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Answers to Your Questions about Keeping Children at a Healthy Weight
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Einstein Healthcare Network
3:08
The live chat with Dr. Feldstein will take place from 1-2 p.m. on Thursday, September 14. There will be no video or audio, just answers to your questions. Please feel free to post your questions ahead of time using the box below. Hope you can join us.
*** Thursday, September 14 ***
Einstein Healthcare Network
12:51
The doctor is in the house. We'll get started in about 10 minutes.
1:00
Welcome, everybody. This is Dr. Feldstein. Looking forward to a great discussion. Let's get started.
Silvana
1:01
My child is 18 months old. She is 30lbs. I have been trying to feed her organic vegetables in a variety of ways (blended, in soups, etc) but now I  believe she is tired of eating the same food texture and she hasn't been eating as before. What she really enjoys is yogurt, her whole milk, and baby cookies. Do you have any ways that I can bring her back to eating veggies?. For constipation in babies, is the best way giving grape and prune juice diluted in water?. Do you think giving her organic vegetables (at least the EWG 2016 Dirty 12) is important?. My baby's nutrition is my priority. Thanks in advance for your help!
Einstein Healthcare Network
1:04
The  decision to buy organic foods for your family really comes down to personal decisions. As a pediatrician, I never want to presume what somebody budgets for food. Although organic fruits and vegetables are becoming more prevalent in your local store, they are more expensive than fruits and veggies grown conventionally. We should probably define what it means when something is labeled organic. It means that it has been grown without the use of synthetic pesticides or fertilizers, and also means that it is non-GMO, which means that it has not been genetically modified. There are a number of fruits and veggies which when grown conventionally are known to contain higher levels of pesticide residue, and these are referred to as the Dirty 12, or the Dirty Dozen. So for families that are concerned about this, they should avoid foods like strawberries, apples, peaches and pears that are not organic. There are other foods grown conventionally that are known to have lower amounts of pesticide residue.
1:05
These are foods like corn, onions and asparagus. This group is also known as the Clean 15. Read more info about this on the EWG website, at www.ewg.org.
Cindi @Eat4Health.com
1:05
This topic is near and dear to my heart and one reason I recently became a Health Coach. How do you see the support of a health coach helping families address wellness and good eating practices?  It's one thing to hear what is needed vs someone meeting and setting goals to help guide the process. Do you agree? Or see the benefit?
Einstein Healthcare Network
1:07
I think as long as the health coach is well versed in nutrition that could be very helpful. We will often refer patients to dietitians and nutritionists to work with families who are trying to establish healthy diets for their children. Parents often are not aware of how many calories their children are consuming. This is something that the nutritionist or dietitian can help them with.
Sherry
1:07
My 3 1/2 yr old granddaughter always wants to eat!  She has grown up with snacks.  Now when she has a snack, she doesn't want a handful, she wants to hold the bag!  Her mom said, "You act like you're starving or have never eaten."  This scares me because she is not as slight as her friends her age.  She is solid and very active, But, has weight issues on both sides of her family.  One had gastric bypass and another is about 50-75 lbs overweight.  How should my son handle this?  Thanks.
Einstein Healthcare Network
1:11
Sherry, in general, parents should avoid giving their children processed snacks that are calorie dense and high in fat, sugar and salt. Companies that make these processed food snacks are very aware of the "bliss point" in foods - the perfect combination of fat, sugar and salt to make them more attractive. These foods stimulate the pleasure receptors in your brain and make you crave more of them without ever feeling satisfied. In general, you want to choose healthy snacks that are naturally low in sugars, fat and salt. Perfect examples would be fruits and vegetables as snacks. It may take awhile for the child's palate to be reeducated; in time they will learn to enjoy these foods.
Mahalia
1:12
I am growing my child to be a vegan, no animal products at all, what are some foods I should be mindful of?
Einstein Healthcare Network
1:15
For children who are on a vegan diet the important nutrients to be mindful of are iron, calcium, vitamin D and B-12. With the exception of B-12, which only comes from animal sources, the other nutrients can all be met with a vegan diet. For example, plant milks like soy milk are fortified with calcium and vitamin D. Iron is found in dark green, leafy vegetables like broccoli. It would also be important to give your child a multivitamin so they get the daily requirement of B-12.
