Feeding Three Year-Olds

     Three year-olds love the word “No”. Parents hear it many times a day – especially at mealtime.

     As with many parenting issues, feeding three year-olds takes, patience, humor and the ability to listen to protest without giving in. The official kid owner’s manual says that we are only obligated to make one meal three times a day and put it in front of our children. No matter how many times the child ate the same meal last week and loved it, you can expect that it will barely hit the table tonight before you hear “No, I don’t like that”. There are many options when that happens. Trying to convince the child that he “loves spaghetti” is worthless. Once the magic word – “No” - has been issued, all debate is over. This is also true for any attempt to list the individual ingredients – all of which the child has previously begged for. Threats are also a waste of time. “You won’t get anything else”; “You have to stay at the table until you eat it” or “You’ll get it for breakfast” are empty because the child knows you won’t follow through with them.

       If every dinner time is a battle, make sure that you aren’t setting yourself up for failure by giving enough juice, milk or snacks when you get home that the child isn’t hungry by the time dinner is ready. A cup of water and a few blueberries will suffice.

     Remember the basic rule of parenting: Your child will learn whatever you choose to teach them. If water and a small snack is your routine, your child won’t expect more. If they are “STARVING”, simply say, “ I know you’re hungry, Darling, and dinner will be ready in just a little while”. If you start to offer other meal options when what you made for dinner is refused, you’re in trouble because you begin to sound like a short-order cook and the child will turn down everything you offer because it is fun to watch mom jump through hoops. If you fix hot dogs or something that you know Junior will eat, you’ve set yourself for a lifetime of making multiple entrées every meal.

     Because I can’t watch a child eat nothing from lunch until breakfast the next morning (even though it will only result in a child who is so hungry that you can bet they won’t turn down breakfast!), I always have one easy substitution for the turned-down dinner. Usually, an apple or a banana will take care of my guilt. Simply say, “If you don’t want dinner, you can have an apple” rather than “Would you like an apple?” which is just another opportunity to turn you down. If that meets with a “no” then it is perfectly all right to give the child ”all the water you want” until morning. There are few actual recorded cases of starvation overnight in middleclass America.

     As parents, we soon learn that it is physically impossible to force another human being to eat, sleep or go to the bathroom. Our children are always ready to prove that to us any time we forget it.

Juice, Soda, Sports Drinks and Energy Drinks

     Human beings evolved eating a diet high in protein and low in sugar. Although we need simple sugar – glucose - to create energy for all our cells, plant sugar – fructose - is not metabolized well in our bodies and converts easily into fat. Unfortunately, fructose is now universally used as a sweetener in beverages that children and adolescents routinely consume.

      A study in the September issue of Pediatrics done by researchers at the University of Virginia looked at the effect sugar-sweetened beverages have on rates of obesity in children aged 2 to 5 years. They studied children who consumed a variety of “soda pops” such as Coke, Pepsi and Mountain Dew. They also looked at children who drink sports drinks like Gatorade and less-than 100% fruit drinks such as Sunny Delight and Hi-C.  It was no surprise that children who drank these beverages routinely had higher rates of obesity. All of these sugar-sweetened drinks provide unnecessary calories and get the child into the habit of always wanting “something sweet” going into their mouth.

     Sales of sports drinks and energy drinks are rapidly increasing. Whereas it is true that water, carbohydrate and electrolytes are lost during exercise, most of the exercise that adolescents engage in only needs water as a replacement drink. The excessive marketing of sports drinks like Gatorade give the false impression that anytime one is involved in exercise, they should be drinking something “more” than water. For anything other than prolonged, vigorous sports activities, drinking water and eating a good diet is sufficient to replace losses. Once again, the extra calories in sports drinks only result in excessive weight gain.

     Finally, energy drinks are mainly a supply of caffeine. They are not sports drinks and have no place in an adolescent’s diet. There have been multiple reports of adolescents having symptoms from excess caffeine and also withdrawal symptoms after consuming these caffeine-heavy “energy” drinks .

     After infants begin drinking things other than breast milk or formula, parents teach them what to eat and drink. It is easy to give milk with meals and water in a bottle or cup between meals. If an infant or toddler isn’t given juice or other sugar-sweetened beverages, the child won’t ask for them. We mistakenly think we are doing something good for our kids by giving them juice rather than water. All we are really doing is giving extra calories and enforcing the need for sweets.  Don’t give your toddler apple juice – give him an apple.

The Crying Newborn

     The old song says, “Fish gotta swim, birds gotta fly”. You can add, “Babies gotta cry”. Nothing is more frustrating (and irritating) to new parents than a baby who is fussing and crying and they don't know why.

     Relax. The baby is just as frustrated as you are. He only knows he wants something. We have to experiment each time he cries to find out what it is. Start with the basics: “Wet – Hungry - Tired.”  Always check the diaper first – even if you just changed him five minutes ago. Don’t rely on the “color change strip” technology on the diaper surface. The smallest spot of urine or stool can upset a baby.

