Lactose intolerance is extremely common among adults in our culture. According to the American Academy of Pediatrics (AAP), about 70% of the world’s population has a lactase deficiency. Lactose intolerance in more common among some ethnic groups. According to the AAP, about 20% of hispanic, asian and black children younger than the age of 5 show some evidence of lactose intolerance, whereas caucasian children typically do not develop symptoms until after 4 - 5 years of age. 

What is lactose intolerance?

Lactose is a naturally-occurring sugar in all mammalian milk. Lactose intolerance is a deficiency in the enzyme (lactase) that breaks down lactose in the gut. Common symptoms are: abdominal pain, diarrhea, nausea, flatulence, and bloating after eating lactose-containing foods. 

*It’s important to note that lactose intolerance differs from a cow’s milk allergy, which is more severe and involves a reaction of the immune system. Lactose intolerance does not cause vomiting or eczema, and these symptoms may indicate a more serious condition.

When feeding infants it’s common for them to be fussy, spit up, and have occasional wet poops. Sometimes it’s difficult to tell if these are normal activities, or if baby is having a reaction to something they ate. Since milk is the primary component of a baby’s diet, it’s easy to assume lactose intolerance may be the cause. 

In actuality, mother nature is quite resourceful, and as lactose is the primary sugar in breast milk and often the sole source of nutrition for the first 6 months, she is pretty good at making sure infants are able to digest that sugar properly. For this reason it is extremely rare for infants to be lactose intolerant, and is uncommon before the ages of 2-3 in all populations for healthy, term infants. However, it is sometimes seen more often in pre-term infants.

Best food? Mom's milk

Although it’s very rare for infants to have an intolerance to lactose, it’s not impossible. Nevertheless, because lactose intolerance will not harm your baby (as long as s/he is growing normally) and the benefits of breast milk are unmatched by formula, the AAP recommends that breastfed infants with a lactose intolerance should be continued on human milk. 

Breast milk always contains lactose and is not influenced by mom’s diet, so there’s no need for mom to stop drinking milk while breastfeeding. For formula-fed infants, lactose-free formulas are available but have not been shown to have any clinical  advantages (growth, development, etc.).  Lactose-free formulas may reduce some symptoms for your baby, but this is not always the case. 

Should kids avoid dairy?

For older children, complete avoidance of lactose-containing foods will resolve symptoms, however, avoidance of all dairy foods is not entirely necessary and has been linked with suboptimal bone development in children. There are different severities of lactose intolerance, depending on the amount of enzyme you produce. 

Some people are able to eat yogurts and aged cheese because the lactose content isn’t quite as high in these dairy foods. As calcium is very important for bones and teeth for growing children, if dairy is completely eliminated it is important to provide a calcium supplement and/or ensure adequate calcium intake from non-dairy sources. 

Talk to your doctor or dietitian if this is the case. Other options include using an oral lactase supplement, or lactose-free milk. Soy, rice and other non-mammalian milks are available as lactose-free substitutes, but their nutritional quality is not quite equal to that of cow’s milk. 

With all the allergies popping up these days, parents who are already facing picky eating difficulties with their children are now also faced with the added obstacle of finding healthy, kid-friendly snack foods that are nut-free. There are quite a few products coming out now with the “peanut-free label”, which make it easy to identify a safe snack choice. Unfortunately, these snacks not always the healthiest and can be loaded with sugar.

Here are some ideas for quick, healthy, kid-friendly snacks (nut-free, of course) to help with this challenge. Print them out and stick them on your fridge for a quick reference when packing lunches.

• Fruit or fruit cups (packed in water or juice)
• Fruit sauces (such as apple) with no sugar added
• Cut-up vegetables (baby carrots, celery, cucumber, cherry tomatoes, broccoli, etc.) with low-fat yogurt dip or hummus
• Cheese strings
• Yogurt cups
• Dry cereal (nut-free, of course)
• Air-popped Popcorn
• Unsweetened dried fruit (raisins, dates, cranberries, etc.)
• Crackers (with cheese)
• Hard-boiled egg
• Low-fat, homemade oatmeal raisin cookie
• Guacamole or hummus with baked pita chips
• Homemade low-fat muffin, such as carrot, oatmeal, blueberry or banana
• Bread with pea or sunflower butter (only if label says it’s nut-free) & jam

When dealing with nut-free restrictions, it’s important to prevent cross-contamination. A good idea is to keep your “nut-free” snack products in a different cupboard than nut-containing products in your home. Cross-contamination can occur any time a nut product has come in contact with another food, a surface or your skin. If the area isn’t properly cleaned, residue can be transferred easily to a “safe” food. 

