Author: Katharine Jeffcoat

Growing Toddlers With Strong Bones, Is Milk the Only Answer?

Growing Toddlers With Strong Bones, Is Milk the Only Answer?

When your baby turns 1 year of age, the American Academy of Pediatrics, (AAP), recommends starting whole milk by cup. Milk is an excellent source of calcium, which is needed for bone formation, muscle development, and nerve functioning. Milk also supplies Vitamin D and Phosphorus, both are essential factors in bone formation. 

Additionally, Vitamin D is required for calcium absorption. Vitamin A, protein and essential fats that toddlers need for development are also supplied in milk. When a child turns 1 year, their calcium requirements go from 260 mg/day to 700mg/day, so drinking 16oz of milk or milk alternative will provide close to what your toddler needs in calcium.  Ironically, babies at this age are often weaning from breastfeeding or bottles as they continue to increase their intake of real food. I often see babies drinking more milk at this age than they need, which displaces the nutrients they need from other foods.

What if your toddler refuses to drink milk?  I’ve had one such toddler who refused to drink milk.  She weaned herself from breastfeeding at 14 months and only wanted her “wa wa” (water) in the cup.   We did try many different cups and offered many different times but most often it just got handed back to us or tossed on the floor.  I’m grateful she is a big fan of yogurt, cheese, and almond butter and luckily she eats an occasional piece of broccoli.   I do occasionally give her chocolate milk and hot chocolate, which she is delighted to drink.  Her older sister drinks milk every meal and I had hoped her influence would eventually rub off, but it hasn’t yet at 3 ½.

I work with a lot of families managing  a milk intolerance or milk allergy.  For those children finding a milk alternative is important.  I’m not a fan of most alternative milks as they are so low in protein and fat, but when it comes to calcium, they are highly fortified and a good way to meet calcium goals.   My new favorite that has changed my opinion on milk alternative is Ripple, pea protein milk which is high in protein (8g) and fat (4.5g).   When looking for a milk alternative,  it’s important to compare brands and make sure they are enriched with calcium and vitamin D and without added sugar.  There are plenty of other foods rich in calcium that are important to include so toddlers are getting what they need.  Here is a list of high calcium foods for toddlers.

Age of childRecommended Dietary allowances mg/day
Infants 7-12 months260mg
Children 1-3 years700mg
Children 4-8 years1000mg

High Calcium foods for toddlers:  

8 oz milk                                             300mg

Siggi yogurt (5.3 oz)                         150 mg

Dannon plain yogurt (5.3 oz)         250mg

Danimals Smoothie, 3 oz                100mg

Chobani 3 oz plain yogurt               85 mg

Yo Baby yogurt (4oz)                       250mg

String cheese                                    150mg

Cheddar cheese 1 oz                        200 mg

Parmesan cheese ¼ cup               250 mg

Milk Alternatives, 8oz

Soy milk, Silk                                    450mg

Soy Dream                                        300mg

Almond milk, Silk                            450mg

Almond Breeze                                450mg

Coconut Milk, Simple Truth          450mg

Rice Dream, Enriched                     300mg

Ripple pea protein                             450mg

Non-dairy Calcium-rich foods for toddlers:

Calcium Fortified OJ, 4oz                   175 mg

Canned salmon ½ can                        230mg

White beans ½ cup                              80mg

Tofu extra firm 3 oz                             150 mg

Almond butter 1 TB                             40mg

Chia seeds 1 TB                                     75 mg

Sesame seeds 1 TB                               60 mg

Plum Organic snack bars                    100mg

Z bars, Cliff Kid                                     200mg

Gerber cereal bars                               100mg

1 cup cheerios                                       100 mg

Broccoli, 1 cup                                       75mg

Edamame 1 cup                                    95 mg

Kale, 1 cup                                             140mg

Orange                                                    75 mg

For more information on alternative non-dairy yogurt options, check out my blog post; 3 Best Non-Dairy Yogurt Options.

For More support feeding your child, join my private facebook group: Raising Confident Eaters.

5 Causes Your Child Maybe a Picky Eater

5 Causes Your Child Maybe a Picky Eater

There are many causes of picky eating and understanding how your child got to be such a picky eater can often help solve issues getting them to accept new foods.  Below are the 5 most common reasons behind picky eating I see in my clients.  You may be able to identify one of these factors in your child and this may help you guide them towards the acceptance of new foods. 

1.    A medical reason –  Common medical reasons that can affect a child’s desire to eat include food allergy, EoE, (Eosinophilic Esophagitis, inflammation of the esophagus, caused by an allergic reaction), constipation,  reflux, GERD (Gastroesophageal Reflux Disease) and celiac. In all of these situations, food makes them feel bad and they’ll have little desire to eat.  Once the medical issue is addressed, these kids typical improve their food intake.  Speak with your child’s doctor about your concerns and make sure none of these issues could be the cause. 

2   Oral delay or tongue tie–  Oral skills issues and lack of ability to move the food in the mouth could result in your child not advancing with textures and avoiding certain types of food.   If food is falling out of your child’s mouth when they eat or you notice they are primarily biting and chewing in the front of the mouth, this could be the cause of their limited diet.  Another red flag is children who never put anything in their mouth as a baby, never mouthed chew toys or had a chance to push back their gag reflex.  They likely are adapting their diet to easy to chew foods because eating is exhausting, resulting in hunger cues that can be turned off due to lack of oral skills.  If you suspect an oral delay, its best to have them evaluated by an OT or SLP who specializes in feeding.  

