Category: Guest Interview

This was originally a 4 week interview series which had since been combined into one informative post. The series was focused on nutrition for toddlers, in particular dealing with picky eaters or children who cannot eat certain foods.

Baby Starting Solids

It is recommended by the American Academy of Pediatrics to start solids at 6-month old. During the first year, the primary nutrition should still come from milk, preferably breast milk as this is still the best nutrition for infants. Before we get into what to eat, let’s first start with the basic of how much to eat.

How Much To Eat

MarcieMom: Given the small tummies of young children and that solids have a different place in their nutrition at various stages, would you summarize for busy moms and dads

what portion sizes their children should be eating?

Natalia: This is a great question and I get it a lot at my workshops and online classes. Generally speaking, babies start with a very small amount of solids and gradually progress to more solid foods in their diet by the time they turn 12 months. At around 9-10 months many babies go through the “big switch”, as I call it. At this point, more calories and nutrition start coming from solid foods than from formula or breastmilk and many babies want bigger portions of solids and also start snacking on solid food rather than drinking milk or formula for snacks. It is important to remember that any guidance on portion sizes for babies can be interpreted only as an estimation, as babies’ appetites vary greatly.

Baby Portion Sizes

What I provide in this chart is more of a “starter” for portions. Some babies need more and some babies need less food.

Babies should never be pressured to finish a portion of food or be restricted in the amount they are hungry for.

Picky Eaters

MarcieMom: With regard to picky eaters, I’ve attended a talk by Dr Sears who suggested ‘grazing’, eating small-size food portions throughout the day. Since then, I’ve seen increasing number of articles that recommended it.

Would you recommend grazing, and if yes, why and for which groups of children would ‘grazing’ work best?

Natalia: Toddlers need to eat more frequently than older kids – every 2 to 3 hours. And serving them snacks in a muffin tray is a great idea! I did it for my own kids and always recommend it in my classes. But I think that the word “grazing” is a little confusing here. Grazing suggests eating small portions throughout the day without any mealtime structure. Dr Sears suggests serving the tray mid-morning and mid-afternoon and I think these are great times for a scheduled snack.

Toddler Meal Structure

Some parents may leave the tray out all day in a hope to get a few extra bites into their toddler. This will most likely result in eating out of boredom and/or no appetite for dinner. Structure in meals and snacks help kids of any ages to eat better at meals and stay attuned to their hunger and fullness signals.

Childhood Obesity

MarcieMom: Obesity is a rising problem among kids, actually not just in US but in Singapore as well. I’m thinking that the main meals or snacks which are planned and prepared ahead by parents and caregivers are likely to be ‘correct’. However, some parents (me included!) may slip and offer ice-cream, ice milo, juice (even diluted) and grandparents may offer chocolate-coated snacks (who can resist?!).

What is the practical way to look at and control these ‘extras’? 

Natalia: Those delicious extras can be a legitimate part of your child’s diet. In fact, research shows that it is important to serve your child’s favorites from time to time because kids tend to value restricted foods even more. It is up to parents, of course, to decide how many treats their child will get per day or per week.

A good rule of thumb I use with my kids and clients is that anything marketed to children or with added sugar is a treat.

To help kids feel in control around “forbidden foods”, we recommend serving them in unlimited amount from time to time (an example will be a glass of milk and a plate of cookies for snack once a month). If served for dessert, the treats should be smaller (think of a size of an oreo cookie) but they should never be served as a reward for eating dinner. Instead, try to serve a small dessert alongside the meal, to “neutralize” it as much as possible. And do not forget that a bowl of fruit with plain yogurt also makes a great dessert!

BMI Chart for Portion Control?

MarcieMom: A final question on how much to eat – is the BMI-chart for kids accurate or should looking at a kid and assessing whether he/she is all chubby/flabby or look firm and fit be a better gauge? !

Natalia: The most important information we can derive from growth chart is if the child is growing consistently. Some health professionals call it “following the curve”. We aim for comparing the child to himself, not to other children. Some children are consistently on the 90th percentile and completely healthy while others thrive on the 5th percentile. If the child suddenly starts “dropping” or “climbing” percentiles on a growth chart, on the other hand, it may indicate a medical or feeding problem. For the most accurate results, it is also important to pick the right chart. BMI chart is available for kids only 2 years and older and breastfed babies are best assessed on the World Health Organization charts, not the CDC ones.

What to Eat for Toddlers

Is the Toddler or the Mom Picking the Food?

Come to think of it, the willingness to open one’s mouth, put food in, chew and swallow can’t be forced. So seen in that light, your toddler is the one choosing the food. The problem steps in when he/she is choosing so much, the term ‘picky eater’ soon becomes how you see your child. Natalia has a special interest with helping parents feed picky eaters, given her own parenting experience, let’s find out more from her!