Pat
1:15
What should the calorie intake be for a child age 13 months?  Should there is a limit of milk intake?  How many ounces?  Thank you
Einstein Healthcare Network
1:17
As a rule of thumb, under 12 months of age children should consume anywhere between 40-55 calories per pound of body weight. Once children are on whole milk after 12 months of age, I would not recommend giving them more than 16-24 ounces a day. Children who drink more than this frequently have no appetite for solid foods.
Christine
1:17
How do I talk to my friends about their child being an unhealthy weight? I don't want to tell them how to parent, but it's difficult to stand by and watch.
Einstein Healthcare Network
1:19
Christine, this is a very sensitive situation. If you give another parent unsolicited parenting advice, you risk losing them as a friend. What you might do instead is talk about some of your visits to the pediatrician and how your physician focused on diet and nutrition. You can maybe even talk about some of the changes that you made in your child's diet based on some of these recommendations.
EHN Content
1:19
If your child is being teased at school for being overweight, how do you help him or her cope without creating feelings of shame or low self-esteem?
Einstein Healthcare Network
1:21
First of all, schools take bullying very seriously. So the first thing you want to do as a parent is call the school and let them know that this is happening. Every child is good at something. I think the best thing to do in a situation like this is find that one thing that the child does well and promote that. For example, maybe the child likes to sing but has never thought about joining the choir. This would be an opportunity for him or her to not only meet a new group of friends, but to shine at something he or she really enjoys.
EHN Content
1:21
How do you distinguish between a child who is a bit overweight and one who is obese or in danger of becoming obese? When should a parent begin to worry?
Einstein Healthcare Network
1:26
In pediatrics we use the child's body mass index (BMI) to determine if the child is at a healthy weight for their height. There is a wide range of what is considered a healthy weight. Anywhere from the 85 percentile BMI for age all the way down to the 5th percentile for age. Anybody whose BMI is above the 85th percentile but below the 95th percentile is considered overweight. Anything above the 95th percentile is considered obese. Of course, we don't use words like overweight and obese when we talk to parents. We focus on being at a healthy weight for the child's height. However, when we see that a child is above the 85th percentile, we want to bring it to the parents' attention because that same child could return the next year and be above the 95th percentile. We want to intervene as soon as we identify the problem, which means focusing on a more healthy diet and becoming more physically active.
EHN Content
1:26
Can obesity in childhood lead to cancer or other serious health risks?
Einstein Healthcare Network
1:30
Yes, there does appear to be a link between obesity and certain types of cancer. For example, people who are overweight have a higher incidence of gall bladder disease and consequently a higher risk of developing gall bladder cancer. People who are overweight have a higher incidence of esophageal reflux disease, which consequently makes them more prone to developing esophageal cancer. Fat tissue produces higher levels of estrogen, which can lead to endometrial, ovarian and breast cancer. People who are overweight have higher circulating levels of insulin and IGF-1, which can lead to higher rates of prostate, colon, kidney and breast cancer. The short answer is yes, there is a link between obesity and certain types of cancer.
EHN Content
1:31
Is there a connection between breast feeding and obesity in children?
Einstein Healthcare Network
1:33
Yes, there does appear to be a connection between breast feeding and obesity in children. Some studies have shown that children who are breast fed for more than six months have a 20 percent less risk of becoming obese as children. Children breast fed for less than three months have about a 10 percent less chance of becoming obese as children.
Sixto Sanchez
1:33
What tips do you have for getting toddlers to eat healthy food?
Einstein Healthcare Network
1:37
Sixto, the first thing that parents need to realize is that the vast majority of toddlers are picky eaters. It really comes down to a control issue for them. What they put in their mouths is one of the few things they actually have control over. I always tell parents that if their toddler is eating well at one meal a day, they are doing pretty good. Don't be concerned that they just pick at the other two meals. That being said, it is important to get the toddler involved in the food selection process and to make the preparation and presentation of food fun. Take them to the store. Let them pick out some new fruits and veggies to try. Have them assist you in the preparation of the food. Cut the food into fun and interesting shapes. The parent needs to model good behavior, too. The child needs to see the parent eating fruits and veggies.
