Lactation Tea

Traditional medical systems have long recommended certain herbs to help increase breast milk production. Most lactation teas contain fenugreek seed ( graecum), which is widely used to enhance the production of breast milk. Fenugreek is quite safe at the amounts used in tea or capsules. The dose is generally three grams per day (two capsules, three times per day) or one cup of tea three times per day. To make the tea, use 30 to 50 g of fenugreek seeds to one cup of boiling water; strain out the seeds, sweeten, and drink three to four cups a day. If you don’t like the taste of this drink, capsules might be a better option. You should see an increase in milk production within 72 hours after starting to consume fenugreek.

K eep in mind that fenugreek has a maplelike flavor and can make your baby’s urine smell like maple syrup. This is n’t a problem, but you should be sure to tell your pediatrician that you’re taking fenugreek, so the doctor doesn’t worry about the odor. If you develop diarrhea while taking the capsules or drinking the tea, reduce the dose.

I n order to support your milk production, be sure to eat a variety of fruits and vegetables every day, which can help you to avoid fatigue and maintain your energy. Watch your fluid intake, too, because drinking more liquids than you need to quench thirst can suppress milk production. And don’t overdo the use of parsley, sage, and peppermint, all of which may reduce your milk supply.

for births in the United States are hospitals and birthing centers, but both organizations acknowledge the right of women to make medically informed decisions about delivery. All things considered, I think home births are just fine for women experiencing lowrisk pregnancies, as long as they and their caregivers take adequate precautions, have medical backup (an obstetrician who works with the midwife), and good prenatal care.

Do You Need a Doula?

Doula is a Greek word that means “women’s servant,” although in today’s parlance it refers to a professional who helps women through labor, childbirth, and the initial stages of motherhood. The role of the doula is to facilitate a positive childbirth experience. She isn’t a substitute for a doctor or a midwife: You still need one or the other for medical care during pregnancy, and one or the other will need to be present when you give birth. However, a doula can enter the picture at any stage of pregnancy or the birth process to answer your questions and provide support and reassurance. Studies have shown that when doulas are present, women are less likely to require pain medications, less likely to have a caesarean delivery, and more likely to report a positive childbirth experience.

You can use a doula at the hospital, as well as at home, and many experts highly recommend having a doula present for the birth, especially if you’re a first-time mother. Check to see if your hospital has nursemidwives as well as doctors on staff. If so, you can be in the hospital but still create a more intimate, home-like delivery. If your pregnancy is low-risk and you are in good health, giving birth at home can be beautiful, but you will need a qualified midwife in addition to a doula. Before hiring a doula, be sure to ask about her education and experience and check to see if she has been certified by a reputable national organization.

What’s Up with Water Births?

Some parents find the concept of a water birth—laboring and delivering in a tub or pool of warm water—very appealing. Indeed, my own daughter was born underwater, because I am convinced that water birth is a safe, nontraumatic experience. First introduced in the 1970s, water births have been gaining in popularity, particularly in Europe. In fact, a recent study from Italy found that in uncomplicated deliveries they may even shorten the first stage of labor. On the other hand, doctors in New Zealand have reported on four cases where newborns inhaled water after underwater delivery, developed respiratory distress, and required oxygen for anywhere from five minutes to six hours after birth. Some needed antibiotics as well.

Unfortunately, water births have not been widely studied so that no one can assure women that labor and delivery are equally as safe for both mother and baby as conventional births. However, a recent national surveillance study in Great Britain found a mortality rate of 1.2 per 1,000 live births of babies born in water compared to 1.4 per 1,000 among a comparable group of low-risk women having conventional births.

Immersion in warm water during labor relaxes muscles, reportedly leading to less painful uterine contractions and shorter

“ Immersion in warm water during labor relaxes muscles, reportedly leading to less painful uterine contractions and shorter labor. ” labor. The Italian study I mentioned above found that water birth was also associated with a lower episiotomy rate and less need for pain relief compared with other methods of delivery. Although I’ve heard claims to the contrary, this study found no difference in the length of the second stage of labor (when the baby is moving through the birth canal).

Water births are usually considered suitable for women with low-risk pregnancies. Some hospitals now offer water birth facilities, and you can rent or buy inflatable tubs for water births via a number of Internet sites that also provide referrals to water birth practitioners.

If you’re considering a water birth at home, I urge you to work with a midwife or practitioner with experience in this mode of labor and delivery. You should also become familiar with safety considerations, including temperature control of the water, the cleanliness of the tub, and a plan to deal with unexpected complications.

A Placenta on Your Plate?

Eating the placenta or afterbirth—a practice known as placentophagia—seems to be a trend among some new mothers these days. Actress January Jones discussed taking pills made from her placenta with People magazine. In a New York Times blog, author Nancy Redd wrote that even the hospital birth class she took suggested the practice. The hype for placentophagia holds that it can improve breast milk supply, increase energy, ward off fatigue and postpartum blues, replace nutrients lost during pregnancy, and even prevent aging.

There’s not a shred of scientific evidence behind any of this. It’s true that almost all nonhuman mammals eat the placenta and amniotic fluid, but regardless of culture, humans don’t, according to Mark Kristal, PhD, professor of psychology and neuroscience at the University of Buffalo, who has been studying placentophagia for more than 20 years. Kristal reports that in nonhuman mammals, eating the placenta is believed to stimulate an increase in mother-infant interaction, boost the effect of pregnancy-mediated painkillers, and activate circuits in the brain that set in motion caretaking behavior and suppress postpartum pseudopregnancy, thereby increasing the possibilities for fertilization. More importantly, it gets rid of tissue that might attract predators to the birth site.