What to do when grocery shopping

When purchasing packaged foods, such as cereals and granola bars, it’s always important to read the label every time, as manufacturers can change their products at any time. 

Below are some ingredients that indicate traces of nuts in a product:

• peanuts
• vegetable oil (may be peanut oil)
• mixed nuts
• ground nuts
• mandelonas
• peanut butter
• beer nuts
• peanut oil
• goober nuts
• goober peas
• peanut flour
• artificial nuts
• hydrolyzed peanut protein

Also, watch for labels which say: "May contain traces of nuts or peanut" and treat these products as if they contain nuts. When shopping, avoid foods that do not have a label, are in bulk bins, or are unpackaged (such as baked goods) and placed near other goods that may have nut ingredients. 


Some other potential sources of peanut are: 

• cereals (especially granola mix)
• granola bars
• cookie and cake mixes
• rice cakes
• crackers
• ice cream
• and candies. 

It seems these days that everywhere you turn there is a child with some type of allergy. Gone are the days of sending peanut butter sandwiches in school lunches, and planning a birthday party can mean accommodating for a few different allergies among attendees. Eggs, dairy, and nuts are the most common food allergies.

Allergy versus Intolerance

It’s important to note that there is a difference between an allergy and an intolerance. An food intolerance is often mistaken for an allergy, and can have a variety of symptoms, often originating in the gastrointestinal tract. Intolerances do not involve the immune system, and are usually caused by an inability to digest or absorb certain foods, or components of those foods.

An allergy occurs when your body’s immune system overreacts to a normally harmless substance. Symptoms can vary widely in type and severity. With food allergies, it is usually the proteins in foods that cause a reaction. There are eight types of foods that are believed to cause 90% of all food allergies. They are: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.

Are allergies more common today?

In a word: Yes. The CDC (Center for Disease Control) reported an increase in food allergies of about 18 percent from 1997 - 2007, especially among children. Current numbers estimate that 5-6% of children have food allergies. The reason(s) for the increase in allergies among kids isn’t clear, and many theories exist. 

One possible explanation for the rise in diagnosis of food allergies is an increase in awareness. Parents and physicians may be more likely to consider a food allergy diagnosis these days when, years ago, people may have attributed a rash or vomiting as just common illness. It didn’t always occur to people to consider food as a cause. Others attribute the increase in food allergies to the changes we’ve made to the way we grow and process foods.

One thing we do know is that most children outgrow their food allergies to milk, egg, soy, and wheat by the time they are 10 years old, and often before 5 years of age.
It is estimated that about 85% of children who are allergic to milk or eggs will outgrow their food allergy, and just about all children who are allergic to soy or wheat will outgrow their allergy, too.

According to The Food Allergy & Anaphylaxis Network, most children will outgrown their food allergies to milk, egg, soy and wheat between 5 and 10 years of age. It’s estimated that about 85% of children with allergies to milk or eggs will outgrow them, however, not all allergies are likely to be outgrown. Only about 10-20% of kids will outgrow their allergies to nuts, fish or shellfish, and therefore, these allergies are usually lifelong.

If you think your child has a food allergy, it’s important to get an allergy test done from your doctor. Eliminating foods from your child’s diet without a proper diagnosis may compromise their nutritional intake. For more information, visit www.foodallergy.org.

In one word: YES! 

Picky eating among children is extremely common. Most children will go through some period where they have an aversion to new foods, a term referred to as “neophobia”. Toddlerhood and the preschool years are the most common times for picky eating to rear its inconvenient and frustrating head.

First things first: Is your child a true picky eater? 

