Doctor Q&A

Feeding Kids Healthy series – Eating a Balanced Diet

Traditionally, parents worry about whether children are eating enough but based on the rise in childhood obesity (2011 – 11% and updated in 2017 – increased to 13% in Singapore), parents also have to be mindful of overeating AND eating the wrong types of foods.

For this 2-part series focused on feeding kids healthy, Abbott facilitated the interviews with nutrition experts. Last week, we covered what and how much a child should eat. This week, we will focus on how we can get the child to eat a healthy and balanced diet. We have Anna Jacob, Director of Nutrition from Abbott.

Health and balanced diet for children with Anna jacobs director of nutrition abbott

MarcieMom: Thank you Anna for helping us figure out how we can actually get our kids to eat the healthy meal we’ve prepared. We assume that parents have the knowledge to serve a healthy meal of half plate fruits and vegetables (the more colour, the better), a quarter of protein and a quarter of whole grains. Let’s overcome the potential obstacles in each food group!

Getting Fruits Rights for Children

For fruits, the common ones in Singapore are apples, oranges, pears, grapes, strawberries and mangoes. Within these fruits, we have red, orange, green, purple and yellow! Would you reckon it is more attractive to kids to be served a variety of colours within a meal or rotating each fruit? What is the serving size in each case? Must they be organic?

Anna Jacob: Fruits are rich in many vitamins, some minerals and dietary fibre. Brightly colored fruits also have many natural plant compounds that are now known to be beneficial to health. For example, beta-carotene in yellow-orange fruits supports healthy skin and anthocyanins in red fruit may benefit heart health.

Beta-carotene in yellow-orange fruits supports healthy skin and anthocyanins in red fruit may benefit heart health.

There are basically five colored types of fruit:

  • Green:  Green apples, pears, kiwi, honeydew
  • White: Bananas, lychees, longans, mangosteens
  • Yellow and Orange: Oranges, papaya, cantaloupe, mango
  • Red: Cherries, watermelon, red apples
  • Blue and Purple: Blueberries, purple grapes

Parents can add color to their children’s meals with a variety of fruits, making recipes more attractive and nutritious.  However, we do not have to serve up all the colored fruits on one plate all the time. Incorporating them through different meals and snacks will help your child appreciate and eat them too.

Dietary guidelines from around the world recommend that fruit should be part of a child’s diet – starting with just half a serving after 6 months and progressing to 2 servings by 7 years. 

Examples of a serving of fruit, as defined by Singapore’s Health Promotion Board, is 1 medium banana, 1 medium apple, pear or orange, 1 wedge of watermelon, papaya or melon or 10 grapes or longans.

Fruits in Singapore are safe and rinsing the fruit in clean running water before cutting and eating it is sufficient. Therefore, it is not necessary for parents to buy only organic fruit for their children. But for those who want it and can afford it, organic fruit – free of synthetic fertilizers and pesticides – may provide peace of mind.

Getting Vegetables Right for Children

MarcieMom: For vegetables, the leafy green ones, cruciferous (broccoli, cauliflower and Brussel sprouts) are packed with nutrients. What is the best method of preparation that retains the nutrients yet appealing to kids? Do you recommend hiding vegetables?

Anna Jacob: Indeed, green leafy vegetables are rich in many nutrients including iron, vitamin C, folate, calcium and fibre.  However, many vitamins are sensitive to light and exposure to air. In addition, the water soluble vitamins and many minerals are soluble in water.

Vegetables retain their nutrients best when they are eaten fresh and not processed. To preserve the nutrients in fresh vegetables, prepare them just before eating; do not soak or cook them in water for too long, prepare just before eating, cut into larger pieces and do not overcook vegetables.

Cooking destroys some nutrients, especially the fragile, water soluble ones.  However, many children eat more vegetables when they are served up cooked. Of the many cooking methods commonly used to prepare vegetables, microwaving and steaming conserve nutrients best.  On the other hand, some nutrients in vegetables are better absorbed when prepared with some fat.  For example, tomatoes cooked in oil make lycopene (the natural red pigment) more available to the body. Cooking also makes many otherwise inedible vegetables suitable for a child’s diet – think potatoes, yam, beets and more.

Your Cooking Method Matters

So, use several cooking methods to prepare vegetables to increase your child’s exposure to a variety.  Aim to provide ½ serving of vegetables a day to a child over 6 months and, gradually progress this to 2 servings by the time he / she enters school.  A serving is defined as ¾ of a 250-ml mug of cooked or non-leafy vegetable, 150 g of raw leafy vegetables and 100 g of non-leafy vegetable.

Ideally, children should accept all food including vegetables. However, some reject vegetables due to color, taste, texture. Some scientists also suggest that a few kids are ‘super-tasters’ and may be more sensitive to the bitter notes of leafy green and cruciferous (broccoli, cauliflower and Brussel sprouts) vegetables – causing rejection of these nutrient-dense foods.

Patience is the key when you want to inculcate healthy habits – offer the same vegetable over and over again, without forcing, so that the vegetable becomes familiar. Model eating the same food item at family meal times and, vary the presentation, cooking method and flavoring.  If and when all these suggestions for introducing vegetable fail or take time to achieve, parents may have to be creative and incorporate vegetables in foods. So, ‘hiding’ vegetables is a last resort and not the best option.  But, it is still a valid option and, so, do not feel guilty if you are doing it. Just keep working on all the suggestions listed above, and, soon over time, you will succeed – at least to some degree.

Getting Grains Right for Children

MarcieMom: For grains, whole grains like whole wheat, brown rice, quinoa are better than white rice. As there is less natural sugar in these than white rice, how should they be prepared to be appealing?

Anna Jacob: Natural grain foods – whole grain and polished – do not contain natural or added sugars. All carbohydrates in grain foods, after digestion are absorbed into the blood stream as simple sugars. This is unavoidable as it is the way the body handles carbohydrates. Sugars and starches are not all bad – they do help provide energy to keep children active. In the right proportion, they ensure that children get the energy they need to grow and be active. One advantage of whole grains is that it has more fibre, vitamins, minerals and natural plant components than refined grains. So, definitely, whole grains are more nutritious and therefore, the healthier choice. Here are some tips on how to cook them:

  • Brown rice can be steamed or boiled. However, you need to adjust cooking time and added water volume to achieve a soft and edible grain suitable for your child’s eating ability.
  • Whole wheat grains can be boiled to prepare porridge or milled to make whole meal flour. The flour is versatile and you can make a variety of breads and biscuits with it.
  • Quinoa, usually prepared by the absorption method, requires two-times the volume of water as quinoa and cooks in 10 – 15 minutes.

As these are staple foods and, we eat a good portion of them at each meal, so, it is best to prepare them simply with less fat, salt or sugar. They can be eaten with vegetables and lean proteins as side dishes.  In addition, for variety, you can toss whole grains with fresh or cooked vegetables, nuts, lean meat and some natural seasonings to prepare delicious one-dish meals or snacks.

5 Tips to Get your kid to experiment

MarcieMom: Apart from the food preparation, can you share your top 5 tips for getting children to experiment different foods and eat the foods served to them? What are the top 3 pitfalls to avoid when getting a child to eat his/her meal?

Anna’s Top 5 Tips for Getting Kids to Experiment Foods
  1. Involve your child in food preparation. From gardening to shopping and cooking, involving your child will help him/her learn about food, become familiar with it and, even develop a sense of pride and ownership. Time spent together over these activities will offer you many opportunities to teach your child about the nutrient-goodness of food as well.
  2. Eat with your child. Children learn about nutrition best by modeling healthy eating behaviors. As you eat a wide variety of food, your child will learn to do so too. You can use these special moments to teach table manners and to bond.
  3. Offer healthy foods. As a parent, you need to ensure age-appropriate and healthy foods are available at regular meal and snack times. However, you need to allow your child to select the portion he wants to eat. Encourage independent eating too. Over time, your child will develop a healthy attitude towards food and eating.
  4. Be creative but do not become a short-order cook. Offer your child a variety of food items, cooked in various styles. You can do this by becoming a creative cook or introducing your child to various food choices out of home. But, once the menu is set, and the food is on the table, do not entertain preparation of special dishes for your child.
  5. Allow your child to occasionally eat with peers. Kids also learn fast by watching their friends. Eating a meal or two with peers helps your child pick up skills he never had.
Anna’s Top 3 Pitfalls of Feeding Kids
  1. Do not abdicate responsibility for your child’s nutrition. Many working parents do not have the luxury to be at home with their child at every meal time. But, set the menu. Know what is served and what is eaten. Talk to your child’s caregivers and, tell them what you would like your child to eat so that they can work with you to ensure good nutrition.
  2. Do not force feed. While you decide when, where and what your child eats, please give your little one the right to select how much he wants to eat. Force feeding is counterproductive as it stresses the caregiver and, scares the child or causes defiance.
  3. Do not distract your child while eating. It is another common practice to let children watch television or play computer games during meals while the caregiver feeds the child. This feeding style does not develop a child’s self-feeding ability – to know and appreciate what is served and learn to be conscious of how much he is eating.

While you should encourage healthy and appropriate eating, this takes time and much effort, you should track growth with your child’s physician at regular visits; and, in the interim you may provide a complete and balanced supplement to fill nutrient gaps, if any – to achieve optimal growth during the critical periods of life.