Dr. Kristal has suggested that eating the placenta might provide human mothers with substances that could help them avoid postpartum depression, failure to bond with their babies, or maternal hostility toward the infant. But there’s no proof that these substances exist or would work as Dr. Kristal suggests, and no study has tested this theory. Dr. Kristal emphasizes that any benefits claimed by women (and some of their husbands) who have eaten placentas are neither reliable nor valid as scientific evidence.

The lack of formal clinical investigation hasn’t dampened enthusiasm for the practice. In response to this trend, some states have passed laws allowing women to take their placenta home from hospitals. (Otherwise, they’re disposed of or kept for research.) And some enterprising women have built flourishing businesses on the preparation of placentas for ingestion by new parents or on “placenta encapsulation”—drying and grinding the placenta into a powder to be put into capsules that mothers can swallow— which is easier than eating cooked placenta or drinking it blended into smoothies.

In her New York Times article, Redd writes that taking encapsulated placenta turned out to be “a terrible idea” for her. Shortly after swallowing the first two pills, she reported feeling “jittery and weird.” After taking eight placenta pills, she said she was in “tabloidworthy meltdown mode, a frightening phase filled with tears and rage” that lasted a few days until she stopped taking the pills and immediately felt better. She wrote that she is still not sure what was in the “cleansing herbs” included in her placenta pills and wonders how many women are taking them for postpartum depression “when it very well may be a cause of their mama drama.” Of course, her experience proves no more about placenta-eating than the testimonials of women who say that doing so boosted their moods, relieved fatigue, and otherwise smoothed the sometimes rocky road of new motherhood.

OH, BABY: INFANCY AND BEYOND

If you’ve got a newborn, baby, or even young toddler, you doubtless have a lot of concerns about keeping your child well. After all, these early years lay the foundation for optimal health later on in life. From breastfeeding to vaccination, here are my thoughts on some common controversies and concerns.

Breast Is Best

Breast milk is the absolute best food you can give your baby during the first year of life. It provides all of an infant’s nutritional needs and transfers from mother to baby antibodies that protect against a long list of infectious diseases. Over time, breastfed babies are less likely to develop such chronic conditions as diabetes, high cholesterol, asthma, and allergies. And breastfed babies are less likely than their bottle-fed counterparts to become overweight children. The American Academy of Pediatrics recommends breastfeeding infants for at least the first year of life and, after that, for as long as is “mutually desirable.” La Leche League International maintains that the health benefits to babies will continue as long as they are breastfed. My feeling is that you should continue to breastfeed for as long as you (and your child) feel comfortable. You can begin to introduce solid foods at six months, but if you stop breastfeeding before your baby’s first birthday, be sure to switch to formula, not cow’s milk.

Children younger than one year old should not be given cow’s milk; they can’t process the proteins. And if there is a family history of allergy, autoimmunity, eczema, asthma, bronchitis, or chronic sinusitis, I strongly recommend holding off on cow’s milk until at least two years of age. I never gave my daughter cow’s milk. Instead, she drank soy milk and rice milk, and unlike her siblings, never had an ear infection. But note that milk substitutes made from rice, oats, or potatoes don’t provide protein, so your baby will need an alternate source.

The latest development in formula has been the addition of two fatty acids found in breast milk: docosahexaenoic acid (DHA) and arachidonic acid (AA), both supplied to the fetus during pregnancy through the placenta. Babies who are breastfed continue to receive these two essential nutrients (especially when mothers eat a diet rich in omega-3 fatty acids). Some research suggests that DHA and AA are correlated with higher IQ scores and that deficiencies may be linked to slow growth, skin problems, and poor visual development. While formulas supplemented with DHA and AA are relatively new in the United States, they’ve been available in Europe for years.

Here’s an additional factor to consider: It appears that the more babies a woman has and the longer she nurses them, the lower her risk of breast cancer. One study showed that if women in developed countries had the same number of babies and breastfed them for as long as women in less developed countries, the risk of breast cancer would drop by more than half. Almost two thirds of the reduced risk would stem from breastfeeding alone. We’ve known for a long time that breastfeeding is good for babies. Now we know that it’s good for mothers, too.

Ready for Solids

Surprisingly, the research is unclear on what foods are best to introduce to babies, or even if it really matters. I believe that parents should offer organic foods whenever possible, and give babies a wide variety of choices. As for what food to start with, vegetables are a good option, followed by fruits and then grains. It is much harder to get babies to accept vegetables than fruits, and it’s possible that starting with them is a good strategy.

Something else to bear in mind when you’re introducing babies to solids: pesticide residues in some baby foods. In 2012, for the first time since 1991, the U.S. Department of Agriculture (USDA) began to look at the pesticide content of baby foods. The Environmental Working Group released some of those results, and they are shocking. For example, the USDA found that green beans tested positive for five pesticides, including the organophosphates methamidiphos, found on 9.4 percent of samples, and acephate, on 7.8 percent of samples. These pesticides are associated with neurodevelopmental effects in children. Pears also tested positive for at least one residual pesticide 92 percent of the time. In addition, 26 percent of samples contained five or more pesticides. Three samples of pear baby food contained iprodione, which the EPA categorizes as a probable human carcinogen. The only tested baby food samples in which the USDA found virtually no pesticide residues were sweet potatoes.

