

http://www.aappublications.org

 

By contactus@allchildrenpeds.com
April 05, 2017
Category: Well Care
Tags: Physicals  

By Dr. Kathleen Maurer

It's time to schedule physicals!!!

Did you now that the Academy of Pediatrics recommends a yearly physical for all school aged children? Those who sign up to play sports or register for summer camps are required to have a physical before they can participate. When time is short and schedules are busy, it might seem convenient to stop in at the local retail clinic at your grocery store or pharmacy.  When children seem healthy, parents may wonder if it is really necessary that they schedule a yearly visit at their pediatrician's office, but there are some very good reasons why this is important:

-Your child's pediatrician or nurse practitioner is familiar with your child and has access to their medical records, including their complete medical history, immunizations, growth charts, allergies, medication, and other important information

-A yearly exam may pick up on health issues that are not always obvious, such as high blood pressure, scoliosis, a new heart murmur, a concerning skin lesion, abnormalities of growth or abnormal pubertal development

-If an abnormality is found at the yearly exam, your pediatrician is able to order labs or imaging, make referrals and arrange appropriate follow up 

 -Guidelines for yearly exams include important screenings for health problems, and age-specific discussions about topics such as nutrition, safety, body changes, risky behaviors, etc 

-Yearly exams provide an opportunity for your child to become comfortable with their physician, and less likely to be overly anxious about doctor visits in the future 

-If your child is due for immunizations these can be provided at the yearly exam

-You may have heard the term "Medical Home" which has become an important concept within this past few years. It is widely recognized that patients are likely to receive better care if they have one primary physician or group where all of their records are in one place and all of their health care is co-ordinated. 

So call early to get your children in for their physicals and get the jump on sports season!  Some families schedule their yearly physicals around the time of their child's  birthday, and others come in during the spring and summer so they will be ready for camp or conditioning for team sports. We have forms available at our office for school physicals and sports physicals. If your child needs a camp physical or if their school has their own form, please bring them in when you come. 

We look forward to seeing you!

By contactus@allchildrenpeds.com
March 03, 2017
Category: Well Care
Tags: Nutrition  

Welcome to our March Blog post!

We are all bombarded with claims that this diet or eliminating that food will solve all of our overweight or chronic health problems.  I hope to clarify some of the current popular nutrition concepts and their common features.

What is Clean Eating?  This way of eating and drinking is about eating more of the best and healthiest foods and less of unhealthy processed ones.  Look at an ingredients list on an add-a-meat, all included box supper package.  If the list has ingredients you can't pronouce or don't know the reason for, stay away from it.  Like yougurt:  milk, the healthy bacteria that fermented it, perhaps fruit and some sweetner, perhaps vanilla makes sense.  But a list of strange thickeners and product stretchers does not.  Look at a hot dog vs. a sustainably sourced piece of beef, or a processed cheese vs. a block of real cheese without the hormone used to make cows make more milk, tater tots vs. real potatoes, peanut butter with sugar or corn syrup or a peanut butter made only of peanuts with salt.  Many packaged foods contain high sodium and sugar too.

Next opt for real fruits and vegetables.  As adults we need 4-5 cups daily of fruits and vegetables for optimal health.  For every serving of each I have read that we live longer.  Other recommendations are increasing whole grains, looking for whole wheat when buying bread and pasta and including some of the many other options like oats, quinoa and brown over white rice.  The processing strips away some essential nutrients like selenium, magnesium and fiber.  Try to eliminate packaged refined carbohydrate "foods" like cookies, cakes and pastries.  Try to decrease meats to reduce saturated fats and increase the nuts and plant proteins using meat as less a centerpiece and more of an ingredient.  So, upping the prominence of fruits and vegetables, depending when possible on fresh or frozen produce and less processed food:  These are the guidelines.  Eggs, fish, nuts, beans - these are great protein sources.

What is the 5-2-1-0 Plan?  This is a nutritional program to help prevent childhood obesity and you'll see posters in our exam rooms mentioning it.  I have read, and I think most agree that it is a healthy framework for all ages.

5 servings of fruits and vegetables (sound familiar?)

2 hours or less of screen time (other than computer homework)

1 hour of exercise

0 sugared drinks

I like to ask children at check ups who express dissatisfaction with their body when we discuss their growth chart, how they do on this list.  Usually we can identify a habit to change to feel better about their body image.

What is the Mediterranean Diet?  This is the diet most often cited by nutritionists to decrease heart disease, many chronic diseases, type 2 diabetes and perhaps even ADHD in children, according to a recent article in the publication Pediatrics.  Think of all the principles of clean eating above and add to that decreasing red meat and encouraging fatty fish several times per week and some poultry.  The ADHD findings may be an association with poor impulse control or the postivie effect of some of the micromutrients in fruits and vegetables or the Omega 3's which are good for the brain in certain fish like Salmon, Tuna and Makeral.

So, as I first asked, what should we eat?  Furthermore, how should feed our children?  Remember that our example and what we buy are how our children will choose their likes.  Remember that a toddler often has to taste a food ten times to get a taste for it and that infants are already accustomed to our "flavors" from their exposure to them in the womb via amniotic fluid and through breast milk.  The best diet is one rich in fruits, vegetables, whole grains, nuts, quality dairy, fish, poultry and eggs and avoiding processed foods and choosing healthy oils like olive and nut oils over saturated ones like hydrogenated oils, transfats and butter. Please ask any of our providers about your families diet if you would like to know more or have any questions.   Bon appetit!





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