What are your top 3 must eat foods that are essential for toddlers, on-top of the standard fruits and vegetables, protein source and carbohydrates?

Natalia: I would change the term Must-eat to Must-served. I feel like when parents are under pressure that their child must eat a particular food, children sense it and are more likely to reject it.

The Must-Serve foods to Toddlers are:

Orange and dark green rich fruit and vegetables, due to Vitamin A, important for eye health and immune system

Oily fish such as salmon and tuna, due to DHA, important for retinal and brain development

Red meat, fortified cereal, beans, due to Iron, important for oxygen transportation and storing it in cells. Most common nutrient deficiency in small children is iron deficiency

Which Option to Encourage Healthy Eating on Served Foods?

MarcieMom: Assume that the child is refusing to eat the healthier butternut squash, broccoli and fish. What would you recommend a parent to do?
i. Forget about these foods, try new ones
ii. Stick to these foods, try new way of cooking
iii. Keep cooking these foods and let the child ‘starve’ if not eating
iv. Keep cooking these foods and more, just in case

In the option(s) you choose or maybe another option or a combination, how long should a parent try a certain tactic?

(It’s already starting to sound laborious to me, lucky for me, my child happen to love superfoods!)

Natalia: I would suggest to keep serving these foods, in the context of family meals, alongside the foods your child has already warmed up to. The biggest mistake parents make is creating pressure at mealtimes in an attempt to get their children to eat particular foods. This does not work. Catering, i.e. giving only the foods that your child likes, also backfires. Non-pressure, pleasant mealtimes, role modeling and plenty of exposure help kids push themselves to learn to like the foods the rest of the family is enjoying. Exposure to less liked foods outside of mealtime through shopping, cooking and taste-testing also works.

New ways of cooking may also help.

For example, many toddlers dislike texture of meat so in the class we will share a recipe of meatballs cooked in broth that are literally melting in the mouth. When it comes to vegetables, even the simplest of them can be prepared in a variety of ways. For example, you can grate a carrot, cut it into matchsticks, make it into ribbons, steam it, roast it or pan fry it with some butter.

We definitely do not suggest starving your child till he eats certain foods. After years of working with children with feeding problems, I know that some of them would rather starve than eat something that is not acceptable to them. Besides, it creates a very negative mealtime dynamics that leads to smaller appetites and ultimately less variety in diet.

Anti-Inflammatory Food Choices

MarcieMom: Various nutritionists have shared on this blog about inflammatory foods. Would you think this is of concern to young children as well?

Which are the top inflammatory foods that you see commonly given to children and should be avoided?

Natalia: While we are still learning more from research what exact benefits anti-inflammatory diet brings to adults and children, it is clear that reducing processed foods and boosting fruits, vegetables, lean protein, oily fish and whole grains is a path to good health for both kids and grown ups. However, research shows that an overall dietary pattern seems to be more important than adding or removing specific foods from diet. I often use 80 to 20 ratio in my talks and classes, where 80 percent of food in kids’ diet are minimally processed from the list above and 20 percent are fun foods including treats. That said, I do not think that hydrogenated fats and artificial colors have a place in children’s diet. Of course, eating a blue lollipop or commercially prepared french fries from time to time is not likely to have a big health effect but if parents have an opportunity to choose candy with natural colors or bake french fries at home in the oven, it is great.

80 percent of food in kids’ diet are minimally processed and 20 percent are fun foods including treats.

MarcieMom: A final question, how would you grade my ‘food grading’ chart that I use to educate my child? Feel free to shift items around!

Natalia: I think it definitely helps to create a balance in the diet, with the focus on more nutritious foods. I think that following a chart like this can help lay down very good foundation for healthy eating habits in the future. However I must say though that as kids are growing up and have more outside influence on their diet from the peers, I had to adjust my feeding strategy to occasionally include “forbidden” foods like soda and cookies. 

Research shows that kids who are restricted tend to over indulge when they are given access to foods that are forbidden at home. 

Again, serving the foods you want your child to eat all the time is the key to get them learn to enjoy their flavor, which is the best nutrition education parents can provide.

What Not to Eat for Kids

What a Child Cannot Eat due to Allergy, Food Sensitivity or Intolerance?

When a parent should suspect there’s a problem with the child after eating the food?
When should a parent bring a child in for allergy testing?

Natalia: In case with allergic reactions, the typical symptoms to look out for are hives, swelling of the face and mucous membranes found in the nose, ears, lungs and throat, nasal congestion and sneezing, intestinal cramps, vomiting and diarrhea. With smaller kids who cannot talk yet, general discomfort and crying after eating a specific food may also indicate an allergic reaction to food. If your child has any of these symptoms after trying a certain food for the first time, food allergy may be suspected. It is a good idea to call your doctor who will probably refer you to an allergist for a testing.