Federal testing for pesticide residue in baby food was long overdue, as infants are especially vulnerable to toxic compounds. The initial results are disturbing; that pears intended for babies contain a likely carcinogen is an outrage. I recommend that parents purchase organic baby foods or, better yet, prepare their own by putting organic foods through a simple hand-turned food mill. (Search the Internet for “baby food mill.”) It is vital that an infant’s developing brain and nervous system receive only uncontaminated, nutrient-dense foods.

Teething Troubles

In many infants, the process of teething is painless, causing only some increased drooling and a desire to chew. However, some infants develop tender, swollen gums; may not sleep or eat well; and may run a low fever (under 100 degrees). A fever above 100 degrees or diarrhea suggests problems unrelated to teething. Here are some recommendations to keep a teething baby comfortable:

• Wipe the drool off your baby’s face with a soft cloth to prevent rashes.

• Rub the baby’s gums with a clean finger.

• Let your baby chew on a wet washcloth that has been placed in the freezer for 30 minutes (wash it after each use). Alternatively, use a cool spoon or rubber teething ring. (Take it out of the freezer before it gets so hard that it can bruise the tender gums.)

• Never tie a teething ring around a baby’s neck—it could get caught on something and strangle the child. The same goes for amber teething necklaces, which are worn around the neck or as a bracelet by teething children. Proponents claim that they stimulate the thyroid gland (to control drooling) and improve the ability of the immune system to reduce inflammation in the ears, throat, stomach, and respiratory system, but modern science does not support these beliefs. The necklaces have the same potential risk of choking that any jewelry poses, including hazards from swallowing a bead if the necklace is broken.

• Homeopathic teething tablets are a good option. Many parents tell me they have used them successfully to relieve the minor discomforts of teething in their babies.

Coping with a Cranky Baby

Crying, fussy, colicky babies have stolen many a night’s sleep from new parents, but the good news is that this behavior is usually quite normal. The first thing parents of a fussy newborn should do is to exclude other explanations for the baby’s crying. Make sure the infant isn’t running a fever, isn’t lethargic, is eating normally, and isn’t having any trouble breathing. Your pediatrician will also want to exclude gastroesophageal reflux disease (GERD), which can occur among babies, although it is much more common among adults.

The good news about colic is that what you see is what you get: a fussy, crying, but otherwise perfectly healthy baby. Some doctors think that this irritating phase may be part of normal development. Between five and 28 percent of infants develop colic, usually between the ages of two to six weeks. Most outgrow it by the time they’re three to four months old. Here are suggestions for dealing with colic—and with the frustration it can breed among parents:

• Try massage therapy, a great way to enhance bonding between parent and child at a time when colic may be interfering with the bonding process.

• Rock your baby rhythmically.

• Turn on music or try the clothes dryer or vacuum cleaner. Sometimes the white noise they produce helps.

• Try cranial osteopathy or homeopathy; both may help and are safe forms of treatment.

• Try herbal remedies such as cooled chamomile or fennel tea. You can get tea bags at the health-food store and give the baby one to two ounces at a time, no more than three to four ounces per day.

• Ask your pediatrician about treatment with probiotics such as L. reuteri. One study showed that probiotic therapy may help relieve colic in some children compared with others treated with simethicone.

• Switch to a cow’s milk-free formula; or, if you’re breastfeeding, change your diet to affect what is entering breast milk (in some cases, a food sensitivity may play a role).

• Swaddle your baby, which provides a nice, snug feeling.

• Find a way to relax. Try breathing exercises or other relaxation techniques to help reduce tension and address frustration.

Should You Circumcise Your Son?

Many parents wonder whether circumcision is the right decision for their son. Opponents of the practice believe it does little, if any, medical good and can impair a child’s sense of sexual self. They also say it harms men’s ability to enjoy sexual sensation, but I don’t know if there is any way of measuring this.

Overall, circumcision does appear to have some health benefits, including fewer genitalurinary problems and slightly lower risk of cancer of the penis (which is fairly rare). Research also suggests that circumcision helps prevent transmission of HIV, syphilis, and gonorrhea. What’s more, female partners of circumcised men have a lower risk of cervical cancer.

Two recent scientific studies have bolstered the case for medical benefits. One, from the National Institutes of Health, reported on two trials in Africa involving more than 7,500 men and found that circumcision reduces a man’s risk of contracting HIV through heterosexual sex by 51 to 60 percent. The studies were halted ahead of schedule because the preliminary results were so striking. The other study, which followed 510 New Zealand newborns until age 25, found that circumcision reduced the risk of contracting sexually transmitted diseases by about half. Interestingly, two new medical reviews of circumcision came to opposite conclusions about the benefits of the practice. One analyzed studies of both infant and adult circumcision and concluded that the risk of major complications ranges from two percent to 10 percent and noted that there’s a lack of consensus and robust evidence on the medical benefits. The authors took note of the African studies linking circumcision in adult men to lower rates of HIV and other sexually transmitted diseases, but argued that only future studies will show if those findings hold true in the Western world where AIDS is less prevalent. The review’s author wrote that circumcision may lead to “significant anger of feeling incomplete, hurt, frustrated, abnormal, or violated.” The second review examined three studies and found that risks of complications from circumcision are less than one percent, and that serious long-term complications are extremely rare. was an unpleasant childhood rite of passage; the advent of the varicella vaccine has made it far less common these days. Chickenpox typically causes itchy red blisters all over the face and body, along with fever, headache, and sometimes a stomachache. It is extremely contagious and spreads in the air through coughing or sneezing, as well as by touch.

The American Academy of Pediatrics has maintained a neutral position on circumcision but is reviewing the issue. My view is that there is no justification for circumcision without appropriate anesthesia. Beyond that, it’s up to you to assess the medical evidence and the familial, religious, and cultural issues that you may have to factor into your decision.