3.   A negative past experience –   A bad illness, vomiting or choking episode can result in an oral aversion. The trauma and fear of that experience can be imprinted in kids brains, even if can’t consciously recall it.  For some children with strong sensory aversions, the meal experience itself can provide negative reinforcements to want to eat, such as wiping the face during the meal and getting their hands messy.  

4.  Sensory overload – If your child is a Sensory over responder, eating can be overwhelming and extra challenging.   Eating is the biggest sensory overload experience a child will have and if they struggle in this area with smells, touch, sight, and taste of new foods, this can overwhelm them, (this also ties in with #3 above, a negative experience). A sensory under responder can have challenges as well.  If you suspect a struggle in this area, it would be ideal to have them evaluated by an OT for sensory processing disorder.

5.  Behavioral – For some children, their picky eating is a learned behavior. They may have learned from a young age they can get what they want if they wait it out or have a tantrum.  This can be common in a child with a strong personality who isn’t making it easy on you.  Perhaps they have turned you into a short-order cook and haven’t branched out from a handful of their favorites and haven’t been exposed to new options? Children with this problem will require the most consistency being firm with the “how” of feeding.

Sometimes picky eating is a combination of a few of these factors or holds a strong genetic link.  Regardless of the reason why your child is a picky eater, helping them accept new foods begins with the “how” of feeding; consistency at mealtime and multiple exposure opportunities to new foods. If you’re unsure of the best way to feed your child, please reach out to us at Portland Pediatric & Family Nutrition.

The Pros and Cons of Spoon Feeding and Baby Lead Weaning

The Pros and Cons of Spoon Feeding and Baby Lead Weaning

I personally spoon feed my babies since I didn’t know too much about baby lead weaning 10 years ago when my oldest started solids.   I started solids with my oldest at  6 months by spoon feeding, she wasn’t eager to start and was pretty slow transitioning to more texture and variety.    My youngest was eager to go at 5 months and quickly advanced to more textures and variety and early on took to wanting to spoon feed herself.  Unknowingly, I was doing a combination of spoon feeding and baby lead weaning without even realizing it (She is in the picture below).   I recently attended a talk by Katie Ferraro, dietitian and Mom to five young children which includes quadruplets!    She convinced me that baby lead weaning (BLW) certainly has it’s benefits and was the ideal choice for her when feeding so many babies.

Choosing how to feed is one’s own personal decision as what feels right and best.  Sometimes the baby will let you know what they want as my youngest did, grabbing the spoon from me early on to feed herself.  She took to feeding quickly and moved herself along to feeding herself solids.

Baby Lead Weaning was first introduced by Gill Rapley, PhD.     It simply means letting your baby from the start feed themselves without the traditional use of puree and spoon.  More can be learned at her website  on the actual research and method.

What I like about it, the Pro’s:

  • It’s easy, baby eats what you eat, no homemade baby food or transporting jars whenever you travel. If you have twins (or quadruplets!) this can save time.
  • BLW is cheaper when not purchasing baby food.
  • It teaches a child early on how to self-regulate their food intake, lets a baby set it’s own pace and less likely to over eat.
  • Helps with skill development, the pincer grasp is developed earlier.
  • Gets families started on family meal time sooner with no short order cooks. Small modification can be made with what the rest of the family is eating (no salt or added sugar) which can make meal time easier.

 Cons to Baby Lead Weaning:

  • Less control as to what baby is eating. Iron needs go from .26mg up to 11mg at 6 months of age and baby needs to be eating meats, iron fortified cereals or legumes to meet these high iron needs.
  • It can be very messy, especially when yogurt is involved.
  • Baby can be frustrated earlier on when not able to pick up foods.
  • Fear of choking. This likely is the biggest concern for parents and why they wouldn’t try baby lead weaning.  In actuality, when baby controls what goes into their mouths, they are less likely to choke.  Gagging can often be interpreted as choking, but it’s not the dame. Gagging is an important part of learning how to eat and a protective mechanism for babies.

 Traditional spoon feeding technique Pro’s:

  • More control of what baby is actually eating and the nutrient density (high iron) foods baby is getting in their diet.
  • Less concern with choking

 Traditional spoon feeding Cons:

  • It can be more expensive, if families are purchasing baby food and pouches.
  • It can be time consuming if families are making homemade baby foods.
  • It doesn’t allow baby to self- regulate food intake, more likely to eat more when being spoon feed.
  • It can slow down developmental skills when babies end up being on purees too long.

The best choice for parents is the choice they feel most comfortable with and what works for them.   This is an area that there is no true right or wrong. If one chooses to spoon feed, it’s really important to read your baby’s cues, make sure they are developmentally ready to start solids and listen to them if they are done, don’t sneak in a spoon if they are turning their head or pushing it away. Starting solids should be fun and enjoyable, since it’s just the start of a child’s relationship with food and we want it to be a positive one.

For more positive feeding tips, see Infant Feeding, When and How to Start Solids.

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