MarcieMom: Thank you so much to Anna Jacob for sharing these tips. Even for families who are already eating healthy, it is a good reminder to keep up the effort, try new foods and enjoy a healthy life!

Doctor Q&A

Feeding Kids Healthy series – What and How Much is Right?

Traditionally, parents worry about whether children are eating enough but based on the rise in childhood obesity (2011 – 11% and updated in 2017 – increased to 13% in Singapore ), parents also have to be mindful of overeating AND eating the wrong types of foods.

Feeding Kids Healthy - Right portion and types of food with Dr Chu Hui Ping

For this 2-part series focused on feeding kids healthy, Abbott facilitated the interviews with nutrition experts. Today, we have Dr Chu Hui Ping, Paediatrician from Raffles Children’s Centre with a clinical interest in pediatric gastroenterology.

MarcieMom: Thank you Dr Chu for helping us in this series to clarify for parents how to feed our children. Firstly, in Singapore, we are familiar with the growth charts included in our child’s health booklet. Parents can work out the weight and height percentile of their child against the right chart for their age and gender.

Should growth charts be used as a gauge of how much to feed a child?

For instance, being above 95% percentile for weight means that the child should cut back and below 5% means parents should feed more?

Dr Chu: It’s probably not that simple and straight-forward just to use the growth percentile to decide on how much the child should be eating. Generally we don’t only look at the percentile for weight; we also consider the height percentile, i.e. whether the child is proportionate for weight and height, as well as the growth of the child over the last few months or a year.

Some children are genetically bigger in size, for instance they are already born bigger and have always been growing along the 95th percentile for their weight and height. So it will not be appropriate to put these kids on a diet. It is more important to ensure that children who are at above 95th percentile and who are at less than 5th percentile for weight are being assessed by their doctors or paediatricians to exclude any medical conditions which make them gain or lose weight respectively. Even if there aren’t any underlying medical conditions, it is also essential to review the various components of their diets and ensure that the diet is well-balanced and consists of the essential nutrients rather than just cutting down or feeding more.

Getting Food Portion Right for Children

MarcieMom: Growth charts don’t take into account the fats a child has (since obesity is defined as excess fats) nor do growth charts take into account physical activity levels. How should parent figure out if their child should be eating more or less based on the amount of exercise they have?

Dr Chu:The child should be able to regulate his intake of food depending on the amount of exercise he has. Generally if the child is active, i.e. participates in active play or exercise for 60 minutes in a day, he will feel hungry and ask for food if his current diet is insufficient to meet his activity level. It is more common for parents to give too much food in proportion to the amount of exercise that the child has, resulting in the child being overweight due to the excess unutilised calories. If the parent feels that the child is not eating sufficient for the amount of physical activity he has, he can increase the proportion of complex carbohydrates or whole grains which can help to release energy in a slow manner, as well as proteins in the form of lean meat for muscle growth.

Getting Food Types Right for Children

MarcieMom: How much to eat is only one part of the equation. What about the type of foods? While we know that excess sugar, trans-fat and processed foods are bad for health, what can parents do to ensure that their child have an optimal diet? Do share your top 5 tips on eating healthy for the child (and family)!

Dr Chu’s Top 5 Tips for Healthy Eating
Kids Healthy Diet
  1. Eat fresh –try to avoid processed foods and to prepare your meals using fresh ingredients.
  2. Ensure that half of your meal should be consisting of vegetables and fruits.
  3. Choose wholesome foods such as brown rice and wholemeal bread.
  4. Reduce unhealthy fats/oils by cooking in a more healthy manner – steaming, boiling, stewing etc.
  5. Drink water for hydration instead of sweetened juices and soft drinks.
Dr Chu’s 5 Recommended Dishes at Kopitiam Coffee Shops

MarcieMom: In Singapore, there are many food courts and coffee shops but these usually don’t meet the healthy plate guideline of half a plate of fruits and vegetables. Which 5 common dishes found in coffee shops would you recommend and which 5 dishes would you discourage for children?

Dr Chu: Choosing health food options in food courts and coffee shops may be tough but not impossible. I would recommend these food choices:

  1. Rice with mixed dishes (choosing at least 1 vegetable and 1 lean meat)
  2. Fish soup with additional vegetables, soup noodles with additional vegetables
  3. Grilled fish or chicken with salad and mashed potato (instead of French fries)
  4. Freshly cut fruit platter
Dr Chu’s 5 Dishes to Avoid at Kopitiam Coffee Shops
  1. Chicken rice (because too oily and little vegetables)
  2. Char kway teow (because too oily and too much salt)
  3. Fried economic beehoon with luncheon meat (because too oily and lots of MSG in the processed meat)
  4. Laksa (because high saturated fats from the coconut milk)
  5. Black fried carrot cake (because too much salt and sugar from the black sauce used)

MarcieMom: Thank you Dr Chu for enlightening us on the types of foods beneficial for our child’s growth. Next week, we will check back on how to actually get our child to eat them!

Guest Interview

Toddler Nutrition series with Natalia Stasenko – What and How Much to Eat

Natalia Stasenko, a registered dietitian, is passionate about pediatric nutrition and shares nutrition tips and coaching on FeedingBytes. Natalia has a Master of Science in Nutrition Education from Columbia University. She co-wrote to books Baby Led Feeding and Real Baby Food with Jenna Helwig.

oddler Nutrition with Registered Dietitian What How Much to Eat and What not to Eat Eczema kids

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

Toddler Nutrition portion

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

Toddler Nutrition series on Eczema Blues
Photo from Natalie Stasenko

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!

Food Grading for Eczema Child

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

Toddler Nutrition on Eczema Blues with nutritonist Natalia Stasenko
Photo from Natalie Stasenko

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

Toddler Nutrition series with nutritionist on Eczema Blues
Photo from Natalie Stasenko

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!

Eczema Facts

Soda and Child series : Impact on Eczema, Allergy

Soda Eczema Allergy

For the past two weeks (here and here), we have explored the Top 10 Bads of Soda for our children. Today, we’d be going into whether soda leads to allergic conditions.

There is actually very little written on this, and I’ve scoured both the web and Pubmed. Thus far, the biggest culprit ingredient linked to eczema, asthma and allergies is Sodium benzoate. This has been covered last week where sodium benzoate is a preservative found in soft drinks, and linked to allergy and behavourial issues.

I only found one study on Pubmed, where 62 children from age 12 months to 13 years were observed for whether restriction in their diet led to an improvement in eczema. Among the restricted foods, soda (11.9%) was the highest, followed in decreasing order by food additives (9.2%), walnut (7.0%), peanut (7.0%), and other nuts (5.9%). When foods were grouped, the crustacean group was the most frequently restricted group, followed by processed foods, nuts, milk & dairy products, and meats.

The observation from the study was that atopic dermatitis/eczema improved for those children which had restricted 1 to 3 food groups, and those that avoided more than 3 groups didn’t showed significant improvement. There may therefore be some impact on restricting foods, but it is not clear nor a causal link directly established through this study.

There are many websites though, through personal testimonies, where various individuals found that removing sugar, caffeine, preservatives and artificial sweeteners from their diets helped. In this case, as there is little nutritional benefit of such ingredients for our children, restricting these ingredients from their diet should be a plus (if not for eczema, for healthy living!).

Eczema Facts

Soda and Child series : Top 10 Bads of Soda

soda and child health effects
Soda is really bad, opt for plain water for our children!

Last week, we started the Soda and Child series and today, we would continue exploring the other ingredients of soda.

#3 Phosphoric Acid – Phosphorous deplete calcium in the body which is essential for the child’s growth, putting teenage girls at risk of osteoporosis. There are some studies that show that drinking soda is related to drinking less of milk, but this is not very significant.

#4 Acids –The acids in soda contribute to an unnatural acid environment within the stomach and can lead to inflammation of the stomach and duodenal lining. The acids also erode the enamel on the teeth and thus up the risk for tooth decay (plus sugar also cause cavities)

#5 Caffeine –Some soda contains caffeine which stimulates adrenal glands. Colas, diet colas and many soda contain caffeine. Energy drinks which are getting more popular among children and teens also contain caffeine. Drinking too much caffeine, as adults can attest to, make us tremble, lose sleep, stomach upset, increased blood pressure and irregular heartbeat.

#6 Sodium benzoate or potassium benzoate –these are preservatives present in diet sodas which have been linked with allergic conditions and possible irritant to the skin, eyes and mucous membranes. Studies on rats indicate increase in anxiety and motor impairment after benzoate consumption.

#7 Aspartame – Used in diet soda as a sugar substitute, there are many studies linking aspartame to brain tumors, birth defects, diabetes, emotional disorders and epilepsy (from Mercola site). Interestingly, Dr Mercola pointed out that “when aspartame is stored for long periods of time or kept in warm areas it changes to methanol, an alcohol that converts to formaldehyde and formic acid, which are known carcinogens”.

#8 More on Artificial Sweetener – Below is an interesting extract from a post written by Mark Hyman, MD at Huff Post:

Artificial sweeteners are hundreds to thousands of times sweeter than regular sugar, activating our genetically-programmed preference for sweet taste more than any other substance.

They trick your metabolism into thinking sugar is on its way. This causes your body to pump out insulin, the fat storage hormone, which lays down more belly fat.

It also confuses and slows your metabolism down, so you burn fewer calories every day.

It makes you hungrier and crave even more sugar and starchy carbs like bread and pasta.

