Breastfeeding
We enthusiastically recommend breast feeding for our newborn patients beginning shortly after birth. The American Academy of Pediatrics recommends exclusive breast feeding for the first 4-6 months of an infant’s life. This means your baby needs no additional foods (except Vitamin D) or fluids (including water) unless medically indicated. Then a diet of solid baby foods with breast feeding is recommended until one year of age. We support these recommendations. Many women choose to breast feed their child much longer than this. We also support this practice as well. The World Health Organization recommends breast feeding for the first two years of a child’s life.
Breast milk has many advantages over formula feeding. Some of these advantages include:
- optimal nutrition. Breast milk provides the nutrients in the just right amounts that your baby needs in order to grow optimally.
- enhanced cognitive function of the child.
- providing anti-infectious factors to the baby from the mother.
- decreased inflammatory conditions in the infant such as asthma.
- the establishment of a healthy intestinal microbiome in the child.
- the establishment of strong emotional ties between the mother and infant which yields strong emotional health for the baby.
- cost savings (as much as $6,000 per year).
- ease and convenience of food preparation.
- other advantages that may not be currently known.
Breast milk is the most nutritionally complete food that is available for babies. We find that the composition of breast milk is WONDERFULLY COMPLEX! Besides the basic sugars, protein, fats and micro-nutrients that are specially designed for babies, breast milk is rich in anti-oxidants needed for eye health, rich in omega 3 fatty acids needed for healthy brain development, rich in oligosaccarhides (or complex sugars) which are needed for the building of a healthy intestinal bacterial micro-flora and rich in nucleotides which helps build the immune system and promote cell growth. These nutrients are in the right concentrations and presented to the baby in the right form for maximum growth. Although infant formulas have come along way since the time of pet milk and karo syrup, attempts to copy the composition of breast milk fall short. Simply put, breast milk is a natural food, that is perfectly designed for your baby.
Breast milk contains several different anti-infectious factors which protect your child from infections. Breast fed babies are rarely sick. If infections do happen, they are generally milder than what they would have been if the baby was not breast fed. We routinely find that when a mother weans her baby, infections usually begin shortly thereafter.
Breast feeding also promotes closer emotional bonds between the mother and the baby. Most breast feeding mothers feel that they are giving their babies a part of themselves which helps develop more satisfying relationships. We call this important maternal infant relationship infant bonding. Successful infant bonding is an important factor in mothers developing an adequate milk supply.
There are other benefits of breast milk. It is readily available, pre-warmed and cheap. This makes middle of the night feedings easier and reduces financial stress. Infant formula can cost $6,000 per year and more. Additionally, at the time of birth, breast feeding helps the mother’s uterus contract so that less blood is lost. In fact, mothers usually feel some mild discomfort in the lower abdomen when they feed their baby, which are the uterine contractions that breast feeding helps to stimulate. These contractions are normal. This sensation will lessen with time. Breast feeding utilizes about 800 calories per day of maternal nutrients, which helps a mother lose the weight that she have may have gained during the pregnancy. As we hope that you can see, the bottom line is this: breast feeding is the optimal way to feed your baby. The benefits to you and your baby are numerous!
For these reasons, our clinic enthusiastically recommends breast feeding for all of our patients. For more information on breast feeding please see our reading list in the back of this handbook.
Now, let’s move our attention to how to initiate breast feeding. The best time to initiate breast feeding is in the first few minutes after your baby’s birth. We call this time period the first period of reactivity. Shortly after birth, babies are wide awake and very receptive to breast feeding attempts. Most babies will latch on to the breast shortly after birth and feed very well. This behavior of newborn babies gives new mothers a lot of confidence in their breast feeding attempts. So, don’t miss this golden opportunity.
After the first few hours after birth however, babies go into their sleepy phase and will sleep and rest very well. During the next two to three days after birth, most babies will be much less receptive to breast feeding attempts than they were shortly after birth. Although some babies will vigorously breast feed, most babies in the first couple of days after birth will only reluctantly latch, suck for two to three minutes and then go back to sleep. Naturally, this behavior can cause you concern. This behavior is normal however and will improve once your baby loses enough water weight and becomes hungry and thirsty.
The second thing to know about initiating breastfeeding is that there is precious little breast milk present at the time of birth. The first milk that a mother produces is called colostrum. During the first couple of days after birth, there are only a few drops of this first milk present per breast. Later, after the first week of life, each of your breasts will produce 2 to 6 ounces per feeding. Most mothers instinctively know that their breasts are essentially empty during the first two days after birth. Unfortunately, most mothers don’t know is that this is normal. Thus, your baby will get very little breast milk in the first two to three days after birth. So, what is a newborn baby to live on during the first few days of life? The answer? What they are born with: extra water.