Food Allergy Testing

Food allergy is often diagnosed by one of the widely available tests: skin prick test and blood test for antibodies, neither of which gives a 100% guarantee of true clinical reactivity. These tests may be helpful to assist in diagnosing food allergy when the patient history indicates that a specific food may be a problem. A double blind placebo controlled food challenge is considered by this and other reports as a diagnostic “gold standard”. This basically means that a person is given the suspected food once and a placebo another time, without knowing what is what.
The challenges are provided in gradually increasing doses and neither the patient nor the practitioner knows in which order they follow, thus patient and clinician biases are removed.

Food Elimination

Once the offering food is identified, the doctor will likely recommend to remove it from a diet. Children with food allergies may be at a high risk for nutritional deficiencies if important foods like dairy, eggs, or wheat are not replaced by nutritionally optimal alternatives. For example: calorie, protein and fat contents of cow’s milk are much higher than those in most milk substitutes, including almond and rice milk. A child who drinks rice milk instead of cow’s milk may not be growing properly because he or she will not be getting enough nutrients in the diet. Soy milk, on the other hand, is closer in calories, fat and protein to cow’s milk and could be considered a good alternative.

Figuring out Replacement Foods

MarcieMom: We know that there are certain foods that are the more common food allergens of children, while others are likely to cause intolerance. Given that a food (say fish) has more than one nutrients, how should a parent know what is a suitable replacement food i.e. as long as replacing the main nutrition, say is a protein or replacing the more beneficial nutrients, the omega-3 or finding a food that is as close to fish as possible (but that may trigger the same allergy?).

Natalia: It is a great question and I would like to provide some background information. Food allergy is an adverse reaction to protein in food. So every time the allergen is eaten, the immune system starts fighting it using the whole arsenal of chemicals causing the potentially life-threatening symptoms. Food allergy is often confused with food intolerance, which is caused by lack of digestive enzymes, such as lactase in case with milk intolerance. However, food intolerance does not involve immune system.

Food allergy can be IgE-mediated and/or non-IgE mediated. IgE-mediated basically means that when the allergen is ingested, the body produces Immunoglobulin E antibodies, which attack the allergen causing the release of histamine and other potent mediators that cause the symptoms of a food allergic reaction. Non-IgE mediated reactions primarily affects the gastrointestinal tract lining and causes allergic disorders such as protocolitis and
entrocolitis. To complicate matters further, a bunch of adverse food reactions can be both IgE and non-IgE mediated.

Fish Allergy Alternatives

As you see, there are many different ways we can react to certain foods. To answer your questions, in the case with fish allergy it is more likely to the protein the child is reacting to so the health care provider will probably recommend stay away from all fish and seafood and take a DHA supplement instead.

Milk Intolerance Alternatives

In case of milk intolerance, switching to lactose-free milk will help to avoid the symptoms but if your child. has food allergy to milk i.e. reacting to milk protein, all dairy products lactose free or not, should be avoided. In my private practice I worked with many kids with food allergies who needed a safe and balanced diet to meet their nutrient needs after removing the allergens. In most cases I needed to collaborate with their allergists and pediatricians to create a plan that works for a specific family.

Foods NOT for Toddlers

What are the top 5 foods that you think under no circumstance a child should be given, or as infrequent as once a month?

Natalia: It is hard to ban certain foods from a child’s diet, especially as they become more independent in obtaining their food when they grow up. To avoid vilifying certain foods, that may only increase their appeal in children’s eyes, I prefer to focus on staying away from certain ingredients and buy or make a better version of children’s favorites most of the time. 

My top 5 food additives to avoid are artificial dyes, artificial sweeteners, sodium nitrate, certain preservatives (BHA and BHT) and trans fats. 

The good news is that by preparing most of the food at home and reading food labels a family can easily cut on their consumption of these foods.

Cutting Sugar in Kids’ Diet

I also believe in watching sugar in kids’ diets because too many sugary foods not only leave less space in small tummies for more nutritious foods but also create real health risks in the future. American Heart Association recommends only 4-5 teaspoons of added sugar per day for children, while most children get 3-4 times the amount. To calculate the amount of sugar in a serving of food, divide the number of grams of sugar on the label into 4, it will give you the number of teaspoons of sugar the food contains.

Children Supplements

MarcieMom: I’m giving my child supplements – she eats a balanced meal but I think 1. Probiotics, 2. Omega-3 and 3.Multi-vitamins (in doses below 100% of daily requirement) could strengthen her immune system. Is that the right thinking/approach or should I throw these out of the window? 