In animal studies, the rats that consumed artificial sweeteners ate more, their metabolism slowed, and they put on 14 percent more body fat in just two weeks — even eating fewer calories.

In population studies, there was a 200 percent increased risk of obesity in diet soda drinkers.

#9 MSG Monosodium Glutamate – MSG is found within the citric acid and has been linked to brain diseases like Alzheimer’s,learning disorders and psychiatric conditions.

#10 Diuretics –Sodas are diuretics which is dehydrating and affects digestion.

These top 10 Bads of Soda, even though studies may not have been conclusive causal links, are enough to stop me, my child and my family from consuming. Is there any impact on allergic conditions? Find out next week.

Eczema Facts

Soda and Child series : Impact on Kids Health

Soda Children Health

For the past few years, there is much awareness on the ‘danger’of soda –even celebrities are more mindful of endorsing soda brands (google Beyonce, Scarlett Johansson and Taylor Swift)! Sugar, which is a key ingredient in soda drinks, is inflammatory and well-known nutritionists like Rania Betayneh and Toby Amidor had offered tips on inflammation in this blog.

Every time I see someone close to me buying a sugared drink (or for that matter, when I buy a sugared drink myself!), I always joke about ‘Heres the inflammatory drink!’. Lately an acquaintance who loves soda had recently been diagnosed with a terminal chronic condition which led me to start looking at soda again. If it’s REALLY (Truly Bluely as my 5-year old daughter would say) BAD for health, we as parents would not want our child to consume soda. So, let’s review the effects on general health in this 3-week soda and our kid series, with the last post with a focused on possible effect on allergic conditions.

Top 10 ‘Bads’ of Soda

#1 Sugar – Sugar is empty calories and linked to obesity, which in turn is linked to a whole host of chronic diseases. It is also linked to increased risk of pre-diabetes (something to watch out for even for adults), metabolic disorders and heart disease which have symptoms like big waistline, high blood pressure and low HDL/good cholesterol.

More recently, sweetened drink has been linked to behavioral issues in children, with issues like aggression, depression and attention difficulties. As to which ingredient causes it, it is not clear but caffeine, acids, HFCS and sugar had been hypothesized to be behind the behavioral issues.

But can all the health problems be blamed on sugar?

The case made by soft drink companies/associations is that soft drinks should not be picked on for the rise in obesity and it is true to some extent – the additional 100-200 calories from a can of soda may not contribute to material weight gain, what is contributing is that because it doesn’t make your child feel full, thus there is a tendency to not reduce overall calories intake. The additional (empty) calories from soda can become truly weight-gaining unless one makes a conscious effort to exercise.

#2 High Frutose Corn Syrup –The HFCS in soda doesn’t make the child full and thus, misled the child to consume more of the drink. This has been covered in Dr Sears L.E.A.N series here, with the Dr Sears LEAN team’s tip below:

Drinking soda should be discouraged. Many juice drinks and all sodas are high in calories, provide no nutrients, and are usually sweetened with high fructose corn syrup (HFCS), which you should always avoid. Click here to learn more about why you should avoid HFCS:

Next week, we will be going through the other ingredients in soda drinks and learn the other possible effects on health of our children!

News & Research

Eczema Research News – More Sun and Vitamin D?

Does the Sun help? And is more sun good for eczema child? or bad?
Does the Sun help? And is more sun good for eczema child? or bad?

Today’s topic is on Vitamin D, should we need more Sunshine? Sunshine has been covered in this blog, but mostly to understand whether we need sunscreen (answer is yes!) and what types of sunscreen and how to apply. Tips on sun protection from renowned dermatologists have been shared, such as

Protecting Skin – by Dr Ava Shamban

Common Skin Rash in Children – Sunburn – by Dr Robin Shaffran

AAD Skincare Video for Eczema – by Dr Joshua Zeichner

AAD Skinccare Video – Sunscreen – by Dr Sonia Badreshia-Bansal 

Children Skin Conditions – by Dr Lynn Chiam

There is much talk about whether sun is good for our children with eczema, and there are some companies that recommend Vitamin D products (be it skincare or oral supplement). What we know about the sun and our skin is

  1. A child’s skin is thinner and thus more susceptible to harmful effects of ultraviolet light, such as sunburn and skin cancer.
  2. UV light is required for the skin to synthesize Vitamin D; vitamin D that comes from sunlight has been shown to increase the production of skin proteins (cathelicidin) and antimicrobial peptide (AMP) which protects against skin infection.
  3. For eczema patients, sun exposure is drying for skin and can aggravate eczema, esp. flare-up.

No wonder there is so much controversy on sunshine and vitamin D; in line with this Eczema Research News series, below are the studies from 2013 onward of the efficacy of Vitamin D:

Vitamin D deficiency is associated with atopic dermatitis (eczema) in children, more severe eczema (here, here)

Increased sun exposure during summer holidays associated with reduced eczema, but not related to Vitamin D level (here)

Children living in hot and humid climate have more eczema flare-ups (here), but contradicted with this study

Vitamin D has some protective function for food allergy in infants (here)

What age Vitamin D supplement is given, and in what form (soluble or tablet) may alleviate or worsen allergic diseases – as to which is best is still unknown (here), no conclusive evidence (here)

Updating with study in Nov 2014 – where 186 children were regularly followed up at clinics for a four-year follow-up period. Low cord blood Vit D levels were associated with higher risk of food sensitization throughout childhood. Cord blood Vit D levels were inversely associated with the risk of milk sensitization at age 2, at which age a higher prevalence of milk sensitization was significantly associated with the risk of allergic rhinitis and asthma development at age 4.

Have anyone tried any Vitamin D related treatment? Do share in the comments, thank you!

Doctor Q&A

Rise and Shine Feature – Baby Health with Dr Sears

Dr. Bill Sears is one of America’s most renowned pediatricians, father of eight children, and author of over 40 books on childcare. He is the Associate Clinical Professor of Pediatrics at the University of California, Irvine, School of Medicine. Dr Sears Lean has a series on this blog that covers many aspects of raising healthy kids. Dr Sears shared many tips in this Singapore workshop ‘Keeping Your Child Healthy’.

Raising healthy babies and successful children with Dr Bill Sears
Listening to the esteemed Dr Sears speak on healthy child is a privilege!

What to Feed the Smart Baby

Omega 3 (seafood) is recommended as it is important for the brain’s development. Other foods recommended by Dr Sears for brain development are fruits (blueberries), greens and nuts for children over 2-year old. Smoothie can be prepared to include these foods, also salads, spice and appropriate supplements.

Rice cereal is no longer recommended as a first food as it does not contain the essential fats.

Picky Eaters

A child may not be picky, sometimes parents have to remember that children have tiny tummies and a fistful of food is sufficient portion meal size. So, instead of feeding 3 meals a day, ‘grazing’ ie giving foods for the child to nibble throughout the day is increasingly studied to improve their growth and helps with even sugar level. Dr Sears suggested leaving foods in a tray and let the ‘picky’ eater pick at it instead of insisting that they be eaten at one go.

When to Feed Your Baby

On-demand feeding is increasingly recommended versus feeding babies on four-hour schedule, which had been associated with a failure to thrive. Breast milk gets out of baby’s stomach in about 45 minutes, much shorter time than formula milk as casein takes a longer time to digest. Mothers who breastfeed will not need to worry about under or over feeding their babies.

How to Prevent Childhood Illness

Dr Sears recommended breastfeeding, feeding the child with real food (not processed, junk food), immune-boosting foods (see this Dr Sears Lean Series: Raising Healthy Kids by Boosting Immune System) and get the recommended vaccinations.

A word on Childhood Vaccinations

Dr Sears shared that vaccinations are good for the child, family and society. About 2.5 million life are saved per year but sadly, 1.5 million children die each year from vaccine-preventable disease. It is a myth that vaccinations should be put on hold till the child is holder, as the whole point of vaccination is to protect the infant who is the most vulnerable. MMR (measles) vaccine has also been disproven to cause autism through a study involving 500,000 children.

What to do with Colic Baby

Colic is mostly due to Gastroesophageal reflux which should not be ignored because continued severe reflux can damage the lining of the esophagus. Sleeping in inclined upright position, sipping rather than drinking too much at a go, antacid prescriptions can help relieve the reflux.

What to do with Fussy Baby

Again, similar to colic baby that is better termed ‘hurting baby’, fussy baby is better termed ‘high need baby’. These babies have a higher need to be touched, held, more intense, more active, therefore demanding and draining their parents more. As they can be more sensitive to separation, it is best to hold these babies in arms, closer to breast.

I didn’t get to have Dr Sears vet through this post before publishing, any and all mistakes mine. Next week, we will cover more on parenting.

Doctor Q&A

Rise and Shine Feature – Healthy Child with Dr Sears

Dr. Bill Sears is one of America’s most renowned pediatricians, father of eight children, and author of over 40 books on childcare. He is the Associate Clinical Professor of Pediatrics at the University of California, Irvine, School of Medicine. Dr Sears Lean has a series on this blog that covers many aspects of raising healthy kids. Dr Sears shared many tips in this Singapore workshop ‘Keeping Your Child Healthy’.

Raising healthy babies and successful children with Dr Bill Sears

Diabetes in Children

Listening to the esteemed Dr Sears speak on healthy child is a privilege!