Yes, normal term babies are born with an extra pound of water. A baby is born with extra water to enable them to withstand the initial period of starvation that breast feeding necessitates. Therefore, during the first few days of life, a term healthy baby will routinely lose up to one pound of weight, or about 10 to 12 % of their body weight. Babies who are breast fed will generally begin to gain weight on the third to fifth day of life when the mother begins to produce enough breast milk to meet the baby’s needs. Rest assured, this is the design of how breast feeding is supposed to work.
During the first few days of breast feeding, besides placing your baby at the breast to nurse, there are several other actions that you can take to help your breast milk come in sooner to minimize your baby’s weight loss and get breast feeding firmly established. First, skin to skin contact with your baby on your bare chest, neck and face will increase your breast milk supply. In addition to touching your baby, you should smell your baby, and think about your baby often. These interactions will increase your breast milk supply.
Mother’s can typically tell when a baby begins to gain weight, because they can feel their breast milk “come in”. There are three breast feeding signs that begin to happen about the third to the fifth day that show that nursing is going well. The first is that you can hear your baby make swallowing sounds while nursing. Second, breast milk is seen in the corner of your baby’s mouth during nursing. Lastly, the opposite breast begins to leak breast milk at the start of a breast feeding session. A mother’s breast will get heavy and feel full or tight when it is filled with breast milk. When the breast milk first comes in, if the breast milk is not drained adequately from the breast during this time, engorgement can occur.
After the third to the fourth day after birth, your breast milk should be in and the baby should begin to gain back their lost weight. During this time many babies become very hungry and thirsty because of the weight loss and will feed very often. Some babies look frantic as they feed during this time. We call these “marathon feedings”, because for about 24 hours, your baby will constantly want to feed. This too is normal. You should cooperate with your baby’s urge to feed during this time and breast feed your baby as often as he or she desires.
Unless your baby loses 10 to 12% of their body weight necessitating some infant formula supplementation, we generally discourage the use of any supplemental infant formula feeding (or bottle feeding) during the first few days of life. The problem that formula supplementation causes is that infants will prefer the infant formula over breast feeding during these first few days of life. This happens because the formula is much easier for the baby to get. We call this condition nipple confusion. Therefore, to insure that your breast feeding is successful, you should exclusively feed your baby with your breast, not a bottle.
We recommend that you bring your baby to our office on the third to the fifth day of life in order for us to evaluate your child’s feeding adequacy. We check for the severity of weight loss caused by breast feeding, how feedings are going, the presence of jaundice and any sign of infection at this routine check up. At the third to fifth day check up, we will let you know when to schedule your next follow up visit.
A frequent question we are asked by parents relates to the need for vitamin and fluoride supplementation in their child. For breast fed babies, there is no question that breast milk provides the best and most complete nutrition. However, for vitamin D, which is needed for calcium deposition to make strong bones, breast feeding may not provide all the active vitamin D (D3) that the baby requires. Vitamin D is taken in the diet and is also made in the skin upon the action of sunlight. Because direct sunlight is not good for a baby’s skin due to the risk of skin cancer and because of an increasing amount of Rickets (vitamin D deficiency) in the US among breast fed babies, the American Academy of Pediatrics recommends that vitamin D supplementation be done for all breast fed infants. We usually begin this in the first few days or weeks of life. You should begin Vitamin D3, 400 IU (international units) daily if your child is breast fed. It is available over the counter. No prescription is needed. For some infants, fluoride supplementation is also done depending on the community water fluoride content. Infants who require fluoride supplementation are started on this after 6 months of age. The purpose of fluoride supplementation is to prevent tooth decay. Consult us if your family drinks water with inadequate fluoride.
Infant Formula Feeding
Sometimes breast feeding is not chosen and an infant formula is used. Please contact our office for the appropriate formula for your child. We do not recommend changing your baby’s formula without our input. Infants who are bottle fed should be on formula which is fortified with iron, as all commercially available formulas in the US are. Formula feeding should be continued until the child is 12 months old. This will provide proper nutrition for your child during this very important period of growth. You should not start your child on cow’s milk during the first twelve months of life because it won’t meet adequate nutritional needs. Cow’s milk has too much protein, too little iron, too much sodium and differences in vitamin, mineral, fat and calorie distribution from breast milk and infant formula.