Chickenpox doesn’t usually leave scars unless a blister becomes infected or you pick at it. The disease tends to be much more severe in adults. Rarely, it may cause complications like dehydration, pneumonia, and other serious secondary infections, and death. As with other viral infections, you should never treat children with aspirin, as it increases their risk of developing a serious condition called Reye’s syndrome. About one in 10 adults who have had chickenpox will later develop shingles (herpes zoster), a painful, burning skin rash that can last several weeks or months.

VACCINE: The CDC recommends two doses of varicella vaccine for children, teens, and adults. These doses are reported to be 98 percent effective at preventing chickenpox. The vaccine isn’t recommended for pregnant women or people who have an allergy to neomycin or gelatin. Some parents eschew the vaccine and prefer that their children develop immunity to chickenpox by contracting the disease through playing with other infected kids (known as “chickenpox parties”). While this practice is relatively safe, chickenpox does have a small rate of complications. On the other hand, having had chickenpox confers lifelong protection against the disease, while the vaccine may not.

Influenza

Flu is a viral respiratory infection that can cause a broad range of symptoms such as cough, sore throat, fever and chills, muscle aches, and fatigue. Complications include pneumonia, ear infections, dehydration, and death. Children, the elderly, those with weakened immunity, and those with chronic conditions like diabetes, congestive heart failure, and asthma are at higher risk for complications.

VACCINE: The best way to prevent this serious disease is to get a flu shot every year, preferably in October before flu season starts. I agree with the CDC, which recommends that both children and adults of all ages receive the flu vaccine.

Measles

A highly infectious viral illness, measles typically causes a rash, bloodshot eyes, runny nose, fever, sore throat, cough, and muscle pain. Complications can include ear infections, bronchitis, pneumonia, encephalitis (inflammation of the brain), hearing loss, and death. Before immunization was widespread, most people had developed measles by age 20. As mentioned earlier, measles is on the rise again, despite the availability of an effective vaccine.

VACCINE: The measles, mumps, and rubella (MMR) vaccine is credited with dramatically decreasing the number of measles cases and deaths in the U.S. When administered in combination with the varicella vaccine, MMR vaccines may rarely cause febrile seizures, which—while frightening for parents—usually cause no lasting problems. The risk is lower when the MMR vaccine is given separately from the varicella vaccine. Despite fears to the contrary, there’s no good evidence that the MMR vaccine can cause autism or other disorders.

Mumps

Mumps is a painful swelling of the salivary glands that’s spread through the air by sneezing or coughing. It can also cause a sore throat, headache, fever, and, in males, swelling of the testicles and scrotum. Complications are rare but can include seizures, paralysis, hearing loss, encephalitis, and sterility in males. Mumps is most common in children under age 12 who have not been vaccinated against the disease. Complications are worse in adults.

VACCINE: The MMR vaccine is effective at preventing mumps.

Pertussis

Also known as whooping cough, pertussis starts with a runny nose, low-grade fever, and mild cough but eventually progresses to rapid, severe coughing that creates a loud “whooping” sound as you gasp for air. It can also lead to pneumonia, brain damage, seizures, and mental retardation, and can be life-threatening in infants and young children.

VACCINE: Since the 1990s, U.S. physicians have administered the acellular diphtheria, tetanus, and pertussis (DTaP) vaccine to infants and children. It is less likely than the previous “whole cell” DTP vaccine to cause side effects and complications, and is about 80 to 90 percent effective in infants and children, providing the best protection in the first two years after administration and waning over time.

My Take

One major reason for the return of infectious diseases once thought to be relegated to the past is the choice by some parents not to immunize their children. As a parent myself, I understand that subjecting your child to multiple shots can be distressing. However, my daughter received all of her recommended vaccines as a child, because I know that the benefits of vaccines far outweigh any side effects or risks.

Unfortunately, the storm of misconceptions and the manufactured crisis perpetuated by the popular press that surrounds vaccines has many people confused about their safety. For example, research suggests that fewer parents in the United States vaccinated their children in the wake of concerns about a purported link between the MMR vaccine and autism, yet a comprehensive 2011 report by the Institute of Medicine concluded that while vaccines are associated with a small risk of seizures, fainting, and other issues, there’s no link between vaccines and autism or type 1 diabetes.

Indeed, declining to immunize can do more harm than good, says my colleague Sanford Newmark, MD, head of the Pediatric Integrative Neurodevelopmental Program at the UCSF Osher Center for Integrative Medicine. “I believe that being totally ‘antivax’ is a dangerous attitude,” he explains. “We do not want to see a return to the polio epidemics of the last century, or of widespread measles infection.”

That said, it’s okay to be somewhat flexible with the pace at which you vaccinate your child. If you adhere to the CDC’s recommended vaccine schedule, your child will have up to 24 injections in the first two years of life. These include vaccines to prevent diphtheria, tetanus, whooping cough, polio, hepatitis A and B, influenza type B, measles, mumps, rubella, pneumonia, and meninigitis. The advantage of adhering to the schedule is that kids get full protection from these diseases early in life. The downside is the need to follow a complicated and sometimes confusing schedule, yet youngsters who don’t follow the immunization schedule tend not to catch up.

“The current immunization schedule doesn’t have to be written in stone,” says Dr. Newmark. “As a general rule, I prefer spreading out the vaccinations where possible. There are certain vaccines that are given in infancy that I feel may be delayed in many cases, such as the hepatitis B vaccine.” If you decide to space out your child’s vaccinations, speak with your pediatrician about an alternate schedule.