Diabetes is an increasing and worrying condition among children. The risk of diabetes decrease with healthy choices and conversely, increase with unhealthy ones. Although genes play a role, recent studies show that whether that gene is expressed is determined by healthy choices, including those at pregnancy. Eating too much junk food and lack of exercise contributes to the rising diabetes problem in children in the US.

Exercise for Children

Exercise can help the baby to be healthier as recent studies found that the body’s internal ‘medicine’ is released from the endothelium, the inside lining of blood vessels. Exercise creates an energy field and the glands along the endothelium open up, releasing ‘medicines’ for growth and regulating mood into the blood vessels, which in turn are circulated. An unhealthy diet and lack of exercise clogs the endothelium, preventing these ‘medicines’ from being released.

Effect of Omega 3 in Children

Increase intake of omega 3, such as fish oil with EPA and DHA during pregnancy has been associated with reduced post-partum depression, less premature births, fewer incidences of pre-eclampsia and less gestational diabetes. Numerous times during the talk, Dr Sears recommended that we stick to the Asian diet which is typically higher in fish and other safe seafood.

Stick to the Asian diet which is typically higher in fish and other safe seafood

Dr Sears also shared the theory that post-partum depression is linked to Omega 3 deficiency – the theory is that the baby drains the mother as their brain grows most during pregnancy and the first year. A baby’s brain is 60% fat and uses glucose and oxygen. Therefore, appropriate intake of omega 3, carbohydrates and antioxidants are required. Dr Sears illustrated that omega 3 is to brain like calcium is to bone, responsible for brain cell membrane fluidity and myelin development. Omega 3 has also been associated with improved cognitive abilities of children and improved visual acuity.

Smoking – Smoking is not recommended and linked to many risks for the baby, including sudden infant death syndrome, affecting the breathing of babies via the paralysis of cilia (found in windpipes for sweeping dirt from lungs), doubling the risk of respiratory infection and causes higher nicotine levels in breast milk. Moreover, smoking also lowers prolactin, which stimulates mammary glands in preparation for milk production.

Dr Sears’ Eating Tips for Pregnant Moms

  • Eat twice as often
  • Eat half as much
  • Chew twice as long
  • Take twice the time to dine

I didn’t get to have Dr Sears vet through this post before publishing, any and all mistakes mine. Next week, we will cover more of Dr Sears’ talk, including on attachment parenting and (the mysterious) colic.

Guest Interview

Tackling Obesity in Eczema Children with Nutritionist Rania Batayneh

Nutritionist Rania Batayneh, MPH, is the author of The One One One Diet and a certified Wellness Coach through the American College of Sports Medicine. Rania has been featured in MSNBC, Oprah, Dr Oz and is a contributor for MarthaStewart. She holds a master’s degree in public health nutrition from the University of Michigan School of Public Health. She offers nutrition and wellness coaching at EssentialNutritionForYou

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 StrategistTM! 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.

A 3-part Nutrition series discussing childhood obesity with celebrity nutritionist Rania Batayneh

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?

RaniaBreakfast: 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?

RaniaQuality 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.

News & Research

Eczema Research Focus Month – Obesity and Asthma

Obesity linked to eczema and other allergic conditions
Obesity linked to eczema and other allergic conditions

This is an interesting study – on obesity. Obesity had been covered in this blog, including tackling obesity in eczema children. Obesity has impact on inflammation and chronic diseases, and in this study, there is some relationship established between obesity and TV on various allergic conditions. The study is part of the ISAAC study, which is questionnaire-based, instead of trials. In any case, it’s never good to be obese! The main points of the study:

1. Study covered children aged 6-7 years adolescents aged 13-14 years

2. Associations between obesity and symptoms of asthma and eczema

3. Vigorous physical activity positively associated with symptoms of asthma, rhinoconjunctivitis and eczema in adolescents, but not children

4. Viewing television for 5 or more hours per day associated with an increased risk of symptoms of asthma, rhinoconjunctivitis and eczema in adolescents

In a separate study, weight loss improved inflammatory skin condition psoriasis. So, even more reason to be healthy – exercise and don’t consume excess EMPTY calories – foods like sugar, fried food and transfat are pro-inflammation foods. Share your diet for your family in the comment!

Doctor Q&A

Skin Health Series – Diet and Lifestyle

This is the fourth of a much-awaited series, where I get to work with Dr Verallo-Rowell again (we last worked on Sensitive Skin Product Series in 2012). Dr Verallo-Rowell is a dermatologist, dermatopathologist and dermatology/laser surgeon, founder of VMV Hypoallergenics, and is also an author, esteemed researcher and speaker. 

Skin Health Connection Interview series with Dr Vermen Verallo Rowell VMV Hypoallergenics

Skin Appearance and Health Conditions

Some people’s skin seem to look more wrinkled, less glowing, dark colors under the eyes if they are not sleeping well. Smokers may have a grayish tone to their skin.  Having a diet heavy with sugar can make it prone to acne. Deficiency of certain vitamins and minerals can also cause the skin to be dry.

MarcieMom: Dr Verallo-Rowell, I know you are deeply passionate about nutrition.

Which are the worst foods you would seriously object to for skin?

MarcieMom: And out of curiosity, could you tell if someone is a chocolate addict or fan of soda from the look of their skin? I’m hoping an occasional indulgence in ice cream can’t be detected by you!

Dr Verallo-Rowell: Hahaha. One look at a patient with adult acne tells me I have to look at her history closely to see which of the stressors – see my last winding paragraph below – is causing the adult acne.

Processed foods are the MOST


In food, the most pro-inflammatory are processed foods because the oils used in processing them are generally more pro-inflammatory. Polyunsaturated they make the lipid bilayer of cell walls more fluid such that the cell wall’s protein receptors/signals do not function well. This is such a No NO NO for saturated oils.  Yet plant derived saturated fats like those from coconut oil are cholesterol free and more stable than polyunsaturates, are not as vulnerable to oxidation by reactive oxygen species our body makes, do not have trans fats because they need not be hydrogenized.  Note that less than 0.5 mg of trans fats does not have to be declared, hence everything now is “trans fat free”. 4 servings of a “trans fat free” product can readily reach 2 Gm. Remember any trans fat in our food is not good. Look instead at the Nutrition Facts and if says it has partially/hydrogenated oil in it – don’t use.

If (nutrition label) states partially/ hydrogenated oil, don’t use it

Also, omega 6 at too high an amount – which is what the seed oils contain at a ratio of 1:100 or more of the omega 3 they contain – is very pro-inflammatory because they are converted into pro-inflammatory eicosanoids. We need them – inflammation is needed to clear up bugs, and react to environmental assaults – but too much becomes too inflammatory and may continue into an inflammatory pathway of disease.

Foods to eat for Healthy Body and Skin

Like everything else in nature, balance is important, as it is in food. So the bit of ice cream and chocolate you indulge in wont make me recognize a skin change with you. Besides the mood elevating effect is also good for you. BUT, balance…eat  more fruits and veggies, brown rice, brown bread, oily fish and shellfish. (all rich in omega 3, anti-oxidants) Cook with coconut oil for high heat, with olive oil for low heat and minimize that canola oil – it’s a genetically altered long chain polyunsaturated flaxseed oil.

Cook with coconut oil for high heat, with olive oil for low heat and minimize that canola oil

Acne and Diet

In acne – the studies out there now show: high carb diets, and dairy products are more acnegenic. Interestingly of dairy products, the skimmed ones are more acnegenic, probably because of the sugar (more carbs) they add to add taste after the yummy oil is removed.

Can you tell you are Stressed from your Skin?

MarcieMom: Ending this series on a more serious note – we know stress is a trigger for eczema, and so is sleep-deprivation. For say someone who has a tough job/ running a business, taking care of kids and elderly, working through the night, could you tell that from his/her skin? And if someone wants to look into the mirror and know ‘Gosh, I need a break!’, what would you ask him/her to look at? (note: I’m being very fair here, both male and female can suffer from this!)

Look for Skin Inflammation

Dr Verallo-Rowell: Look for inflammation. This is the process that is now seen as the basic pathogenetic pathway in our cells triggered by stress. Most people think of stress in terms of the mental and emotional stresses of personal life and work. Very true, yet this kind of stress you are aware of, familiar with, share and moan about to your family and friends. It is stressful but other causes of stress that are not so obvious, hidden and may not be addressed by you and/or your physician.  Examples are the stress from recurring low grade infections – like being a streptococcal carrier with mild but recurrent sore throat or dental problems or UTI, or stones in the gall bladder; or less than 6 and more than 8 hours sleep; lack of exercise, obesity and of course a diet with more pro-than anti-inflammatory elements in it, or too much weight loss.

Look for markers of inflammation: your acne flaring up, rosacea attacks becoming frequent, the eczema bigger, wider spread; those with psoriasis too – the lesions are bigger and persistent; boils recurring more often. These may indicate a lowered immunity from such things as too much exercise.

MarcieMom: Thank you Dr Verallo-Rowell, I can feel so MUCH Passion in you about nutrition and anti-inflammatory vs pro-inflammatory foods, I’m inspired to learn more!

Guest Interview

Anti-Inflammatory Recipes by SkinnyChef – Broccoli, Kale, Mushrooms

Jennifer Iserloh, also known as SkinnyChef, is a trained chef, certified health coach and healthy cooking celebrity. She is a bestselling author, including 50 Shades of Kale, The Healing Slow Cooker. She graduated with honors from the Institute of Culinary Education, worked as a celebrity chef and became a certified health coach through the Institute of Integrative Nutrition.