Certain infants may require a certain formula for health reasons. In some circumstances, it may be dangerous to change from one formula to another. For these reasons, you should disregard infant formula advertisements, sample promotions, and coupon promotions which are directed at obtaining your business for their formula company. The choice and use of an infant formula should be under our direct supervision for the proper health and nutrition of your child. You should not change your baby’s formula without the advice of your doctor. We do not recommend “follow-up” formulas routinely.
Formula fed infants usually do not require vitamin supplementation because the vitamins are contained in the infant formula. Fluoride supplementation is not necessary in bottle fed infants if the formula is mixed with water containing adequate amounts of fluoride. Most communities, including Little Rock and North Little Rock have adequate amounts of fluoride in their water supply. If you have questions concerning this, you should contact your local water official for information about fluoride levels in your water system.
Solid Foods
Four to Six Months: During the first four months of life, breast feeding and infant formula feeding provide all of the calories, water and nutrients that your baby will need. We generally recommend starting solid foods at four to six months of age when your child is physically ready to swallow them. Solids have less calories per unit volume than both breast milk and formula. Because of these two considerations, it is best to wait until four to six months of age to start them. Rarely, some babies may need to begin solids earlier than this time as directed by your doctor (such as for reflux or spitting up). The goal of introducing solid foods into your baby’s diet is to provide a starting place for a more mature diet. Your baby’s first solid food should be an iron fortified infant cereal. There are three cereals available: rice, barley and oatmeal. Any of these are fine to use. The first feeding should usually be one tablespoon mixed with either breast milk, formula or water. The eventual goal is four tablespoons per serving, two or three times per day. This should be increased gradually.
Recently, the US Food and Drug Administration has raised some concern regarding a small amount of arsenic that is naturally found in rice, and thus is present in infant rice cereal. The concern does not preclude the use of infant rice cereal in your baby. The FDA recommends that you do not exclusively use rice cereal but that you use all of the infant cereals available (rice, oatmeal and Barley), thus limiting the small arsenic exposure in rice. Multi-grain mixed cereals would be a good choice to comply with the FDA’s recommendations.
Vegetables can also be started at four to six months of age. You can try carrots, squash, green beans, peas, sweet potatoes, avocados to name a few. Most any order of introduction is fine. Vegetables should be introduced before fruit so that your child will develop a taste for them.
After a new food is introduced into your child’s diet, you should wait three or four days before introducing another food because of the possibility of food allergy. Vomiting, diarrhea, bloody stools, rash, colic, irritability and insomnia can be signs of food allergy. If these should occur after the introduction of a new food, you should discontinue it and report this to us during a regular office visit. Each feeding that your child receives should be followed by milk. The amount your child eats should depend upon her desire. Give as much as she wants, but do not be insistent when the child is no longer interested.
The next food to introduce in your child’s diet once he or she is eating a variety of vegetables is fruit after they are on a variety of vegetables. You can introduce a new fruit every three to four days. You should initially use individual fruits and not mixed fruits because of the need to identify which food your child might react to. We recommend starting vegetables first, then fruits. Fruits are much sweeter and your child will prefer these over vegetables if you start them first.
Juices such as apple juice, white grape juice, pear juice, etc., can be added to the diet at the time the fruits are added. These are not essential to the diet, but are a good source of extra fluid and calories, and may be given at any time during the day. Try to not give your child more than about 4 – 6 ounces of juice per day so that more of the nutritious milk will be taken. In regards to fruit juice, please know that a large consumption of fruit juice has been shown to be associated with poor weight gain, poor eating habits and sometimes obesity. You should limit the amount of fruit juice your child gets each day. In addition, fruit juice can cause cavities.
Meats are the last foods that you should introduce into your baby’s diet. They have the highest protein content and are the most difficult for the infant to digest. We generally recommend delaying meats until the child is seven months old. You can try chicken, lamb, veal, turkey, beef, liver, pork and fish.
Omega 3 Fatty Acids (Fish): The topic of fish introduction into a child’s diet is complicated and frankly controversial. A lot has been written on the topic by various people. We will try to explain this topic in some detail here. The US government has set guidelines for fish consumption for children and pregnant women and has changed their recommendations over the years.