Many children who are perceived as picky eaters by parents are actually just small eaters. Parents often think in adult portions and overestimate how much their child should be eating at each meal. A true picky eater often complains about or refuses specific foods, which often happen to be vegetables. 

Or, they will only want to eat one or two foods for an extended period of time. Despite all this, typical picky eaters usually get enough Calories throughout the day to meet their needs. However, picky eating can be frustrating and worrisome for parents.

What you can do about it

There are a number of things you can do to help encourage your child to try more foods, without getting into a power struggle or resorting to bribes.

• It’s important to let the child know that s/he is expected to eat the same foods as the rest of the family, at scheduled meal and snack times. When it seems your child isn’t going to eat anything you’ve prepared for the rest of the family, it’s tempting to become a short order cook. By doing this, the child will soon learn they can have whatever food they want, whenever they want it, and s/he is less inclined to eat at meal times. If they don’t want to eat, have them sit at the table with the family for the social aspect. If they are hungry after a meal, snack time should be the next time you offer food.
• Place a time limit on meal times. Children are often slow eaters and should be given plenty of time to eat meals, but place a reasonable limit on that time. 20 - 30 minutes should be plenty. 
• Don’t offer foods in between snacks and meals. Snacks and beverages with Calories, such as milk and juice, can decrease a child’s appetite and cause them to not eat as much at meals and snacks. Offer water if they are thirsty.
• Eat together at the table. Structured meals help set a positive eating environment.
• Get kids involved in meal planning and cooking. Kids who help make meals are more likely to want to eat them. Let your children make decisions like “do you want broccoli or carrots for dinner?” rather than “do you want broccoli for dinner?"
• Make foods fun! When broccoli and dip becomes “trees with snow”, or carrots become “super vision carrots”, kids are more inclined to eat them. Vegetables and fruits don’t come in fun boxes with cartoon characters. Giving healthy foods fun names can make them more appealing to kids. Be creative in your food presentation. 
• Be a good role model. Children are often curious about what adults are eating. It’s important to show your child that you enjoy eating a variety of healthy foods.
• Relax! Power struggles are never fun. Often times refusal of a food isn’t about the food, but rather independence and control. Providing a pressure-free environment helps avoid a power struggle.
  
  

Things to Remember:

• Be patient and persistent - children will often out grow most of their picky eating.
• Sometimes picky eating is a true dislike of a food. If your child is a generally good eater and expresses a dislike, it’s important to respect that.
• It can take 15 - 20 times of seeing a new food before a child wants to try it. Children are sensitive to different sensations, and often avoid new or difficult textures (such as hard vegetables or tough meats), bitter tastes, and foods that look or smell different.  Keep offering it to your child, without pressure. Eventually, they may become curious enough to try it. They may just play with a new food at first or spit it out. This isn’t a failure! This is your child’s way of getting to know the food and becoming familiar with it. Keep offering it over time.
• Young children have small appetites. Be sure to serve child-sized portions. 
• Children’s appetites will change. From day to day and week to week often according to growth spurts, it’s normal for kids to adjust their intake accordingly.
• Don't offer bribes or rewards for eating -  this goes back to developing a healthy feeding relationship.
• Offer a variety of foods - to give your child some choice, and set a good example. 

30% of kids aged 6-11 are overweight, and 15% are obese. For teens, the numbers are slightly higher. Obesity is a complicated condition with many contributing factors. One of those factors is probably sitting in your living room.

According to the Kaiser Family Foundation, most children under age 6 watch an average of 2 hours of television per day, and kids and teens 8 to 18 years of age spend nearly 4 hours a day in front of a TV screen (plus almost 2 additional hours on the computer). Television has become our entertainment, our babysitter, our relaxation tool, and our source of information.  

Research has shown that the risk of being overweight or obese, and developing type 2 diabetes and other conditions, increase with the more hours of television that kids watch. The risks of overweight and obesity may be greatest when kids watch over 2 hours of television per day, but most experts agree that any amount of television is detrimental. 

Is TV really the culprit?

Is it purely the lack of physical activity that causes the link between time spent watching Tv and being overweight, or is there something more? Some researchers claim it’s not the amount of time spent watching television, but rather what is being watched that matters. 