    Next, check hungry. As I mentioned in “Advice on Breastfeeding”, try both breasts twice (back and forth) before deciding they are completely empty. Then, if Junior is still rooting and acting hungry, give him a bottle of formula or expressed breast milk. Let him drink until:  (a). he stops eating   or    (b). more formula is drooling down his neck than is going in his mouth   or   (c). he is asleep. (After the feeding, it is good to put him up on your shoulder and walk around a bit while patting his back - not so much to burp him as to allow him to throw up any extra formula on your shirt.) If he is still crying and you know that he is dry and not hungry, you can be certain that he is tired.

      Newborns would like to be held 24 hours a day with a nipple one-quarter inch in front of their mouth. This is why baby slings work. The baby is carried in a sling across the mother’s chest with the breast in front of his face. If he fusses, he is simply switched to the other side. Babies love it. However, this system necessitates that the mother walks around bare-breasted all day and doesn’t work well during a Minnesota winter.

     The tired baby wants you to hold him with the breast (or pacifier) in his mouth the entire time he is sleeping. Lay him down and he wakes up and cries. Pick him up and he falls asleep again….and again…and again.

It’s good to teach your baby to settle himself down. If you teach him that he needs to be held and rocked to go to sleep, that’s what he will demand. If you don’t want to have to pick him up and hold him every time he wiggles himself awake, there are alternatives.  In the uterus, he slept while you walked around doing things, so, he is used to having a little motion while falling asleep. You can rock or carry him or put him in a rocking, swinging or bouncing device (but please don’t drive him around town in the car all night). If you hold him until he’s quieted down, then lay him down and let him fall asleep even if it involves some crying.

     Parents need to remember that what worked yesterday may not work today. One day, the baby loves to be swaddled. The next day, he wants to be wide-open wriggling on a blanket. One day, he loves to swing in the chair-swing, and the next day he hates it.

     Don’t get frustrated. Just smile wearily and remember that he has been thrust into a world that is totally different from what he has been accustomed to for nine months. You need to cut him a lot of slack.

Strep Throat

      Now that school is in session again, parents will find themselves dealing with strep throat.

     Strep throat is an infection with Group A streptococcus that occurs commonly in children from about a year of age (if in daycare) to fifteen years. However, strep is not the most common cause for a throat infection. The most common cause for sore throat is a viral infection (see “Sore Throat” Oct 2012). Viral sore throat often comes along with runny nose, cough or other viral symptoms. As with any other viral infection, it needs no treatment.

       Strep throat brings sore throat and fever for up to three days without other cold symptoms. There are many misconceptions about strep throat. It is often said that strep throat causes white areas or “spots” on the tonsils.  This isn’t true. Strep infection often causes bright red spots on the back of the throat and the roof of the mouth. When there is a lot of white material on the tonsils, the cause is usually mononucleosis – another viral infection.  Another misconception about strep is that you won’t get over a strep throat without antibiotic treatment. While it is true that a strep infection can cause more serious infections in the throat and neck that do need antibiotic therapy, most cases of strep throat are self-limiting (your body’s immune system fights off the strep by itself). People with strep throat usually start to feel better in about three days – with or without antibiotics. The problem with a Group A streptococcal infection is that the same immune response that destroys the streptococcus in the throat can turn around and attack the valves in the child’s heart. This is called rheumatic fever. By treating every strep throat, doctors believe that they are preventing the immune response from getting started and, therefore, preventing rheumatic fever.  This is why your doctor treats you with antibiotics if a throat culture turns positive on the third day of the illness, even if you are feeling better. The doctor doesn’t give you the antibiotics to make you feel better, he gives you the antibiotics to prevent rheumatic fever.

     To make the diagnosis of strep throat in children, a rapid strep test is done at the time the child is in the clinic. That test can often tell whether the child has a strep throat within minutes. If the rapid test is negative, a throat culture for strep is taken and the results are known sometime within three days (throat cultures are not usually done on adults). During that time, the child doesn’t need antibiotics, but, as with ANY sore throat, the child shouldn’t share food or drink or have any oral contact with anyone else in order not to spread whatever infection they have. As mentioned earlier, if the throat culture becomes positive within three days, the child is treated with antibiotics, even if they no longer have symptoms.

     If strep throat has been treated with antibiotics, the fever and the pain should improve within 48 hours. If the fever and pain do not resolve, the infection may be more serious. If there is swelling on one side of the back of the throat but not on the other, especially if it moves the uvula (the “hangy-down thing” in the back of the throat) over to one side, the infection is worrisome. If, along with the pain in the back of the throat, there is pain or swelling in the neck, the child needs to be examined. Finally, if the sore throat causes child to have difficulty talking, swallowing or breathing, the child needs to be seen immediately.