Should my child and my family eat fish? The answer is quite simply, yes! Studies show that fish provide nutrients that are important for your child’s cognitive and visual development. A diet which includes certain fish safely provides two key nutrients, omega-3 fatty acids – DHA (docosahexanoic acid) and EPA (eicosapentaenoic acid) – which are difficult to find in other foods. These two nutrients help build strong nerve membranes which help with cognitive and visual function. Hundreds of studies suggest that omega-3 fatty acids provide additional benefits to a wide range of diseases such as cancer, asthma, depression, heart disease, ADHD, dementia, memory problems and autoimmune diseases, such as rheumatoid arthritis. This list of benefits of omega 3 fatty acids are long and well documented. In addition, fish is high in protein, vitamin D, and other nutrients needed for your child while being low in bad saturated fats. Certain types of fish are an excellent source of child nutrition.
In the past the U.S. Food and Drug Administration (FDA) has warned that fish can contain contaminants such as mercury, which can harm a child’s developing brain and nervous system. How does mercury get into fish? Unfortunately, Mercury is everywhere, even present in the air we breathe. Some sources of the element mercury are natural like volcanoes and forest fires. Mercury is also released as pollution from power plants, cement plants and chemical plants. In the past it was in thermometers, thermostats and fluorescent lights. When mercury settles into water, bacteria convert it into a form called methyl-mercury. Fish absorb methyl-mercury from the water they swim in and the organisms they eat. Methyl-mercury binds tightly to the proteins in fish muscle and remains there even after the fish is cooked. If your child eats fish that is high in mercury, it can be absorbed into your child’s body and then the mercury can damage your child’s brain. So, why not just take fish out of your child’s diet altogether to avoid the mercury risk? Because certain fish safely provide too good of a nutritional source of omega-3 fatty acids which are crucial, especially during infancy, to the development of your child’s vision and cognitive ability. Simply, the consumption of fish provides great nutrients that are crucial. Breast milk naturally contains omega 3 fatty acids and infant formula are supplemented with them.
Where do omega 3 fatty acids come from? Algae in the ocean are the primary source of omega 3 fatty acids. Small fish eat the algae containing the omega 3 fatty acids and larger fish eat the smaller ones. The omega 3 fatty acids then go up the food chain. Omega 3 fatty acids used in infant formula are produced by a company called Martek, from algae farms. This ensures that infant formula has no mercury contamination from the omega 3 fatty acids that are added.
Here are some FDA and EPA guidelines to help you limit your child’s exposure to mercury while making sure she gets the nutrients she needs from fish consumption.
- For adults, eat 8-12 ounces of a variety of fish each week. That’s 2 or 3 servings of fish a week. For young children, give them 2 or 3 servings of fish a week with the portion that is right for the child’s age and calorie needs.
- Choose fish lower in mercury. Many of the most commonly eaten fish are lower in mercury. These include salmon, shrimp, Pollock, tuna (light canned), tilapia, catfish, and cod.
- Avoid 4 types of fish that are higher in mercury. These include: tile-fish from the Gulf of Mexico, shark, swordfish, and king mackerel. Limit white (albacore) tuna to 6 ounces a week.
- When eating fish you or others have caught from streams, rivers, and lakes, pay attention to fish advisories on those water bodies. If advice isn’t available, adults should limit such fish to 6 ounces a week and young children to 1 to 3 ounces a week and not eat other fish that week.
Many foods – such as eggs, milk, soy beverages, juice, yogurt, bread, and cereal – are now fortified with omega-3 fatty acids. However, most of these contain only ALA (alpha linolenic acid). ALA is an omega-3 fatty acid that provides some health benefits, but not the same ones you get from DHA and EPA. Most food labels don’t specify the type of omega-3 fatty acid that you are getting. Therefore, fish consumption which provides DHA and EPA cannot be replicated. You may have heard that flaxseed is a good source of omega 3 fatty acids, but it too does not provide DHA or EPA. The only omega-3 fatty acid in plant foods is ALA. So, it is heart healthy, but does not increase brain health.
Some people choose to take fish oil as an omega 3 fatty acid supplement. This is a good strategy as mercury is not generally found in fish oil, but in fish muscle. We recommend fish consumption for the children in our practice. It’s the easiest and safest method of obtaining the needed omega 3 fatty acids.