You can also reduce the risk of vaccine reactions by making sure your child has a clean bill of health first. Children with certain immune deficiencies, for example, should not receive any of the live vaccines (MMR, chickenpox, nasal flu vaccine). Kids who have had concerning reactions to a particular vaccine should not have the vaccine repeated. And children who are ill should not have any vaccine until they are well. If you’re still concerned, your doctor can further help you weigh the risks and benefits for your child.

Childhood and adolescence are times of considerable change. The hormonal shifts of puberty contribute to growth spurts, mood swings, and concerns such as acne. Some developmental conditions, including autism and attention-deficit/hyperactivity disorder (ADHD), are first diagnosed during these years. Kids have other special needs when it comes to health and wellness, too: They tend to be more prone to problems like ear infections and colds.

This is also an opportune time to establish healthy habits in nutrition and physical activity that will last a lifetime, and to help ward off “adult” diseases such as heart disease, diabetes, and obesity that have their roots in childhood. Much of the information in this section of Whole Life Health Advisor comes from my colleague Sanford Newmark, MD, head of the Pediatric Integrative Neurodevelopmental Program at the UCSF Osher Center for Integrative Medicine.

Raising Healthy Eaters

Children learn by example, and eating habits and nutrition are not exceptions. Your kids are more likely to eat well—and less apt to demand high-calorie, low-nutrient fare—if they see you enjoying a wholesome diet. They’ll also lower their risk of childhood (and adult) obesity.

There is no magic formula for raising a healthy eater. Simply put, you should eat as you would like your child to eat. That means eliminating processed, junk, and fast foods and focusing on choices that are high in fiber, such as fruits, vegetables, whole grains, whole soy products, nuts, legumes, and seafood. Don’t just micromanage your child’s diet: Change the way your entire family eats. Here are some additional tips for encouraging healthy eating in kids.

Build boundaries. Children are less likely to ask for pizza, chicken nuggets, burgers, and other such fare if they learn to avoid them early on. According to one recent study by researchers at the University of Buffalo, children whose parents set restrictions on what and when they could eat at age two had healthy eating habits by age four.

There’s no harm in the occasional treat in the context of a well-balanced diet, but try to encourage snacking on healthier foods—fresh or dried fruit; a small handful of raw, unsalted nuts such as cashews and walnuts; a piece of flavorful, natural cheese; or a piece of dark chocolate.

Watch what they drink. Kids may crave sugar-sweetened beverages like soda, chocolate milk, and fruit juice—drinks that provide a surprisingly large number of calories per day. For instance, the average 20-ounce soft drink contains 15 to 18 teaspoons of sugar and more than 240 calories. A 64-ounce cola may have as many as 700 calories. That can translate to heavier kids: A well-publicized study by Harvard researchers found that children’s risk of obesity significantly increased with each daily serving of sugar-sweetened beverage they consumed. Studies have found that reducing consumption of sugary drinks can help children control their weight.

Share family meals. Busy schedules can make finding time for family dinners difficult, but your effort to make it a priority will pay off. Eating meals together gives you more control over what your child eats and allows you to make sure that everyone gets at least two nutritious meals per day. According to one recent study, sharing just a couple of family meals a week may have lasting effects on weight. Among teens who reported that they never ate meals together with their family, 60 percent were overweight and 29 percent were obese 10 years later. Even having one or two family meals each week during adolescence was linked to lower odds of being overweight or obese within 10 years.

Preventing Picky Eating

It’s a common problem for parents: Their child favors only plain or buttered pasta, macaroni and cheese, cheese pizza, French fries, or grilled cheese sandwiches and typically eats a very small number of foods. If your child eschews most edibles, don’t despair. You may be frustrated now, but most kids outgrow such habits as they get older. In the meantime, follow these steps for dealing with a picky eater.

Don’t force it. It’s natural to worry about your child’s nutrition, but forcing meals or using bribery or punishment with food isn’t the answer. Such tactics may lead to a power struggle and reinforce his or her feelings of anxiety about food.

Be patient. Let your child experiment with food without insisting he or she eat it. You can talk about the color, shape, smell, and feel of the food at first—without the pressure to taste it right away.

Have fun. Make mealtime more enjoyable by serving a variety of brightly colored foods, cutting them into fun shapes, and serving produce with a dip or sauce that your child likes. Engaging your child in the process of growing, shopping for, and preparing food also builds enthusiasm. Indeed, research suggests that kids who help tend an edible garden are more likely to choose healthier foods such as produce.

Approaches like these may not transform a picky eater immediately, but they can go a long way in setting your child up for a lifetime of healthy eating when he or she is ready to expand their diet. If you’re concerned that picky eating may be negatively affecting your child’s growth and development, consult your pediatrician.

Are Supplements Necessary?

I’m often asked whether children should take supplements regularly. In 2013, the National Institutes of Health noted that about one in four children take a daily multivitamin/ mineral supplement and that adolescents are least likely to take them. The information about many “required” micronutrients at these ages can be confusing and is still evolving, but some suggestions are straightforward. For example, the American Academy of Pediatrics and the Institute of Medicine recommend a daily intake of 400 IU per day of vitamin D during the first year of life beginning in the first few days after birth, and 600 IU for everyone over age one.