Anti-Inflammatory Recipes for Eczema SkinnyChef Jennifer Iserloh

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

garlic-broccoli recipe
Picture contributed by SkinnyChef


  • 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


  • 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

Sunny Side up Egg with Kale Recipe
Picture from SkinnyChef


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


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

Stuffed Mushroom Recipe
Picture from SkinnyChef


  • 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


  • 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!).

Eczema Tips

What Foods for Eczema Kid – Tips from Nutritionists, Dietitians and Experts

This blog has featured many experts and there are still many more who are working on bringing you a themed series to help your eczema child. There are yet many many more who are helpful over social media, and so for the past weeks, I took to Twitter and Google Plus to ask nutritionists ‘What Foods do you recommend for Eczema Child?’. Many nutritionists and dietitians kindly offered their take, so much that pediatrician and skin experts also chipped in!

Foods for Eczema Kids Nutrition

Nutritionist PhiVan Ha at Nutrition4Women

My theory for eczema is caused by high acidity in the body. Recommendation: eat more alkaline foods & try magnesium  supplement (65mg is the safe dosage for kids). Green vegetables, beans, peas, seeds, nuts and unrefined grains such as brown rice and whole-wheat products are high in magnesium. Some people also swear by magnesium oil as a topical treatment. My problem is acne and magnesium has helped a lot.

I’ve found an article on magnesium on Livestrong here.

Dietitian Judy Converse MPH RD at NutritionCare RDs often don’t realize dairy proteins frequently cause eczema, how to test, & that soy is not always ok as a substitute.

Judy has previously helped with Eczema Kids Nutrition Series, and a relevant extract below:

Anti-inflammatory, probiotic foods are good for everyone. Though there is plenty of debate on this topic, this generally means eating a plant strong diet: Lots of fresh raw organic vegetables, greens, and fruits, along with traditional fats like those from organic meats or dairy products, butter, whole unprocessed, unsweetened organic coconut milk, olive oil, and oils from organic raw nuts and seeds. Humans have always made and eaten fermented foods. If you don’t like or can’t eat yogurt, kombucha, kim chee or sauerkraut, naturally cured meats, poi, or other fermented foods, or if you don’t have access to safe raw dairy products (which contain healthful fats and enzymes that are altered or lost when pasteurized), you can supplement with probiotics. There are now hundreds of probiotics products available. Look for diverse strains and high potency, over 15 billion colony forming units (CFUs) per dose. I often use much higher doses than that in my practice.

Dietitian Maryann Jacobsen at RaiseHealthyEaters Eczema is usually not related to diet but one study showed organic milk may help prevent it

Nutritionist Mary Hartley at AskMaryRD  It’s an individual thing. Know which foods bother you, don’t mistake a diet cause for stress.

Dietitian Kelly Jones MS, RD at EatRealLiveWell

Try eliminating dairy & increase intake of omega 3 and water. Any food intolerance could possibly be related though can have reactions to dairy that don’t seem like true allergies. Water intake can relate to inflammation and the immune system.

Nutritionist Jan Katzen CN at NutritionforLearning High vitamin or DHA cod liver oil & other anti-inflammatory essential fatty acids (EFAs) (with supplementing nutrients for utilizing from whole foods) helps eczema. 

Dermatologist Cynthia Bailey MD at DrBaileySkincare Vegetables, carrots, no cow dairy, watch the gluten, minimize refined sugar. This is my opinion and not based on science.

Pediatrician Cigal MD at MomMedicine Foods should be individualized by an allergist.

Laura VR Bertotto at VMVHypoallergenics I know nutritionists live the Mediterranean diet for kids, too. My mom’s very big on healthy oils for eczema for sure! 🙂 (side note: Laura’s mom is Dr Verallo-Rowell, dermatologist who on worked on Sensitive Skin Product series with me here)

Nutritionist at FitnessRepublic

Although most foods and supplements have not shown promise in eczema research, research is ongoing. For example, some studies suggest that probiotics may help relieve the symptoms of eczema in children. Probiotics are a type of live bacteria. They can be found in foods like yogurt and in some supplements. Most of these studies were done in other countries and tested different kinds of probiotics. So it is not clear what type of probiotics are most useful. “More research in this area is surely needed before we can make a definite recommendation,” says Cambio.

Another food being studied as a benefit for eczema is tea. Although there is no definitive evidence, a few studies suggest that drinking black, green, or oolong tea may help relieve eczema symptoms. Omega-3 fatty acids found in fish and fish oil, which help fight inflammation, are also being studied for eczema.

Note: above tips may not have been conclusively proven in studies but are friendly suggestions given over social media. For eczema and diet studies, see here.

Eczema Tips

My Food Grading System for Eczema Child’s Diet

ood Grading for Eczema Child
What do you think of my food grading system?

This is a post to share my food grading system that I use with Marcie (my eczema toddler). Now that she’s older (3+), she certainly knows what’s good and what’s not good. We play a simple game with her, especially during buffet, by going through the dishes and saying, this is GOOD! (THUMB UP ACTION) or this is NO GOOD< THUMB DOWN! Those on the good list, such as broccoli and shiitake are also anti-inflammatory foods, which though no study confirmed benefits for eczema, certain compounds of the food are anti-inflammatory, read more here and here (from Julie Daniluk, TV nutritionist’s recommendation).


News & Research

Eczema and Diet Studies

Eczema and Diet on EczemaBlues
This post is just what it is – The investigative bug has caught up with me and given that there are (i) more studies on impact of diet on eczema, and (ii) more people (experts or not) claiming that their diet is ‘proven’, I’m setting out in this post to POUR THROUGH ALL THE ECZEMA and DIET studies I can find and make sense of it for you here; Let’s see my investigation report!

Studies on Pregnancy Diets

Impact on Preventing or Reducing Severity of Eczema in Newborn

Antigen Avoidance Diet during Pregnancy

In a trial conducted with 952 participants, there was no evidence of protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Another two trials that had 523 participants similarly did not see benefit of avoidance of antigen during pregnancy for babies up till 18 months nor on their skin prick test results up to 7 year old.


In a review article of 21 trials from 1997 to 2007, there was evidence that probiotics prevented the onset of pediatric atopic dermatitis. In another article covering up to 2011, there was evidence of probiotics for the prevention of atopic dermatitis in infants, and this benefit was seen both for mother and child, and whether taken during pregnancy or early life of child.

Studies on Children Diets

Impact on Preventing or Reducing Severity of Eczema in Young Children

Timing of Introduction of Solids

In a consensus document, the conclusion from reviewing 52 studies from 1998 to 2006 was that early introduction of solids can increase food allergy. The recommendation was to introduce at 6 months, dairy products 12 months, hen’s egg 24 months, and peanut, tree nuts, fish, and seafood at least 36 months for those with higher risk of food allergy. An update on a study on early introduction of eggs done in August 2015 showed that the elevated immune responses to egg were established prior to egg ingestion at 4 months and were not affected by whether eggs were introduced early.

Using Hydrolyzed Milk Formula

In a review article of 12 studies up to 2006, there was (i) no evidence to support hydrolyzed formula to replace exclusive breastfeeding, and (2) limited evidence that supported hydrolyzed formula for high risk infants who could not be 100% breastfed. One article that provided such evidence concluded that partially hydrolyzed formula is more effective than standard formula for high risk infants.

Prolonging Breastfeeding

In a trial of close to 14,000 mothers, there was no evidence of protective effect of prolonged and exclusive breast feeding on asthma or allergy.

Using Soy Formula

In a review article of 3 studies up to 2006, there was no evidence of reduction in allergies for children fed with soy formula.

Adding Prebiotics to Infant Formula

In a review article covering 13 studies up to 2012, there was limited evidence of prebiotics added to infant formula can prevent eczema, but the authors cautioned that further research is needed prebiotics can be routinely prescribed.

Adding Probiotics to Infant Formula

In two review articles (one of 12 studies up to 2007, the other up to 2008), there was insufficient evidence to recommend adding probiotics to infant feed.

Consumption of Omega 3 and 6

In another review article covering 10 studies up to 2009, there was no evidence for reduced risk of allergic sensitization or a favourable immunological profile.

Impact on Minimizing Eczema Flare-ups for Children already diagnosed with Eczema

Elimination Diets

In a review article, the conclusion from reviewing 9 studies (up to 2006) was that there was (1) no evidence of benefit to an egg and milk free diet, (2) no evidence of benefit to an elemental or few-foods diet, (3) some benefit to egg-free diet for infants with positive IgE to eggs, with improved eczema.

Dietary Supplements

In a review article covering 11 studies up to 2011, there was no evidence of benefits of supplements in the treatment of eczema. The background of this study was that many patients turned to supplement to avoid steroid treatment, fearing long-term effects. However, there was no evidence for supplements like fish oil, olive oil, corn oil placebo, zinc sulphate, selenium, selenium plus vitamin E, vitamin D, pyridoxine, sea buckthorn seed oil, sea buckthorn pulp oil, hempseed oil, sunflower oil (linoleic acid) and DHA.

The Conclusion

1st, I’ve made it a point to look at the studies themselves, rather than articles that refer to studies (so that I minimize the lost in translation effect). I also urge parents who are taking the leap to try a specific diet to ask your doctor and read up on studies, instead of relying on fad posts or personal testimonies.