Natalia: When it comes to supplements, it helps to remember that it is a very loosely regulated market. FDA controls (somewhat) their safety, not efficacy. In our class we talk about consumer organizations that test and review supplements and I use their input in my work and personal life all the time. I see a lot of multivitamins of supermarket shelves that are mostly sugar and food coloring, missing the nutrients children are most likely to fall short on. So I think it is important to work with a dietitian to choose the supplements your child may truly need.

For example, many toddlers do not get enough iron in their diets and at the same time it is missing from most multivitamins. The good news is that there are specific additive and allergen-free comprehensive multivitamin formulas I recommend to parents of picky toddlers but they are not typically sitting on the eye level in supermarket shelves and some may only be purchased online.

Back to your question: providing your child with multivitamins, probiotics and DHA may be a good strategy to help close the potential nutrient gaps if your child does not eat many fruit and vegetables, eats no fermented foods and oily fish. But we know that nutrients are best absorbed when they come in the whole package, in foods. So I would still focus on exposing children to the nutritious foods that they are still learning to like, which I feel you are already doing wonderfully!

Thank you so much Natalia for being with us and sharing so many nutrition tips!

This was originally a 3-part post series which had been combined into a single informative post. It was a timely series due to rising childhood obesity as well as studies linking obesity with asthma symptoms and eczema in children.

Childhood Obesity

Marcie Mom: Thank you Rania, I’m so pleased to have you help in this series. I’m passionate about helping eczema families, and for those who have eczema children who are obese, they may have concerns over the type of foods to eat. Let’s tackle obesity, and along the way, offer some alternatives to children with eczema. Let’s get started!

Wait, what’s Obesity? Isn’t a little plump ok?

According to CDC’s data, the number of children from 6 to 11 year old in the US who were obese increased from 7% in 1980 to 18% in 2010. In 2010, more than 30% of children and adolescents were either overweight or obese. Overweight is defined as having excess body weight for the particular height while obese is defined as having excess body fat.

Parents in certain cultures may wrongly think that children ought to be chubby, but data collected showed obesity in children can carry on to adolescence and adulthood.  Children who are obese are also at risk of high cholesterol, high blood pressure, diabetes, heart diseases, bone and skin problems.

CDC’s Children BMI Calculator

MarcieMom: I’m looking at CDC’s page on BMI for children and parents should know that BMI for kids though calculated the same as for adults, don’t have a healthy weight range to follow. Instead the BMI should be compared versus growth chart that takes into account the child’s age and sex.

Rania, can you share with us how you would assess if a child is beyond his/her acceptable weight and for parents who wish to monitor this themselves, should they be looking at local growth chart (vs CDC) or is there a even simpler way for parents to monitor?

Rania: A child’s weight is largely dependent on his age and gender, and even taking into account those factor, it’s still variable. Because the calculation for BMI takes into account height, BMI-for-age percentiles are often regarded as the most precise way to measure obesity in children. Based off of this measurement, children who are below the 5th percentile are classified as underweight; between the 5th and 85th percentile is regarded as a healthy weight; between the 85th and 95th percentile is classified as overweight; and equal to or greater than the 95th percentile is classified as obese.

Contagious Eating Behavior

Rania, you have blogged about the likelihood of someone being obese if there is a friend or family. Do you have any example to share where you’ve helped the whole family (parents and child) to overcome obesity? What is usually the key motivation for these families who have successfully lost weight?

Rania: Yes, eating is a contagious behaviour not only between groups of friends but also within our own families. Clients come in and they see the effect they have on their families. They may be bringing donuts home or they like to snack on the couch. Of course, we like to share but sometimes this is not always caring!  Oftentimes, I will have a client come in who wants to lose weight and sometimes couples decide to get healthy together. They also realize that their diets/lifestyles affects their children’s food choices and preferences (frozen and fast food preferred to fresh/home cooked meals). When working with families it is important to get the children involved. Take them to the grocery store, get them involved in menu planning, and find ways to get them excited about being in the kitchen. You also want to keep in place some of their favorite meals but find a way to make them healthier and fun.

Kids Eating Strategically

For children, including those with eczema, fruits and vegetables, omega 3 and probiotics are beneficial (see Dr Sears series here). In a study of more than 500,000 children over 50 countries, three or more weekly servings of fruit reduced the severity of asthma, hay fever and eczema symptoms in 11 percent among teens and 14 percent among children. Moreover, essential fatty acids in Omega 3 are also good for the heart, brain, hair and skin.

Children’s Calorie Needs

MarcieMom: To maintain a healthy weight, one part of the equation is not to consume more calories than we need or use (for living and exercise). On WebMD’s website, an active child of 2-3 year old can consume 1000 to 1400 calories, while a 4-8 year old girl consumes 1,400 to 1,800 calories (boys 1,600 to 2,000 calories).