Omega 6 Fatty Acids: Unfortunately, the American diet is high in omega-6 fatty acids instead of omega 3 fatty acids. Our diets over the years have shifted from fresh veggies and fish to foods that are high in omega-6 fatty acids such as crackers, cookies, and corn-fed beef. Before the introduction of grains, fats, and artificial substances (processed foods) the ratio of omega-6 fatty acids to omega-3 fatty acids was two to one. Today, American consume at least 20 times more omega-6 fatty acids than omega-3 fatty acids. The problem is that excessive amounts of omega-6 fatty acids can promote inflammation, which is a key step in many chronic inflammatory diseases, such as asthma and arthritis. Thus, the consumption of fish not only helps visual and cognitive function, but it also reduces the development of inflammatory conditions. Bottom line: Eat fish! It’s important. Be sure to choose the safer species of fish as stated above.
Peanuts: In the past, clinical practice guidelines from the American Academy of Pediatrics recommended the avoidance of potentially allergenic foods in the diets of young children. Our advice at All For Kids was to follow the AAP guidelines and introduce peanuts, a highly allergenic food, into the diet of our young children at two years of age in an attempt to protect them from peanut allergy. Unfortunately, the strategy of delaying peanut consumption in the diet failed, resulting in increasing the prevalence of peanut allergy in Western countries by 2 to 3 times the former rate over the past 10 years. Now, up to 1 to 3% of all US children have peanut allergy, the highest rate ever. Peanut allergy is the leading cause of food allergy related death in the United States. Schools have strived to be peanut free as a form of safety for peanut allergic children. As one can see from these statistics, the entire strategy of peanut avoidance has been misguided and actually harmful to our population.
New Research on Peanut Allergies: Researchers in the United Kingdom noticed something interesting about the incidence of peanut allergy in differing populations. Peanut allergy in Jewish children living in the UK was about 10 times more common than it was in Jewish children living in Israel. Since these children shared a similar ancestry, they reasoned that the difference had to be something that those children were doing differently. It turned out that their diet was the difference. Jewish Children in the UK rarely ate peanut products in the first year or two of life like the rest of their British cohorts, whereas children in Israel commonly ate a snack food called Bamba. Bamba is a corn puff made with peanut butter. Could this have been the difference? Israeli children ate peanut products from an early age and somehow this protected them from peanut allergy. So the researchers tested it.
The Learning Early About Peanut Allergy (LEAP) study, supported by the National Institute of Allergy and Infectious Diseases (NIAID) and conducted by the NIAID-funded Immune Tolerance Network (ITN), tested the theory that the very low rates of peanut allergy in Israeli children were a result of high levels of peanut consumption from a young age. They did a study of about 640 babies who had severe eczema and or egg allergy, which are known to increase the risk of peanut allergies. They divided the children into two groups: one was given Bamba to eat regularly (if they didn’t like Bamba, they could eat smooth peanut butter), and the other was told to stay away from foods containing peanuts. They did this until the children were 5 years old. Researchers found that exposing infants to peanuts in their first year of life helped prevent peanut allergy by as much as 81 percent. While recent studies showed no benefit from allergen avoidance, the LEAP study is the first to show that early introduction of dietary peanut is actually beneficial and identifies an effective approach to manage this serious public health problem. Thus, most peanut allergies can be prevented by feeding children food containing peanuts at an early age.
So, what should we do in response to this new information? We now recommend that young children be fed peanuts at an early age. Peanuts should not be their first food, but should be introduced between 4 and 6 months of age in the sequence we related previously. Remember that you should never give whole peanuts or peanut pieces to children under the age of 4 years. Young children can die from choking on a peanut. You can spread a thin layer of creamy (not chunky) peanut butter on a cracker or piece of bread, or give foods that have peanut butter in them. Some mothers dip their finger in a little peanut butter and then have the child suck it off. Alternatively, a tablespoon of peanut flour can be mixed with applesauce and given to a child. Like in the afore mentioned study, Bamba is the number-one selling snack in Israel, with 90 percent of Israeli families buying it on a regular basis. You can give your young children Bamba. Bamba contains 50% peanuts and is fortified with vitamins and minerals.
The LEAP researchers say many questions remain, including whether the same approach works for other common food allergies like eggs or milk; how much peanut products a child should consume; and whether allergies can develop if a child stops eating a certain food.
What about children who are known to be peanut allergic? If your child has ever had a rash or other allergic reaction to peanuts, please don’t give them peanuts. That’s not what the findings of this study would recommend. This study is about preventing allergies, not treating children with them. If your child has a peanut allergy, you should consult an allergist. Call our office for help in selecting one.
If your child is at high risk for peanut or other food allergies for any reason (family history of food allergies, the child has other food allergies, or eczema), talk with us before giving any peanut products. Doing some allergy testing or referral to an allergist first, might be a good idea. For high risk kids, their first taste of peanut could be at our office (with our help and medicines nearby) rather than in your home.