2nd, I must make it clear that I’m no expert in reading studies, the review articles mentioned were all written by medical professionals. Should any medical professional coming across this post and see any misinterpretation, do point it out to the rest of me.

3rd, after this investigation, the following seem to be actionable take-away that we parents can ask our doctors on and decide if we should apply them:

1. Consider Probiotics

2. Not to introduce solids before 6 months’ old, and check with doc on timing for other more common food allergens

3. If you can’t breastfeed exclusively, consider partially hydrolysed milk formula

References (from PubMedHealth and The Cochrane Library)
1.    Food allergy and the introduction of solid foods to infants: a consensus document
2.    Meta-analysis of clinical trials of probiotics for prevention and treatment of pediatric atopic dermatitis
3.    Probiotics for treating eczema
4.    Dietary supplements for established atopic eczema in adults and children
5.    Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial
6.    Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis
7.    Meta-analysis of the evidence for a partially hydrolyzed 100% whey formula for the prevention of allergic diseases
8.    Probiotics supplementation during pregnancy or infancy for the prevention of atopic dermatitis: a meta-analysis
9.    Dietary exclusions for established atopic eczema
10.  Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child
11.  Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants
12.  Prebiotics in infants for prevention of allergy
13.  Probiotics in infants for prevention of allergic disease and food hypersensitivity
14.  Soy formula for prevention of allergy and food intolerance in infants
Guest Interview

Eczema Kids Nutrition with Judy Converse: Breastfeeding – Impact on Eczema & Infant Reflux

Newborn Eczema Kids Nutrition with Judy Converse Dietitian Nutritionist EczemaBlues

Judy Converse, MPH RD LDN is the founder of Nutrition Care, a licensed nutritionist, a registered dietitian who has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Her books include:

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.

Breastfeeding – Does it Prevent Baby Eczema?

MarcieMom: Judy, thank you for joining me today! Now, on breastfeeding’s impact on eczema, it appears to be still a controversial conclusion if it helps prevent eczema (I did a quick online search, and here and here already present varying conclusions).

Are you aware of any definitive study on whether breastfeeding (i) prevents eczema and (ii) lessens the severity of eczema?

Judy: Okay, this gets technical, so bear with me. One of the papers you’ve mentioned comes from a collaboration with the International Study of Asthma and Allergies in Childhood (ISAAC), which is an ongoing survey across several countries for inflammatory conditions in children. Given the large numbers in the study, the finding of “lack of benefit” from breastfeeding was puzzling. It also puzzled me that other papers from ISAAC have been equally muddled on benefits of breastfeeding relative to asthma.

Sounds impressive – a “study” with over 50,000 subjects? But this was a weakened tool in many ways: It is a survey, not a study; it is retrospective, not prospective; it is uncontrolled (no control subjects to compare who had only formula); it is based on voluntary parent reporting, which may be faulty or biased some of the time; and I did not see that there was a comparison of exclusively breast fed to exclusively formula fed children. It appears that the survey may only have looked at degrees of breastfeeding relative to eczema.

How can we measure the impact of a variable (breastfeeding), if nearly all of those surveyed got some of it? You need an exclusively formula fed population as a control to really find the answer.

Also, the abstract doesn’t allow us to see detail for methodology. It mentions that over 50,000 children with asthma and allergies were evaluated somehow, but doesn’t say much about the breastfeeding survey, methodology or numbers, or introducing solids, which is another big factor. It says that the benefit of breastfeeding that was noted disappeared after age four months – which is when many babies are first given some solid foods. The authors state that benefit of breastfeeding for eczema disappeared at that point. There is no mention of introduction of solids here – was this observed in any way?

I think it is over-simple to state that benefits cease at this point. If the survey only looks for “ever” breastfed and “any eczema ever”, it is weakly designed and can’t give very clear information. It also takes a somewhat trivializing tone on the finding that breastfeeding lessened “sleep disturbed” eczema, which is a significant benefit for weary families and babies struggling against inflammation. Having your baby wake in pain or bleed from scratching is pretty unpleasant.

To make this survey powerful, the authors would have needed a control group of over 100,000 matched children (8-12 year olds with asthma or allergy) who were exclusively formula fed ever, that is, never breast fed at all.

When I see information gathered in this way, I am skeptical – Why go to such lengths to collect or evaluate data in a weak fashion? Surveys are useful to point researchers toward next questions. But I think this survey almost does a disservice, by casting doubt on benefits of breastfeeding for eczema, without careful controls. Even with the design flaws in this survey, the authors still found a small benefit to breastfeeding. Breastfeeding is so important for so many reasons.

Childhood Vaccinations’ Impact?

A further dilemma here, the elephant in the room, is the influence of vaccination, which strongly correlates with more allergy, asthma, and eczema (the authors of that study inexplicably attribute this effect to doctor visit frequency). Earlier vaccination correlates strongly with asthma, another inflammatory condition. There is meanwhile a compelling ongoing survey that shows less allergy, eczema and asthma in unvaccinated children (and better health over all). This too is limited by voluntary parent reporting, no true controls – but the difference in the two groups is so dramatic that a true trend appears to exist. It certainly needs closer study. A prospective study comparing exclusively breast fed babies to exclusively formula fed babies, vaccinated and/or not, would be fabulous. We need robust prospective design to really answer these questions. But there is considerable opposition to work in those areas.

Probiotics in Breastfeeding Moms’ Diet

All that said, there are still other studies that show weak or little impact on eczema for breastfed babies. We may simply be looking at the wrong parts of the puzzle, or looking at it in too narrow a way. For example: A baby’s gut biome may be quite predictive of who gets inflammatory conditions like allergies, eczema, and asthma. This well controlled and blinded study found a dramatic reduction in likelihood of eczema for babies who were breastfed by moms supplemented with probiotics. And, breast milk supports a different, healthier gut biome than formula. Bifido species bacteria appear so far to be more useful at lessening eczema for infants than Lactobacillus species, which may play more of a role as the baby grows toward childhood.

Do Allergens Go into Breast Milk?

MarcieMom: As mentioned in the previous Q&A, allergy testing is not accurate for an infant. Many moms with eczema children feel really stressed about whether it’s what they eat, that ends up triggering the rashes via the breast milk.

How does the mom’s body process the food that she eats into breast milk? Do the proteins (or whatever else?) in common food allergens like cow’s milk, wheat, egg, peanut and soy go into the breast milk and therefore capable of producing the same allergic reaction as if it’s ingested directly by the baby?

Judy: I was one of those moms whose baby could not tolerate my breast milk. It was devastating. I agreed to a trial of hypoallergenic formula and had mixed feelings when it helped my son. In my training, there was no explanation for this. I was taught that there was no such thing as a baby allergic to breast milk, but here we were. What I ate clearly affected my son too. So when I did go back to nursing him, because I wanted him to have all the benefits of breast milk, my diet was limited to rice, meats, some vegetables and fruits, and nuts for fats. I ate a lot of pecans and walnuts, and a little peanut butter, because I craved fats and was shirking all the fish I loved to eat (this was 1996, and we lived near the ocean). Well, those are the only tree nuts that my son is still quite allergic to at age sixteen, even though he has never eaten them himself! His only exposure to pecans, walnuts, and peanuts was via my diet through breast milk. He has shown IgE reactivity to these ever since.

I was taught that there was no such thing as a baby allergic to breast milk, but here we were.

I don’t know if we can confidently say that we know everything about how we process dietary proteins into breast milk, but we can likely assume variation across individuals. There is an interesting conversation here on this topic. Certain things don’t seem to vary much – like how much total protein is in mom’s milk, mineral levels, or total calories – these can waiver very little – but vitamins, types of fats, or amounts of fats can vary quite a bit relative to mom’s food intake, and toxins certainly do too.

Leaky Gut – Mom & Baby

One of the emergent pieces is the gut biome, again – that is, what microbes populate the mom’s gut, and the baby’s gut, and are either of their intestinal lumens compromised in any way? Is there any permeability that shouldn’t be there? If mom harbors a suboptimal biome that allows for “leaky gut”, then larger fragments of food proteins may enter her blood and will be picked up by breast tissue, which is richly vascularized with high blood flow. If on top of that, the baby’s gut biome is weak or his gut wall is leaky, you have a double hit for increased odds for eczema and allergy.

So, again, several moving parts to this puzzle: The mom’s diet, mom’s gut biome, digestion, and intestinal wall integrity; mom’s toxicity level, stress, fatigue, and endocrine functions that regulate her milk production. Then we have the same factors to consider for the baby, including stress. 

The mucosa that lines a baby’s throat and gut is less developed and more permeable than an older child’s or an adult’s, so mom having a healthy gut may be the best prevention, to keep larger food peptides or proteins out of her milk in the first place. Antibiotics, certain toxins, heavy metals, and vaccines can interfere with intestinal wall permeability and function too – and infants now get more exposure to these than ever.

Is there an Ideal Breastfeeding Diet?

MarcieMom:What about some foods that a mom ought to eat more when breastfeeding? I understand that the field of epigenetics is gaining more attention as results of studies on animals are promising – the eating and health habits of one can reduce the chances of an individual being diagnosed with a disease he is genetically predisposed to. 

Should a mother who is breastfeeding then consume more anti-inflammatory foods, probiotics or foods that aid skin repair? If yes, which foods would you recommend and how to ensure that moms don’t over consume?