Rania, few questions –

1. You are America’s Eating Strategist^TM! Do share with us what eating strategically looks like for a child?

Rania: Eating strategically for a child is actually very similar to eating strategically as an adult. Regardless of a person’s age, he should aim to eat as nutrient-rich a diet as possible; this would include plenty of (and a variety of) fruits and vegetables, lean protein, whole grains, nuts, seeds, and dairy. Certain nutrients are especially important for children, like calcium (which supports bone health and nerve, muscle, and heart function), iron, folate, vitamin A, and vitamin C. While treats are okay in moderation, aim to limit calories from saturated fats, trans fats and added sugars; these foods can often displace healthier nutrient-rich foods.

2. I’m looking at the calories guideline (above) by CDC. Would this differ for a girl in US who is Caucasian versus a girl in Singapore who is Chinese?

Rania: A child’s recommended calorie intake is consistent across all cultures and ethnicity.

3. For a child who is obese and need to cut down on calories, how many calories are safe to be reduced without compromising the health of a growing child?

Rania: The number of calories a child can safely reduce in his diet is dependent on the child’s age, current weight, activity level, and gender, so there’s no specific, all-encompassing number. For younger children, sometimes allowing the child to grow into his weight–as opposed to losing weight–may be preferred. Talk with your child’s health provider to determine a safe weight loss or weight maintenance goal.

Sample Meal Plan

MarcieMom: Rania, for a child who has eczema and obese, what do you think is a sample meal plan to ensure that the calories to be consumed include sufficient fruits and vegetables, fish and other sources of omega 3, and probiotics?

Rania: Breakfast: Steel cut oats with blueberries and almonds; Lunch: Hummus and chicken wrap with vegetables (tomato, lettuce, onion, etc.); Dinner: Salmon, mashed sweet potatoes, and a salad; Snack: Yogurt with probiotics

Vitamin D, Milk Allergy

MarcieMom: I read on your blog the benefits of Vitamin D and calcium. For children who dislike milk or have a milk allergy, what would be your recommended alternatives to ensure they get the protein and calcium?

Rania: Quality sources of protein include lean meat, poultry, fish, eggs, nuts, seeds, legumes, and beans. Different types of dairy, like cottage cheese, kefir, and Greek yogurt, combine both protein and calcium. Besides milk, good sources of calcium include leafy greens like kale and spinach, white beans, cheese, some fish, tofu, and fortified products like cereal.

MarcieMom: The common food allergens for children are egg, cow’s milk, wheat, peanuts and soy. Which of these do you consider important to be in a child’s diet and what are the alternative sources of food to get the same nutrition benefits?

Rania: None of these foods are absolutely essential for a child’s health, but they do contain valuable nutrients.

Eggs and milk are probably the two most important foods in this group, but there are other foods that provide the same nutrients as they do. Eggs are a great source of protein and contain vitamin D and choline. Vitamin D can also be found in certain fish and fortified orange juice, milk, and yogurt. Choline, which maintains proper cell functioning and communication between muscles and nerves, is also found in chicken, turkey, shrimp, grass-fed beef, collard greens, swiss chard, and cauliflower.

Cow’s milk is another good source of protein, and it also contains calcium and vitamin D. Calcium is found in leafy greens like kale and spinach, white beans, cheese, some fish, tofu, and fortified products like cereal.

Anti-Inflammatory Foods

MarcieMom: Obesity is linked to chronic diseases, and chronic inflammation. Which are the anti-inflammatory foods that you would recommend as part of a child’s meal plan?

Rania: An anti-inflammatory diet should include plenty of fruits and vegetables; omega-3 rich foods like salmon, flaxseed, and walnuts; and herbs and spices, especially turmeric and ginger; and whole grains (refined grains exacerbate inflammation); nuts and seeds.

Snacking for Kids

MarcieMom: From what I’ve read in magazines, advice on snacking or no snacking and eating before 7pm or not seem to be changing all the time. 

For children, what do you think is the right snacking approach? Is there a difference if the child is obese?

Rania: The belief about the healthfulness of snacking is constantly changing–studies have found that people lose weight when they snack, and others have found that people gain weight when they snack. It seems as though there’s no hard and fast rule; instead, it’s an individual thing. Some kids may perform and feel better with snacks; others might do better with three square meals. It’s helpful to teach your child about mindful eating and to listen to his body–as opposed to external cues, like the amount his friend’s are eating–to determine when he’s had enough food. If he eats when he is hungry and stops when he’s full, your child should naturally fall into an eating pattern that’s ideal for him.

It’s helpful to teach your child about mindful eating and to listen to his body

Dessert Recommendation

Any dessert recipes would you recommend for eczema kids?