I recommend that children take a daily multivitamin/mineral supplement to cover nutritional gaps, but it shouldn’t be regarded as a substitute for eating whole foods, especially fruits and vegetables. You may want to wait until children are at least four years old before giving them vitamin or mineral supplements (other than the vitamin D they already should be taking). It isn’t always easy to find a quality child’s multivitamin that doesn’t contain sugar or artificial colorings. Kids who take chewable “gummy” vitamins should get additional dental attention. Supplements for children between the ages of four and 12 should provide no more than 50 percent of the adult RDA of the major vitamins and minerals, especially the fat-soluble ones (A, D, E, and K). After age 12, kids can safely take the adult dosage. Be sure to keep all vitamins out of the reach of young children. Because some supplements for kids taste and look like candy, there is a danger of overdosing, especially when supplements contain iron.

Kids On The Move

As with optimal nutrition, encouraging regular exercise early on can help set the stage for a lifetime of healthy habits. Once again, you should set a good example. For instance, studies have found that children are more likely to be physically active if their parents and siblings are active, and if they’re encouraged to take part in physical activities. Take family walks, hikes, or bike rides on a daily basis, if possible, or simply play outside with your child. Kids should get at least 10 to 15 minutes of vigorous exercise a day and an hour or more of overall physical activity.

You should also consider encouraging your child to play a sport. Team sports offer the advantage of motivating kids and supporting

Heading Off Concussions

them through coaching and interaction with peers. Playing team sports also shows children where they may need improvement and how to achieve it. That said, team sports may be too competitive for some people, including parents. Some kids thrive under pressure and some don’t. There are many benefits if your children are on a team that provides just the right amount of competition to get them excited but not stressed. In addition to the obvious health benefits of exercise, the social aspect of team activity helps kids forge friendships. To find the right team for your child, ask what kind of sports he or she likes. It could be swimming, basketball, football, dancing, or something else. Ask other parents for recommendations and talk to coaches until you discover the right fit.

Historically considered an inevitable part of contact sports, we’re now learning more about the consequences of concussions, and the news is troubling. When you experience a violent blow to the head, neck, or upper body, the force of acceleration on the brain can temporarily disrupt its function. (In more severe trauma, the brain can impact the inner wall of the skull, causing potentially fatal bleeding in or around it.) Immediately following a concussion, you might lose consciousness briefly and experience a headache, dizziness, confusion, and ringing in the ears. It may take hours or even days for other symptoms to develop: memory problems, personality changes, and impairment of smell and taste.

As an increasing number of professional athletes have come forward about their health struggles following multiple concussions, doctors are now warning of the long-term effects of this type of traumatic brain injury. These include permanent and progressive cognitive impairment, as well as a higher risk of epilepsy. “Second impact syndrome”—sustaining another concussion before the first has healed—can lead to fatal brain swelling. As you might imagine, anyone who plays football, hockey, soccer, or another contact sport is at greater risk for second impact syndrome, especially if he or she continues to participate before a doctor gives a clean bill of health.

I’m concerned about the cumulative effects of concussions, particularly in younger people. Worse, a recent study in Neurology found that even traumatic head injuries that don’t result in concussion can negatively affect verbal learning and memory—over the course of just one season. I generally encourage children to pursue safer, non-impact sports and to always wear proper equipment while doing so.

Addressing Stress

Stress may seem like a grown-up problem, but even the littlest members of your family can feel frazzled. Childhood isn’t all fun and games: These days, a kid’s calendar can be just as full as yours. Factor in a heavy homework load, friendship ups and downs, the challenges of puberty, and stressors like moving, divorce, or the death of a loved one, and you can see that children aren’t free from anxiety.

The American Academy of Pediatrics (AAP), which represents the nation’s pediatricians, has urged parents to lighten their children’s loads and give them more time to just be kids. The organization has said that packed schedules and a fast-paced lifestyle can create stress for both kids and parents and can even cause depression in some children. It notes that play is recognized as a right of every child by the United Nations High Commission for Human Rights. I’m afraid that right is often neglected when parents focus on giving their children a full complement of the “advantages” they hope will ensure success in school and in life.

Experts agree that children need time to exercise their imaginations in playing with “true toys” such as blocks and dolls. Unstructured playtime can be just as beneficial as the enrichment programs, videos, and computer games designed to give children an academic edge from babyhood on. Left to their own devices, children can tap into their own creativity, develop problem-solving skills, learn to relate to others, and discover their own passions. And while parents should play with their children, parental participation can also cramp a child’s style: When children play by adult rules, they lose some of the benefits of informal play, including the creativity, leadership, and group skills it can foster. I don’t believe that parents should completely abandon enrichment programs and extracurricular activities. But I do favor unstructured, “non-screen” time for play.

Here are some other suggestions to help keep a lid on stress.

Talk about it. Ask your children if they feel overworked or stressed because they are doing too much after school. You can suggest one day a week with no mandatory activities when they just stay at home or hang out with their friends. If they insist that they don’t feel overworked, don’t push them. Trust them and let them make their own decisions.

Keep the pressure off. It’s fine to put a little pressure on getting your kids to be active. But too much pressure will likely make your kids not want to do anything after school but lie on the couch watching TV.

Practice stress management. Teach your kids a relaxation technique such as breath work, progressive muscle relaxation, yoga, or guided imagery to practice when they’re stressed, and also practice it together often. Children may be particularly suited for guided imagery, since it harnesses the power of their imagination.