If your child doesn’t have any food allergies and or extra risk, you should introduce some peanut products into his or her diet as described at 4 to 6 months of life. We realize this is a big change from before.
One Year and Older
The first year of life is your child’s period of most rapid growth. After about 12 months, the rate of growth decelerates and parents notice that the child’s appetite decreases. Many times, parents become very concerned that their one-year-old child seems to be eating less. Part of your health supervision visits is to actually plot the height, weight and head circumference of your child on a growth chart. As long as his/her growth percentiles are within the normal range and the blood count is normal, you can be assured that your child is receiving adequate nutrition.
After the age of 12 months, usually breast feeding and/or formula feeding is discontinued and cow’s milk is introduced into the diet, although it is fine for breast feeding to be continued after 12 months. In fact the World Health Organization recommends breast feeding until two years of age. If breast feeding is not chosen after 12 months, we generally recommend whole milk if your child is thin and 2% milk if your child has a normal weight or is overweight.
It is a good idea for young children to have mealtimes at a regular hour each day. Between meal feedings are usually not a good idea, although there are exceptions. We like for children to eat a balanced diet from all food groups. However, you should never force your child to eat food he does not want. Simply make foods available to your child. At 12 months of age, we also like to encourage parents to discontinue the use of a bottle and offer their children beverages in a cup.
Lastly, the timing of milk and fruit juice consumption is important. There is a phenomenon called milk cavities. Dental caries or tooth cavities in small children can be caused by giving milk or juice right before bedtime. The sugar in milk and juice can cause the bacteria that cause cavities (alpha strep viridans) to release acid. Acid can damage enamel, the hard covering of teeth. This is how a cavity forms: acid production by bacteria in the mouth due to sugar consumption erode the enamel and cause cavities. So, to prevent milk cavities, we recommend that you give no sugary beverage (milk, fruit juice, cola, etc) within 30 minutes of bedtime. Although brushing your child’s teeth at bedtime is important to prevent cavities, you can’t brush away the damage caused by giving milk at bedtime. You see, when a child sleeps, they stop swallowing and saliva is not produced. The sugary beverage charges the bacteria with sugar and acid continues to be released despite brushing. With sleep, there is no saliva and swallowing to wash away the sugar. So, what can you give your child at bedtime? Answer: just water. Further, one cavity that develops in a child’s mouth is actually a disaster for them. Cavity forming bacteria now have a foot hold in their mouth. More cavities are now sure to come. Prevention of cavities is of high importance. This advice applies to nap times as well.
Vitamin supplementation after the first year of life is usually not needed as long as the child is eating a well balanced diet from all of the food groups. If this is not the case, then a multivitamin with iron is probably a good idea. Fluoride supplementation for the older child is needed only if the water supply contains inadequate amounts of fluoride.
The Picky Eater: We find that many of the parents in are practice are exasperated with their toddlers and young children because of their picky eating habits. Some children eat only a very limited diet which is unhealthy for them. Most of the time, a picky eating child will graze on snack foods such as crackers, Cheerios and cookies all day long, ruining their appetite. In addition, picky eaters may consume a lot of fruit juice or drink too much cow’s milk, thus limiting other healthy diet choices, such as vegetables and fruit.
This is not a healthy pattern because nutritional deficiencies may result. Also, patterns of unhealthy eating develop this way resulting in obesity, or malnutrition. These patterns may well last a lifetime if not checked. You must change your child’s eating habits. To help your child overcome this bad habit, there is a wonderful, natural remedy for this situation. It is called “hunger”. Simply wait out your child’s picky eating habits and refuse to give them unhealthy foods. At three meals times per day, provide your child with a healthy, nutritious meal from all the food groups in appropriate proportions. If your child eats a good meal, then a snack and some fruit juice is fine between meals. However, if that child refuses to eat the nutritious meal you have served, there is nothing offered except water until the next meal. This pattern is repeated until the child eats a good diet. Most children will throw a temper tantrum with the loss of their first snack of crackers, cup of juice or glass of milk as their expectations are not met. Simply ignore the temper tantrum and give no food or fruit juice until the next meal. Give only water. After missing one to three meals, most children will miraculously develop healthy eating habits. Missing a whole day’s food supply will not hurt normal children, just make sure that your child drinks adequate water and that you have offered healthy food choices. The point of this exercise is discipline. Discipline is healthy and needed in our kid’s diets.