Judy: Anti-inflammatory, probiotic foods are good for everyone. Though there is plenty of debate on this topic, this generally means eating a plant strong diet: Lots of fresh raw organic vegetables, greens, and fruits, along with traditional fats like those from organic meats or dairy products, butter, whole unprocessed, unsweetened organic coconut milk, olive oil, and oils from organic raw nuts and seeds. Humans have always made and eaten fermented foods. If you don’t like or can’t eat yogurt, kombucha, kim chee or sauerkraut, naturally cured meats, poi, or other fermented foods, or if you don’t have access to safe raw dairy products (which contain healthful fats and enzymes that are altered or lost when pasteurized), you can supplement with probiotics. There are now hundreds of probiotics products available.

Look for diverse strains and high potency, over 15 billion colony forming units (CFUs) per dose.

I often use much higher doses than that in my practice.

Anti-Inflammatory Foods for Eczema Children

Beyond that, if there are still skin symptoms, then work with an experienced provider to identify the trigger foods. I usually use an ELISA IgG food antibody profile for this in my practice. There is debate about that too, but used in the context of a total nutrition assessment (which should always include signs, symptoms, a food diary, and a medical history – never just lab tests alone) I can use that lab result as a jumping off point to make a good elimination plan for my clients. Then we add in anti-inflammatory supplements if more is needed: Things like nettles, curcumin, fish oils, N-acetyl cysteine, and of course the right probiotic.

Dealing with Reflux in Eczema Infant

My baby had from drinking more than 100ml per feed, it dropped as low as 20ml due to the reflux. I don’t even know what type of reflux it was – sometimes she simply seemed not hungry and refused milk; other times, she would drink all (after much coaxing) only to vomit a flying trajectory of milk over her head about 30 minutes later.

Is there any conclusive study linking eczema and reflux?

Judy: I have not looked for that, but I have witnessed it often in my practice. My experience agrees with often finding the two together. It doesn’t matter anyway, because the baby just needs to feel better! My first suspects are always protein intolerance, and gut biome imbalance – and yes, these two problems are often linked. It’s easy to assess and begin treating both, even with just a good history (no lab tests), though at most a stool test may be useful.

In my book Special Needs Kids Go Pharm Free, reflux, colic and eczema are what I address in the first chapter. What amazes me is that many pediatricians don’t seem to realize that while this is quite common, it is not normal, and may not be benign, for a baby to experience all this.

What Infant Reflux Mean?

It can mean that there is inflammation, weak absorption, or gut dysbiosis, especially after ruling out structural or mechanical concerns that cause a baby to reflux. Reflux medications assume that the baby’s stomach is too acidic, when the opposite may be true. If these can give a little short term relief, that’s fine, but I like to see them used only short term, and after a well managed trial of natural steps have failed. Long term, medications for reflux can exacerbate it. They diminish nutrient absorption, and favor colonization of the gut with fungal species – which in turn may worsen gut permeability. Once you have more permeability, you are likely to have more allergy/eczema.

Types of Infant Reflux

MarcieMom: What types of reflux are there? I looked it up online and but got quite confused; could only understand that Gastroesophageal Reflux Disease (GERD) is when the lower esophageal sphincter does not close properly and the stomach reverses its contents back into the esophagus. Judy, what are the common types of reflux affecting infants?

Judy: Many things can trigger reflux in any age group, and a sudden onset of it warrants your doctor’s attention. Your pediatrician or pediatric gastroenterologist can rule out structural or mechanical triggers, or very unusual causes or circumstances that may warrant different treatment. In any case, the norm is to have peaceful digestion – not reflux, spit up, projective vomiting, or chronic hard colic (gas with a hard belly and inconsolable crying). Most often babies with reflux do not have a serious medical circumstance or mechanical flaw causing the trouble, and natural steps may solve the problem. 

It is more common that the baby is not tolerating the feeding well, or has a weak gut biome that does not aid digestion. 

This biome is so important for the baby especially at birth, when the gut is not immune-competent and has limited ability to digest food. Certain microbes appear to “train” the immune system via the gut, and help us digest first feedings. I discuss this in Special Needs Kids Go Pharm Free too. It’s an exciting niche of medicine that I think will become more and more important – what is our relationship to the biome in general, how do we best co-habitate with it, and what are the best ways to nurture a supportive biome in the body? This is where I think medicine needs to go.

Home Remedies for Infant Reflux

MarcieMom: In Singapore, it’s common to burp the baby and if the baby still refuses milk, the common assumption is that there is air in the tummy creating fullness. Remedies that parents use are usually anti-colic drops available in pharmacy and herbal oil that purports to reduce tummy air. Judy, are the abovementioned correct remedies for reflux? (or are these not reflux issues/treatments? My baby’s reflux disappeared at 3 month old, around the time I use Dr Brown, a bottle with a tube insert to release air.)

Also, when should a parent start to be concerned with the reflux, i.e. no longer a common reflux that affects babies, and seek doctor’s advice?

Judy: I’m not sure what is in the drops you mention. One brand called Mylicon (which is simethicone, an artificial compound that helps air bubbles stick together into larger ones, presumably so the baby can burp better) was found to be least effective of all treatments, compared to changing the baby’s primary protein source or using herbal remedies. Meanwhile I have been pleased in my practice with natural measures, like certain herb drops, changing up the feeding strategies and protein source, probiotics, homeopathy, and treatment for fungal species overgrowth in the baby’s gut.

When Infant Reflux Warrant a Visit to the Doc

As for when to intervene, include your baby’s comfort and your intuition in this process. Reflux medications have been overprescribed for infants, at least in the US. Reflux is common, but it has been normalized to a point where placing a baby on reflux medication is considered benign. I don’t agree. A little spit up is normal as the baby is developing coordination in swallowing and in digestive functions. But losing most of each feeding is not normal, nor is it normal for a baby to suffer constantly with hard inconsolable crying and a hard belly, or to drop away from his growth trajectory on the growth chart.

Chronic projectile vomiting is not normal.

Your baby deserves to feel well, comfortable, and happy, to gain and grow steadily, and to pass stools easily every day, eg, soft formed, or wet/mushy for breasts fed babies. Stool that explodes up the baby’s back or runs down the legs, or is dry and painful to pass, or are less frequent than daily or every other day – these are all signs that digestion is impaired and things can be made more comfortable for your baby. If those symptoms occur along with reflux and eczema, intervene for your baby’s contentment and comfort.

MarcieMom: Thank you Judy, once again I’ve learnt much and should I ever decide to have a second baby and he/she has reflux, the first person I think of calling is you!

Guest Interview

Eczema Kids Nutrition with Judy Converse: Newborn – Just Milk but Complicated

Newborn Eczema Kids Nutrition with Judy Converse Dietitian Nutritionist EczemaBlues

Judy Converse, MPH RD LDN is the founder of Nutrition Care, a licensed nutritionist, a registered dietitian who has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Her books include:

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.

MarcieMom: Judy, thank you so much for helping us. My questions will be based on my (thankfully, past!) experience and what I know other moms of eczema children face. We know that the American Academy of Pediatrics recommend breastfeeding for 6 months, but in reality, it’s not always possible in every family. In my case, I just can’t generate sufficient milk supply even after consulting with lactation consultant, taking their recommended supplements and a harrowing ordeal with tricking my baby to latch despite my lack of milk (using the supplemental nursing system).

Selection of Milk Formula for Eczema Babies

For parents of eczema child who are choosing formula milk, would you recommend that they go for fully hydrolyzed or partially hydrolyzed formula from the onset?

Or should they wait and see if the child is allergic to cow’s milk before switching to alternatives? Since allergy testing is not accurate for a new born, how can a parent know if it is cow milk allergy?

Judy: First we should understand “hydrolyzed”. That means the formula uses an in-tact, whole protein source – casein or whey or soy – which is treated with enzymes to partly break it up or hydrolyze it. The idea is that this will make it easier for the baby to absorb. It’s a reasonable place to start. If it works, it should work in a week or so, to settle eczema down. But many babies do just as poorly on this as they do on whole protein formulas (this was my son). Then what?

But many babies do just as poorly on this as they do on whole protein formulas (this was my son)

Probiotics in Formula Mix

There are a couple of options. The baby may do better on any formula, if gut biome is replenished with probiotics. I work these into care plans for many infants and children. There are many different types and potencies. Some probiotics are not appropriate for babies. More experience and data are emerging to show that beneficial bacteria are critical to mitigating inflammation in a newborn’s gut. What grows in a newborn’s gut appears to be predictive of whether or not they have allergies or asthma years later. So, no matter what, if a baby is having signs of inflammation, I would be keen on getting a probiotic in the mix.

Elemental Formula for Babies

If trouble persists, the next step is elemental formula. These are different from hydrolyzed formulas because they are not made from naturally occurring protein. Instead, individual amino acids are blended in a specific ratio known to be essential for human newborns. These are ready to absorb. A healthy human gut will break protein down into these constituent amino acids during digestion. So this formula simply provides the protein in that form, ready to absorb, and it can’t trigger inflammation. What surprises me is how often this option is not offered to families whose infants are really uncomfortable with eczema and colic. Many pediatricians may not know about elemental formulas. Brand names are Elecare or Neocate. The caveat with using formulas is that they change the baby’s gut biome. That is, they change the profile of bacteria in the baby’s gut. Breast milk sets up the healthiest gut biome, which humans need to develop normal, healthy immune signaling and avoid allergy. Formulas, especially the elemental ones, make it easier for nasty species like Clostridia difficile or fungal strains to grow.