Curbing Screen Time

Overall, American kids age eight to 18 spend 4.5 hours per day watching television, and an estimated 70 percent have television sets in their bedrooms. Research shows that having a TV in the bedroom can have negative health effects. For example, in one study, researchers analyzed data collected from 369 children and adolescents ages five to 18 for waist circumference, resting blood pressure, fasting triglycerides, HDL (“good”) cholesterol, blood glucose, fat mass, and stomach fat. They then correlated these physical attributes with the children’s social histories. Results showed that children with TV sets in their bedrooms were fatter and had a greater waist circumference compared to kids without bedroom TVs. The youngsters with bedroom TVs, as well as those in the study who watched television for more than two hours a day, had 2.5 times the odds of having the highest levels of fat mass. The study also found that watching five or more hours of television daily was associated with double the odds of being in the top quartile for visceral fat located deep in the abdomen surrounding internal organs. This type of fat is associated with higher risks of diabetes, cardiovascular disease, and certain types of cancer. Kids with television sets in their bedrooms had three times the normal risks of diabetes and cardiovascular disease. The researchers also observed that having a bedroom TV correlates with less sleep and fewer regular family meals, both of which are associated with weight gain and obesity. The study was published in the American Journal of Preventive Medicine.

To me, the overall exposure of children to electronics is already much too high. Having a television in the bedroom only increases this exposure. It also decreases possible time that you and your family can watch a television show or movie together, ideally a stimulus for some useful discussion and positive social interaction. Plus, the more time kids spend in front of the television, the less time they have for interacting with others, which means that they’re not learning social skills or how to resolve conflicts. Indeed, research from Johns Hopkins University has linked having a TV in the bedroom at 5.5 years of age with behavioral problems, poor social skills, and poor sleep.

An increasing amount of research has also shown a link between time spent watching television and the risk of childhood obesity. For example, one study of 13- to 15-yearolds found that those who spent the most time watching TV, playing video games, and using computers were more likely to be obese than those who had less screen time. This relationship doesn’t appear to be based solely on the fact that screen time is passive and replaces healthier activities like exercise. There’s evidence that screen time also means snack time for many kids: One study found that every hour of TV a child watches is associated with the consumption of an extra

167 calories, particularly in the form of fast food, salty snacks, and sugar-sweetened beverages. It’s no wonder, since children are exposed to constant commercials for these unhealthy options. Screen time also crowds out sleep, which can influence appetite and hunger.

I’m not against spending a few leisure hours in front of the television. I often watch movies on television in the evenings, but enjoyable as that can be, it is no substitute for the relaxation techniques that I recommend to help manage stress. Television can be much too stimulating, and stimulation is an obstacle to relaxation. Kids are unquestionably at greater risk from overdosing on TV. Limit the time your child spends in front of the television, computer, and other gadgets, and encourage active play instead.

Sweet Dreams

Children need optimal sleep and should have a regular bedtime. Sleep provides a bevy of benefits: The brain is active and dreaming during rapid eye movement (REM) sleep, while during deep, non-REM sleep the body is busy increasing the blood supply to muscles and restoring energy. During the latter state, tissue growth and repair occur, and hormones that are needed for growth and development are released.

We evolved as a species to fall asleep soon after sundown, so it is probably better for children to have a relatively early bedtime. If your child’s bedtime is 9 pm instead of 7 pm, that shouldn’t be a problem. But if he or she is going to bed at 10 or 11 pm, try to make it a little earlier.

Recent research from the UK has found that children with regular bedtimes, regardless of whether they were early or late, had fewer behavioral problems compared to kids whose bedtimes were irregular. In fact, the researchers from University College London found that the longer irregular bedtimes persisted, the more severe the kids’ behavior problems were. They gathered their information by interviewing mothers when their children were ages three, five, and seven. Both mothers and teachers completed questionnaires about the children’s behavioral problems. The researchers reported that almost 20 percent of three-year-olds had no regular bedtime, compared with 9.1 percent of five-year-olds and 8.2 percent of seven- year-olds. Commenting on the findings, the study’s lead author, Yvonne Kelly, a professor of epidemiology, said that “getting kids into a regular bedtime routine does appear to have important impacts on behavioral development,” but she made the point that lots of other practices have beneficial effects and that regular bedtime is only one of them.

For the record, according to the National Sleep Foundation (NSF), parents should expect preschoolers to sleep 11 to 13 hours per night and not expect most to nap after five years of age. The NSF notes that difficulty falling asleep and waking during the night are common in this age range and that with normal development of imagination, preschoolers commonly experience nighttime fears and nightmares. Sleepwalking and sleep terrors also peak during preschool years.

Kids ages five to 12 need 10 to 11 hours of sleep a night, but in this age range they are also dealing with increased demands on their time from homework, sports, and other extracurricular activities, as well as television and computers, all of which can cause difficulty falling asleep, nightmares, and sleep disruptions. The NSF warns that watching television close to bedtime has been associated with bedtime resistance, difficulty falling asleep, anxiety around sleep, and sleeping fewer hours. What’s more, the foundation notes that poor or inadequate sleep in kids this age can lead to mood swings, behavioral problems such as hyperactivity, and cognitive problems that impact their ability to learn in school.

Stemming The Tide Of Childhood Obesity

In 2009, President Barack Obama established a national Task Force on Childhood Obesity aimed at reducing the rate of childhood obesity to just five percent by 2030—the same rate as before the problem began to increase in the late 1970s. It was an initiative driven by sobering statistics: According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated 10 percent of children age five and younger, 18 percent of children ages six to 11, and 21 percent of adolescents ages 12 to 19 are obese. The numbers are even higher when taking overweight youths into account—all told, about a third of kids and teens are either overweight or obese.