Jill
1:38
My child is in a very low percentile for weight (he is 12 years old, 76 lbs and 5' tall). I feel that he eats normally. Should I be concerned?
Einstein Healthcare Network
1:41
Great question, Jill. It really depends on how the child has been tracking along their particular growth curve. If the child's growth velocity appears to be slowing down either for height or for weight, then it can be a concern. However, if the child has been growing consistently along his or her particular growth curve, then it is not much of an issue unless the child's BMI is less than the fifth percentile, which puts them in the underweight category. For these children, we often recommend that parents supplement their diet with nutritional drinks like Pediasure or Boost.
Renee
1:42
I struggle with encouraging eating in moderation and controlling the eating (I'm trying not to create an eating disorder).  My son eats probably healthier than most of his peers, but he eats so much of it that he is overweight.  I try the drink water first and the wait 15 minutes before going back for seconds, but he pushes back and then sneaks snacks (granola bars, 5 cheese sticks, half a jar of apple sauce).
Einstein Healthcare Network
1:47
This is great question, Renee. First of all, it is important that you break down some associations that your child may have with food. For example, does he always get a snack when he is watching TV or when he is playing a game. Often these become habits that have nothing to do with whether the child is hungry or not. It is also important to have structured meal time as well as structured snack time. It is OK to say the kitchen is closed. As we discussed in a previous question, you want to avoid snacks that are high in sugar, fat and salt because our body begins to crave these without ever developing a sense of being full. You also want to limit distractions while eating. For example, the TV and cell phones should be turned off. Children engaging in these activities fail to recognize the signals that they are actually full because they get distracted by these other activities. It also is important to stay well hydrated. Often a young child will mistake thirst for hunger.
Nakia
1:48
Do you know of any resources for overweight teens?
Einstein Healthcare Network
1:53
There are dietitians and nutritionists in the area that your child can meet with to help develop a healthy diet. Another resource that I will sometimes use for a teenager is a program like Weight Watchers. As long as the child has a note from the doctor indicating that it is safe to participate and establishes a goal weight, the child is allowed to participate in a program like Weight Watchers. Some of the hospitals in the area, like Einstein, St. Christopher's and CHOP, also have programs for overweight teens that are often multi-disciplinary in nature, combining specialists from Endocrine, GI and Nutrition.
RigoVillasana
1:54
Will be provided-posted any papers or documents to advice parents about healthy habits-food?
Einstein Healthcare Network
1:55
There are many great resources on the Internet. One I recommend frequently is http://www.choosemyplate.gov. This is a great resource for parents.
RigoVillasana
1:55
What do you think about 'healthy' products taken from fast food restaurants, nuggets, apple juice, etc, my 2 year old is addicted and mother is happy to take him there everyday
Einstein Healthcare Network
1:59
It can be hard to find healthy food options at fast food restaurants, but it is possible. However, chicken nuggets and apple juice would probably not be the healthiest choices. In general, we try to eliminate any sugar sweetened beverages. Make sure that the apple juice is 100 percent juice and not a juice "drink" with a lot of added sugar. The chicken nuggets are fried, which is often not the healthiest option.  A salad or grilled chicken breast or fresh fruit would be healthier choices.
EHN Content
2:00
What are some of the mental health issues I should look out for in my overweight child? Are there warning signs I should be monitoring for?
Einstein Healthcare Network
2:03
If your child is being teased at school or becoming self-conscious about his or her weight, watch out for signs that they are isolating themselves socially and withdrawing from friends. These could be indications of depression. It is also important to watch out for body image issues. Adolescents, including those who are overweight, can develop eating disorders like anorexia or bulimia. It would be important to monitor your child for any large, unexpected weight loss.
2:04
Our chat is over. Thanks so much to all of you for taking part! For more information or to make an appointment, please visit: www.einstein.edu/pediatrics
The information contained in this chat is not intended or implied to be a substitute for professional medical advice. Einstein has a talented team of primary physicians and specialists who you can contact or make an appointment to see to discuss your specific medical problems; but most importantly, you must always seek the advice of a physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in this chat should be used for medical diagnosis or treatment.
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