Rania: Because dessert’s main ingredients–sugar, saturated fats, and refined grains–are inflammatory, it’s best to limit desserts. Desserts that include anti-inflammatory foods, like zucchini chip muffins, can help counteract the effects of those ingredients and add valuable nutrients at the same time. Look for desserts that include fruits, vegetables, nuts, seeds, and spices (like cinnamon), which can display less healthy ingredients and add flavor. If desserts with healthier ingredients are unavailable, it’s okay to indulge in less healthy desserts once in a while.

Exercise for Weight Loss

MarcieMom: A last question on the other part of the equation to lose weight – through exercise. What is your recommended type of exercise for children, and number of hours, taking into account that some children with severe eczema may not be able to go swimming or tolerate excessive sweating?

Rania: The CDC recommends that children get 60 or more minutes of aerobic exercise per day. Exercise doesn’t have to be planned; just running around on a playground during recess contributes to a child’s daily 60 minutes. Exercise can exacerbate symptoms of eczema, but even moderate exercise, like brisk walking, is beneficial to a child’s health. Team sports are another good option: in one study, it was found to decrease depression and emotional upset in patients with eczema.

This was originally a three-post series that had been combined into a single informative post. I got to know Jennifer via Twitter and asked her to share her anti-inflammatory recipes, including broccoli which is a super vegetable that my daughter still loves.

Broccoli with Garlic Sauce

Ingredients

• 1 large bunch fresh broccoli, (about 1 1/3 pound)

• 3 large cloves garlic, minced

• 1/2 cup fat-free, low-sodium beef or vegetable broth

• 1 tablespoon low-sodium soy sauce

• 1 tablespoon cornstarch

• 1 tablespoon brown sugar or sugar substitute

• 1 teaspoon sesame oil

• 1 tablespoon canola or corn oil

• 4 scallions, thinly sliced

• 2 tablespoons chopped almonds

Instructions

• Trim broccoli and cut into florets. Peel stalk with a vegetable peeler and slice thinly. Set aside.In a medium bowl, stir garlic, broth, soy sauce, cornstarch, sugar or sugar substitute, and sesame oil.

• Heat a large skillet over heat high and add the canola or corn oil. When the oil is hot, carefully add the broccoli. Cook 3 to 4 minutes, stirring continuously until the broccoli begins to brown slightly. Reduce the heat to medium and add 1/4 cup of water. Cover and cook 3 to 4 additional minutes until the broccoli begins to soften.

• Lower the heat to medium low. Pour sauce over broccoli, cook 2 to 3 minutes longer until the broccoli is tender-crisp and the sauce thickens. Sprinkle with scallions and almonds if using. Serve immediately.

MariceMom: Thanks Jennifer for sharing the above yummy and healthy broccoli recipe. Now, I usually chop off lots of stalk and only cook the floret; I noticed that you peel the stalk and slice it thinly.

Is there a different cooking time for the stalk vs the floret?

Jennifer: They cook up well together as long as the stalk is thinly sliced, that cuts back substantially on cooking time.

When broccoli starts to brown, does this mean that part of its nutrition is lost?

Jennifer: No vitamins are lost after about 20 minutes of high heat cooking. Also I never boil my veggies.  If you boil vegetables in high amount of water, vitamins like vitamin C – which is water soluble will leach out into the water.

If you boil vegetables in high amount of water, vitamins like vitamin C – which is water soluble will leach out into the water.

MarcieMom: How do you gauge which is broccoli is fresh? Is there a best way to keep it? I noticed that broccoli kept in plastic bag tend to turn watery for the parts touching the plastic bag.

Jennifer: Florets should be tightly closed and dark green, with no yellow spots. Also look at the end of the stalks, if they are hollow or look dry that is a sign that they’ve been in transit too long.

Sunny Side Up with Kale

Ingredients

• 3 cups Kale, chopped
• Non-stick cooking spray
• 1 egg
• 1/8 teaspoon salt
• 2 teaspoons chipotle mayo or barbecue sauce

Instructions

Rinse the kale under cold running water, drain in a colander. Heat a large skillet over high heat. Pull it off the heat to coat it with cooking spray. Carefully add the kale. Cook 2 to 3 minute, pressing down the kale with a spatula. Move the kale to the side and add another spray of cooking spray in the center of the skillet.

Crack the egg in the center of the skillet and sprinkle it with the salt. Reduce the heat to medium. Continue to cook 3 to 4 minutes, until the white part of the egg is cooked through. Top with mayo and serve immediately.

Can kale be eaten raw?

Jennifer: Yes kale is delicious raw but the baby varieties are best for this preparation.

MarcieMom: How do you usually wash Kale? It is quite soft and sometimes I find that I over-wash it after running it under the tap and soaking it! (I’m one of the really paranoid moms who keep washing everything, even when it’s labelled pre-washed!)

Jennifer: Kale is hearty and it doesn’t absorb water when it’s washed. You can clean it in a 1-4 water to vinegar ratio water bath if you like, dry it well with a towel before making my kale chips so it crisps properly.