The effects of childhood obesity extend far beyond self-esteem issues and bullying. The condition can have both immediate and longterm consequences that take a toll on health. For example, a large population study by UCLA researchers found that obese children have twice the risk of developing a wide range of physical and mental conditions, including bone, joint, and muscle problems; attention-deficit/ hyperactivity disorder; learning disabilities; asthma; allergies; ear infections; and headaches. For example, a large population study by UCLA researchers published in Academic Pediatrics found that their hearts are also in peril: Research suggests that about 70 percent of obese kids already have at least one risk factor for cardiovascular disease, such as high cholesterol, high blood pressure, and pre-diabetes. Indeed, there’s evidence that type 2 diabetes appears to progress more quickly in obese children and becomes much more difficult to treat.

Obesity in childhood can have lasting effects as well. Obese kids often grow into obese adults and have a greater chance of developing all of the health complications that come with extra pounds, including cardiovascular disease, type 2 diabetes, metabolic syndrome, stroke, sleep apnea, infertility, osteoarthritis, and many different types of cancer. Worse, they tend to develop these problems much earlier than people who didn’t become obese until adulthood. Ten years ago, a troubling report in The New England Journal of Medicine made headlines when it predicted that being obese during childhood could shave an estimated two to five years off a person’s life. It seems that little has changed in the decade since that study.

The good news is that childhood obesity is completely preventable—but tackling it can be quite challenging. Perhaps more than any other time in history, parents and kids alike are faced with enormous obstacles to maintaining a healthy weight. From the constant onslaught of advertisements for junk food, to the decline of recess and other physical fitness programs in schools, to limited time and financial resources, a number of daily influences can conspire against healthy habits. Childhood obesity is particularly problematic in certain racial, ethnic, and socioeconomic groups: African Americans, Native Americans, and Latinos have higher rates of it, as do lower-income communities.

Clearly, telling parents to feed their children healthy food and encourage more physical activity isn’t enough. “We need to look at the issue of childhood obesity from every level— kids, parents, schools, communities, and policy makers,” says Dr. Newmark. “It’s not just about what one person should do.”

Prevention: The Sooner, The Better

With all of the serious negative complications associated with childhood obesity, it makes sense to start preventing the problem as soon as possible. That means addressing it even earlier than you might think, advises Dr. Newmark. Indeed, a growing body of evidence shows that childhood obesity begins during pregnancy before a child is even born. Some research suggests that many of the racial and ethnic disparities in childhood obesity appear to occur early in life. One large study found that black and Hispanic children were more likely than white children to have gained weight rapidly during infancy. These babies spent less time breastfeeding, were introduced to solid foods sooner, consumed more fast foods and sugar-sweetened beverages, slept less, and had television sets in their bedrooms during the first three years of life—all risk factors for childhood obesity. Black and Hispanic moms were also more likely to begin their pregnancies while overweight or obese.

The exact reasons for these differences are still unclear, but researchers do know that the choices a woman makes during pregnancy and in the first several months of her baby’s life can have a dramatic affect on that child’s risk of obesity. Here are some of the most important factors, according to recent research.

Healthy mother, healthy baby. Research demonstrates that children born to women who were overweight while pregnant are at higher risk of gaining extra pounds themselves. One study found that children of mothers who had gained excessive weight in pregnancy had about four times the risk of being overweight by age three. More recently, a study of more than 41,000 mothers and their children showed that high pregnancy weight increases the risk of childhood obesity all the way until age 12. Other evidence suggests that children whose mothers smoked while pregnant have twice the risk of being overweight by age three than those whose mothers did not smoke.

Delivery makes a difference. According to one study, three-year-old children who had been born by Caesarean section were twice as likely to be obese as those who had been delivered vaginally. Differences in the microbiome—the collection of trillions of bacteria and other microbes that populate our bodies soon after birth—may be responsible. Researchers believe that babies born by C-section have a different microbial makeup than those born vaginally, which might affect energy balance and metabolism.

Breast is best. A number of studies suggest that children who are breastfed are less likely to be overweight or obese. That may be because breastfed babies learn to better regulate their appetite and food intake by responding to hunger rather than other cues. Meanwhile, one study found that children who were introduced to solid food before four months old were six times more likely to be obese by age three, compared to those who didn’t receive solid food until at least four to six months of age.

Sleep more, weigh less. Research suggests that adequate sleep during infancy and childhood can help protect against extra pounds. One study found that babies who slept less than 12 hours a day were twice as likely to be obese by age three than those who slept more. Another showed that children who consistently had reduced sleep in early childhood had increases in obesity by age seven. It makes sense: The hormones produced during a good night’s sleep help regulate appetite.

Antibiotics may add pounds. I’ve long warned against the overuse and misuse of antibiotic medications, which can lead to the rise of drug-resistant bacteria. Now, two recent studies suggest that antibiotics may have even more insidious effects. In the first, Pennsylvania researchers reviewed electronic health records from more than 64,500 children to determine the incidence of obesity in kids ages two to five years old. They found that 69 percent of the children had been given antibiotics before age two, and that there was an increased risk of childhood obesity among those who were exposed to broad-spectrum antibiotics, particularly among children who had been prescribed antibiotics on four or more separate occasions.

Likewise, a study by Columbia University researchers found that children who were exposed to antibiotics in utero during their mother’s second or third trimester of pregnancy had an 84 percent higher risk of childhood obesity at age seven. In both cases, antibiotics may alter the children’s microbiota, leading to imbalances between beneficial and harmful bacteria and increasing the likelihood of obesity.

What You Can Do

While it’s ideal to start preventing childhood obesity very early in life, many parents may not even consider it a problem until their child begins to gain noticeable weight. Still, there’s much you can do to help kids achieve and maintain a healthy weight, no matter what their age. Follow the advice in this section on healthy eating, physical activity, stress reduction, and other lifestyle changes to help your child keep off extra pounds.