According to the American Academy of Pediatrics (AAP), kids in the U.S. see about 40, 000 commercials each year (I imagine this number to be on par with Canada), and a large portion of those commercials are for food products that promote an unhealthy diet. Most of the commercials for food are products that are typically low in nutritional value, and high in fat, sugar and Calories. 

Kids can't tell the difference

Sugary cereals, candy, snacks, fast food and sugary beverages are made to look appealing to kids and often feature your child’s favourite Tv characters. Companies spend millions on advertising campaigns to get your children to want their products, and it works! Research has shown that kids under 6 years of age are unable to distinguish program content from commercials, especially if the product features a recognizable Tv character. Anyone with who’s been to a grocery store with a young child can tell you what types of foods they ask for, and it’s usually something that comes in a box that they’ve seen on Tv. 

Does this really matter? I think it does. The Institute of Medicine reports that television advertising has a strong influence on what children under the age of 12 eat, and unfortunately, there aren’t a lot (if any) commercials for fruits and vegetables. Kids will want the unhealthy yet attractive foods they see on Tv, which starts kids off on the wrong nutritional food and puts them at risk for long-term health issues. For this reason, many groups are advocating to ban advertisements aimed at children altogether.

Even if you take the television out of your home completely, you can’t get away from marketing entirely. So what can you do? 

• Limit Tv time. The AAP recommends that kids under the age of 2 do not watch any Tv at all, and those older than 2 watch no more than 1 - 2 hours per day of quality programming.
• Teach your kids to be critical of what they see. Talk about what they’re watching and ask questions like "Do you think that's a healthy choice?"
• Explain the purpose of marketing. Explain to your kids that commercials are meant to make people want things they don't necessarily need 
• Use the Tivo. Record programs without the commercials, or use your PVR to fast forward them. 
• Goto the video store. Buy or rent children's videos or DVDs.

Will banning food ads on Tv stop the obesity epidemic? Not likely. It is, however, a step in the right direction, and any long journey starts with one step.

What is a “feeding relationship”?

A “feeding relationship” basically refers to all the interactions between you and your baby that have to do with feeding. This includes choosing the food, eating, and attitudes and actions related to food and eating. 

A healthy feeding relationship is important for a number of reasons. A good feeding relationship helps your baby develop a positive association around food and eating, helps them further develop their cues for hunger and satiety (fullness) to regulate how much they eat, now and later in life. 

The earlier parents are aware of this and work towards building a healthy feeding relationship, the better. Research shows that children who are allowed to decide when they have had enough to eat grow up with less chance of having weight or eating problems later in life. A happy, healthy feeding relationship is essentially one without battles and can positively impact all aspects of the parent-child relationship.

Children are a lot smarter than you.

Children have an inherent ability to regulate their needs. Successful feeding occurs when parents pay attention to these cues from their child. Before they can speak, infants have ways of showing you their preferences about amounts and types of foods, and when they want to eat. 

Gone are the days of using the airplane spoon to trick your baby into opening their mouths, or using rewards to get kids to polish off their vegetables. Research has shown that some of the old ways of doing things may actually do more harm than good. The new food rules for feeding children, according to Ellyn Satter, dietitian and expert in child nutrition, encourage a division of responsibility between the parent and the child. 

The three W's

Your role, as the parent, is to decide:

• What: What is served
• When: When it is served
• and Where: Where to eat

The child gets to decide if they eat, and how much to eat. Your child will let you know when they’ve had enough and as parents, it’s important to trust your child’s cues. It’s up to you to provide and offer a variety of healthy foods to your child at regularly scheduled meal and snack times. 

Forcing your child to try new foods, or coercing them into eating everything on the plate is going to have the opposite effect you want it to in the long term. Children who are forced to eat a new food are usually less inclined to eat it or to try other new foods in the future. 

As for the where, eating at the table with the family has been shown to have a positive impact (as opposed to eating in front of the TV or running around) and sets structure to the eating environment. Make mealtime a relaxing, pressure-free and enjoyable experience. A good feeding relationship will be less stressful for all involved.