MarcieMom: How best to spread the oil if one has no cooking spray?

Jennifer: Be sure the pan is hot first, then the oil will coat the pan more efficiently.

Mushroom Stuffed with Sausage and Goat Cheese

Ingredients

• 4 ounces spicy turkey sausage (about 2 links), crumbled
• 24 white button or Cremini mushrooms, stems removed and reserved
• 2 sprigs of fresh rosemary, one sprig left whole, plus 2 teaspoon minced
• 2 tablespoons white wine (optional)
• 1/4 cup low-fat, skim milk
• 1 6-ounce package of fresh goat cheese
• 1/4 cup reduced fat Parmesan cheese, grated
• 1/4 teaspoon pepper

Instructions

• Preheat oven to 350° F. Heat a large heavy bottomed skillet over medium-high heat. Add sausage, stirring occasionally, breaking it up with a spoon as it browns. I like my sausage well-done, so I cook for about 20-25 minutes until the meat is a rich golden brown.
• While the sausage is cooking, prepare the mushrooms. With a damp paper towel or dishcloth, wipe off any dirt clinging to the mushroom caps and stems. Remove stems, mince them and set aside. Place mushroom caps, stem side up in a 9-inch baking dish with one of the sprigs of rosemary. Sprinkle with 2 tablespoons of wine or water and bake 8-10 minutes until the mushrooms are tender.
• Once the sausage is to your liking, turn off the heat and drain (if it is too oily). Add 2 tablespoons of the milk and scrap any brown bits sticking to the bottom of your pan. Place the sausage and its juices into a large bowl. Stir in the goat cheese, Parmesan, minced rosemary and season with salt and pepper. If the mixture seems heavy, add the remaining milk.
• Fill each mushroom with 1 teaspoon of sausage mixture. Bake the mushrooms for an additional 10-12 minutes until the filling is hot. Serve immediately. Warning: These guys move fast so if you might want to prepare a back-up plan or make double!

MarcieMom: In this recipe, I noticed you suggested wiping the mushroom. I always run it under the tap, does that affect the texture of the dish?

Jennifer: Yes mushrooms are like a sponge and they soak up a lot of water.  This keeps them from browning properly when you cook them.

MarcieMom:  Is it possible to overcook mushroom? What to watch out for to ensure that it doesn’t become too soft or get too dried out?

Jennifer: If you over cook mushrooms they can taste a bit spongy but usually they do well in all cooking preparations since they are high in water content to start with.

MarcieMom: Which mushroom cook best with soup, and which one best in oven, and which for stir-frying?

Jennifer: All mushrooms do well in soup and in the oven, for stuffed mushroom Cremini, portobellos, and white button are best. I prefer shiitake for stir frying since they have this delectable meaty texture and taste amazing after they are properly browned.

Thanks Jennifer, I love shiitake as a superfood that is linked to strengthening immune system against flu (boy, my family sure needs it!).

This is a 4-topic series focused on nutrition for babies and toddlers with eczema. It was originally spanning 7 posts, and combined to 3 longer informative posts.

• What’s Reliable Nutrition Information
• Newborn Nutrition – Just Milk, but Complicated
• Breastfeeding – Impact on Eczema Babies & Infant Reflux

Starting with the Fundamentals – What’s Reliable Nutrition Information?

MarcieMom: Judy, thank you so much for helping with this series, it’s very relevant for children with eczema and parents would be eager to learn more on nutrition (don’t we all think of what to feed our kids!). We will work through 4 different topics for this series, but before that let’s tackle something more fundamental.

Nutritional Study for Eczema

Nutrition advice is seldom given by dermatologists or pediatricians and understandably so since doctors are (i) not trained in nutrition and (ii) always careful not to advice beyond what’s been clinical proven. Are there then insufficient studies on nutrition’s impact on health and eczema? If so, can you explain the difficulties with conducting a large scale nutritional impact study? (I’ve googled eczema and nutrition study and could only find studies relating to pregnancy diet, fish oil and probiotics, and even that seem inconclusive.)

Judy: Nutrition is hardly a new science – It has been around as a science for over a century. But it has not been part of most physicians’ training for decades. So we have a huge gap in the knowledge base of physicians. Some data show pediatricians know little more than parents do about nutrition. To get reliable information, at least here in the US, parents may have to turn to a naturopathic doctor, a dietitian specializing in pediatrics, or find a physician who happens to have decided to become knowledgeable about nutrition. You would look for a masters degree in a nutrition science from an accredited university, in addition to the MD degree, in that case.