Breast milk sets up the healthiest gut biome, which humans need to develop normal, healthy immune signaling and avoid allergy.

To have a win win, use a probiotic for your baby. My book Special Needs Kids Go Pharm-Free guides parents on how to pick these, and what to do for colicky babies with eczema.

Is it Cow’s Milk Allergy for your Eczema Baby?

Second – how do you know it’s cow’s milk allergy? Easy. Do an elimination trial. Newborns eat one protein source (breast milk, or formula). Change it and observe. Note that soy protein is triggering often as well. My preference, if breast feeding is truly out, is to trial homemade goat milk formula (I provide recipe and steps to do this safely in my books) first. This often goes very nicely, and it may support a healthier biome than commercial formulas. If eczema is still persisting, then I suggest hydrolyzed casein or whey formulas, then elemental. If you must use soy protein, which I hesitate to do since it has other impacts as a phytogen and is usually genetically modified, then be sure you use an organic source.

Which Cow’s Milk Formula to Choose?

MarcieMom: Let’s talk about the scenario where the child has no cow’s milk allergy and parents can decide among the many brands of formula cow milk. I’ve read about the toxins in formula milk – the antibiotics given to the cows and the cows eating a diet of genetically modified corn. I’ve also seen babies who drank lots of formula milk growing very big, exceeding far more than 100% on the growth chart.

Is there (i) any conclusive study done on formula milk and its impact on the child’s health, (ii) does formula milk contain toxins and is it inflammatory? (if yes, which ingredient makes it so?) and (iii) how soon should parents attempt to replace formula milk with solid food that are rich in protein, calcium, vitamins and other minerals?

Quality of Breast Milk

Judy: Breast milk is best, hands down. We’ve all heard that, and it is still true. There are so many immune modulating components in human milk that formula will never be able to emulate. It is so powerful in this regard, that it may outperform vaccinations in protecting the baby. Its impact on gut biome and long term immune function is just emerging in the literature. Unfortunately there are toxins in breast milk too, simply because we now live in a toxin filled world. These concentrate in breast milk. Rather than not breast feed, I would like to see women become conscious prior to pregnancy about eliminating toxins from their diets. Begin early to eat very healthfully, avoid pesticides, poor air quality, heavy metals, and other toxins. Consider working with providers who can help you detoxify prior to conception.

Quality of Commercial Milk Formula – Corn Syrup & GMO

Meanwhile, yes, it is often easier for babies to gain and grow on commercial formula, as long as they are not allergic/sensitive to it. Bottle-feeding can offer faster delivery, so more is taken per feeding. But “more and faster” is not necessarily better. The carbohydrate source is often corn syrup, which is troubling for weight gain in older children. And yes all these ingredients – unless you have an organic formula – may come from genetically modified sources. I think there are enough data implying that GMO foods may be more allergenic to consider avoiding these entirely for a newborn, or during pregnancy. This is a big debate. For more info, parents can visit Click on the link for health professionals, then on the “state of the science” link.

Solids for Your Baby

Solids can be introduced once your baby is able to sit well unassisted, can hold his head up, and is able to move soft foods to back of tongue and swallow them safely with a little practice.This can be around six months, but later is okay too. This might also depend on your baby’s growth pattern. Some will want solids sooner than others.

Cow’s Milk Alternative

MarcieMom: Let’s talk about the scenario where the child has cow’s milk allergy. What would be the cow’s milk alternative? Fully hydrolyzed formula or goat’s milk (which I understand to be similar to cow’s protein, so may not help cow milk allergy?) or soy milk or rice milk?

Judy: We covered that in the previous section, except for rice milk. Rice milk should not be used for infant formula, period. It is devoid of protein and healthy fats that are essential for brain development. Please do not use rice milk! Same goes for oat milk, hemp milk, or almond milk. None of these are safe or appropriate for babies as a substitute for breast milk or formula.

Rice milk should not be used for infant formula, period. 

Goat milk has casein, as does cow or human milk. But it is in a gentler configuration, slightly different than the cow casein, and is often quite tolerable for babies who can’t take cow’s milk. Again think in terms of two parts to this puzzle – the protein source, and the baby’s gut biome. Both may need changing to successfully arrest inflammation.

Advice for New Moms – Choosing Cow’s Milk Formula Alternative & Reading Product Label

MarcieMom: I remembered the first six months when my baby was too young to take allergy test, we were advised to switch to partially hydrolyzed milk (our girl turned out not to have any allergy). When her rashes didn’t go away with the partially hydrolyzed milk, we switched to goat’s milk then soy milk (her rashes were still there all the time). It was a stressful experience copying all the ingredients across formula brands and different types of milk, and comparing which brand had higher carbohydrates, protein, calcium, DHA and more than 20 nutrition elements listed. What would be your advice when choosing formula milk – I assume first decide on the type of milk and once that’s decided, how to see which brand is better formulated?

Judy: This is too much stress for a new mom! I went through that and then some myself. This is how I became so interested in this niche of practice. I could not fathom that my pediatricians didn’t have good answers for me, or why it was so hard. I would have added an elemental option to those you were told to try, plus probiotics. As I mentioned earlier, this is commonly overlooked.

Worth Looking Into – Why a Baby’s Gut Could be Inflamed

I would also want to know what set your daughter’s gut up to be inflamed. Did she need antibiotics, C-section delivery (another early antibiotic exposure), time in NICU? All these things disrupt optimal colonization of the newborn gut with healthy bacteria. If this is found to have been the case, sometimes babies need herbs or medications to treat fungal species dominating the gut biome. I give this topic a lot of ink in both my books.

Milk Protein Sensitivity

Your daughter may have had a milk protein sensitivity and a soy protein sensitivity, without allergic to either. These are mediated by different classes of immunoglobulins, one is IgE (allergy) and the other is IgG (sensitivity). Both can cause skin changes, feeding problems, and eczema.
A negative IgE test does not mean that a food protein is safe. Most allergists do not test for IgG reactions, because they think the testing is unreliable. This is not my experience in practice. The tests are not perfect, but they are useful, when interpreted in the context of food intake, signs, and symptoms.

MarcieMom: Thanks so much Judy, honestly, I feel like bursting into tears now, just thinking how difficult the first 9 months are, sorting through the milk formula, breast feeding, solid feeding – if only I’ve known you earlier! I’m sure many parents reading this will feel the same, and start to ask their docs of other alternatives.

Guest Interview

Eczema Kids Nutrition with Judy Converse: What is Reliable Nutrition Information

Newborn Eczema Kids Nutrition with Judy Converse Dietitian Nutritionist EczemaBlues

Judy Converse, MPH RD LDN is the founder of Nutrition Care, a licensed nutritionist, a registered dietitian who has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Her books include:

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.

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.)

JudyAssess 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.

News & Research

Does Fast Food Cause Eczema?

And you'll run faster as you choose healthier options!
And you’ll run faster as you choose healthier options!

The short answer is we don’t know, but get your kids away from fast food.

Apart from the risk of obesity, a recent study of more than 500,000 children in over 50 countries showed a linkage between fast food and chronic illnesses, namely severe asthma, hay fever and eczema. For kids who eat fast food 3 times or more a week, there’s a 30 percent increased risk in severity of the above conditions.  There’s no causal relationship, but signal a link between fast food and eczema. This study was widely reported because it covered a large number of participants and across countries, however, there are limitations which NHS (UK) pointed out. Professor Hywel Williams, one of the co-authors of the study, mentioned in an NIH interview that three or more weekly servings of fruit reduced the severity of symptoms in 11 percent among teens and 14 percent among children. Fast foods is defined as burgers, while eczema is an itchy rash in the past 12 months with symptoms defined as severe if sleep disturbance was reported at least once per week.

I also come across other interesting reports relating to trans fat (abundant in fast food) and coke, and eczema.

Dr David L Katz replied to a Q&A on to reduce intake of saturated or trans fat, as well as foods related to inflammation. He also suggested increasing omega-3s that can help increase anti-inflammatory hormones in the body. He pointed out flaxseed oil, which I’ve been giving my toddler Marcie. For those of us who are celebrating Chinese New Year, you’d be aware (and beware) as many of these commercial cookies have been prepared with partially hydrogenated vegetable oil and one piece of bak-kwa is 300 calories!

Dr Jeff Benabio in his video said that people severely allergic to formaldehyde can also be allergic to diet soda, as diet soda contained aspartame which after ingestion, created formaldehyde. Specifically, aspartame is hydrolysed to methanol, which is metabolized to formaldehyde then to formate.

For readers of this blog, you’d know I’ve been blogging about eating anti-inflammation food and staying away from inflammatory sugar and trans fat, in the link below:

Interview series with nutritionist Julie Daniluk on various anti-inflammatory foods, such as shiitake mushroom.

Interview series with Dr Sears L.E.A.N. on boosting immune system of children, via consuming more fruits and vegetables.

Interview series with nutritionist Toby Amidor on eczema kids’ nutrition & inflammatory foods.

So, in conclusion, there’s no doubt that fast food, which are high in trans fat and mostly fried, are to be avoided. I’ve been cooking healthy food for my family daily, and you’d be amazed at how fast you can whip out a meal once you’re used to it, faster than fast food!