You would look for a masters degree in a nutrition science from an accredited university, in addition to the MD degree

As for data on nutrition and health – absolutely, the impact is profound. This is why there are nutrition program initiatives in UNICEF, the World Health Organization (WHO), and US government. You truly are what you eat. You grew in the womb from what your mom ate and rearranged into you! And in infancy and childhood, nothing is more predictive of healthy outcomes than strong nutrition status.

You truly are what you eat.

Challenges in Eczema Nutrition Studies

Regarding eczema, I have seen published data on this. Elimination diets, probiotics, fish oils, and other supplements are promising and frequently helpful. This may be a little harder to find since much of what gets published in medical journals is about pharmaceuticals, not natural substances.
Pharmaceuticals get researched much more, because they are patentable and thus very profitable. Nutrients and foods are neither, so there is less interest in studying these in any medical context.

Studies are hard to do on this topic because it’s hard to control the test variable – mainly, foods eaten. There are a few methods of assessing food intakes in a research context, all of which are time consuming and interviewer dependent. And, people lie or forget when it comes to reporting what they eat. They just do. You then also need well controlled subjects, e.g., 3000 kids age 4-5 years old who all have the same growth status at the start of the study, no bowel or feeding issues, and so on. Lastly there simply is no controlling the biggest wild card: What is in each child’s gut for biome (microbe population), which has much to do with how they digest/absorb food, and how inflammatory a food may become. Lots of moving parts, for something that cannot create a profitable product. This is why these studies don’t get done.

Lots of moving parts, for something that cannot create a profitable product.

Reliability of Nutrition Information on Web

Supposing that doctors won’t be able to advice on nutrition and should patients not have access to nutritionist and turn to the internet for nutrition information, what is your advice on how parents can discern which nutrition advice they ought to read and adopt?(Particularly given that there always seem to be a nutritious food that suddenly receives all the magazines’ attention or different website will go all out to propose that their type of supplement works wonders.)

Judy: Assess the source of the info, and look for credentials. University degrees, clinical experience, peer review authorship, lecture experience at respected venues, and licensure demonstrate expected level of expertise. Nutritionists in the US are licensed by state, and have to complete ongoing credit hours, pre-approved by the licensure boards, to keep their credentials. Licensure is not the same as a certificate, which can mean anything, from attending an afternoon lecture to taking unaccredited correspondence courses with no professional oversight. People often identify themselves as “nutritionists” but may have little training.

Assess the source of the info, and look for credentials. University degrees, clinical experience, peer review authorship, lecture experience at respected venues, and licensure demonstrate expected level of expertise.

Look also at whether or not the info you are reading is from a person who simply writes a lot, or is actually in practice. Many dietitians choose careers in communications or media, and never actually see patients once they leave school. They don’t have hands on experience. For tough questions, case experience is invaluable. It’s where scientific inquiry incubates, when it comes to medicine.
Ultimately, if you’re really motivated, you may find that you need to delve into the medical literature yourself. This is unbelievably easy now with the web. I’ve met many parents in my practice who have become laudable experts on certain facets of nutritional biochemistry, in their quests to solve their children’s health challenges. I am grateful to learn new things all the time from the families I work with.

Supplement Trial DIY Style – What to Take Note

MarcieMom: Also suppose a parent decides to try a certain food or supplement for their child, what would be the time frame to look at to determine if it is making the child healthier (or improving his eczema) and what signs should the parent look out for to determine that the child is better or worse? (for instance, weight/height or skin or bowel or hair or teeth or alertness?)

Judy: First, parents need to know if a supplement or food is the appropriate measure. That is what I help parents sort out with an initial nutrition assessment. That’s best – you get a baseline, identify the problems, and choose the tools to fix the problems. But in reality, parents do tinker with supplements. I discuss this dilemma in both my books. You can waste a lot of time and money here, if you don’t approach this more methodically. There are tables and charts in my books to help parents sort out what might be the right next steps, with regard to using supplements. I explain dosing, time frames, and more.

You get a baseline, identify the problems, and choose the tools to fix the problems.

Kids Nutrition – A Process, not a Pill

Next, nutrition is a process, not a pill. If a child has entrenched eczema and underweight, there is probably not going to be a single answer to that, and it is probably not going to go away overnight. Unlike medications, nutrition aims to solve the problem from a deeper level and help the body heal itself. I would look at several factors in the assessment process to sort and prioritize what is
going wrong. Different problems respond at different paces; some supplements work fast; others, like fish oils, can take weeks to calm and restore the skin. Nutrition tools are only as good as the weakest piece. They all work together. If you only fix one problem and overlook others, that child will continue to do poorly, even if you’ve picked a great supplement to try.
That said, once I have the pieces in place for an initial plan, I expect a child to respond fairly quickly. Positive changes should emerge within the first month.

MarcieMom: Thanks Judy, and your explanation sheds light into why there sometimes is a disparity between what the supplements say they will achieve and why it sometimes do and don’t.