Interestingly, babies tend to suck more vigorously when a new flavor is introduced into their mothers’ diet (even if the mothers don’t notice the change in nursing, researchers can measure it). The babies’ bodies seem eager to learn new flavors. When that flavor has been repeated a few times, nursing returns to normal, suggesting that babies have indeed learned the new flavor.

Though the ability of breast milk to provide babies with exposures to a series of specific flavors is exciting, perhaps even more exciting is the ability of the variety of flavors in breast milk to help kids be more accepting of vegetables in general.

One interesting study looked at breastfed babies versus exclusively formula-fed babies and how quickly they learned to enjoy their first pureed vegetable. The babies were given either peas or green beans every day for ten days. Both groups of babies could learn to like the veggies with repeated exposures. But the breastfed babies learned to like them faster, even though their mothers hadn’t focused on either of these flavors during nursing. And after the full ten days of the experiment, the breastfed babies still tended to eat more of the veggies than did their counterparts with limited flavor experience.

Learn more in Feeding Baby Green Chapter 6, The First Months
Sullivan, S. A., and Birch, L. L. “Infant Dietary Experience and Acceptance of Solid Foods.” Pediatrics, 1994, 93: 271–277

I remember, not long ago, seeing many children with ear infections every day I was in the office – children that were often up screaming the night before. Today it’s not surprising to go an entire day in clinic without seeing a single one.

Visits to doctors’ offices for ear infections more than doubled between 1975 and 1990, from about 10 million per year to about 25 million per year. They kept increasing through about 1994, when they started to decline steadily by about 5% per year, now at their lowest level in three decades.

Over thirteen years, office visits for ear infections in kids under age 6 dropped from about 640 visits per 1000 children per year to about 380 visits. The drop for hospitalized children being diagnosed with an ear infection is even steeper. And the annual price tag for ear infection treatment in the US has fallen by about $2 billion.

Why the dramatic disappearance?

Several things have changed since the early 1990s. Air pollution, linked to ear infections, fell significantly after the Clean Air Act of 1990. Breastfeeding, protective against ear infections, increased modestly from less than 2/3 of babies starting on mother’s milk to more than ¾ today. A vaccine that may help prevent some ear infections came into wide use in 2002.

But the strongest link, according to a May 2011 study from researchers at Harvard University, came from a drop in tobacco smoke inside children’s homes. We’ve known since the 1990’s that exposure to second hand smoke causes millions of ear infections every year. In 1993, most US children were still exposed to tobacco smoke in their own home. Today only 14 percent of kids live in a home where smoking is allowed inside – a change big enough to account for the difference.

Four thoughts for responding to this good news.

1. If you smoke, smoke outside.
2. Keep the air in your home fresh. Avoid cleaners with harsh fumes. Consider houseplants to clean the air. Open windows when practical.
3. Given the option, breast feed. After weaning, choose foods that support healthy gut bacteria.
4. If your child does get an ear infection, choose a gentle treatment first, if appropriate. Antibiotics are wonderful, when needed, but each time they are given it makes another ear infection more likely. With more resistant bacteria.

Alpert HR, Behm, I, Connolly GN, Kabir Z. “Smoke-free households with children and decreasing rates of paediatric clinical encounters for otitis media in the United States.” Tobacco Control. May 2011; 20:207-211.

Bhattacharyya N and Shapiro NL. “Air quality improvement and the prevalence of frequent ear infections in children.” Otolaryngology – Head and Neck Surgery. Feb 2010; 142:242-246

A new Harvard analysis has calculated what we could accomplish if 90 percent of babies drank only breast milk for the first six months of life. The starting point for this analysis was a group of ten conditions identified by the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of our health care – the Agency for Healthcare Research and Quality (AHRQ). Their data suggest that each of these ten conditions is at least slightly less likely in children who were breast-fed. Right now, only one in eight babies drink only breast milk for the first six months. If we could increase this to nine babies in ten, we would expect to see fewer cases of SIDS, childhood leukemia, type 1 diabetes, necrotizing enterocolitis, hospitalizations for pneumonia or bronchiolitis, childhood obesity, childhood asthma, gastroenteritis, ear infections, and eczema – enough less that we would prevent 911 unnecessary deaths in the US alone each year (more than half of these in babies) and save more than $13 billion each year. Eight babies in ten would still save more than seven hundred lives and more than $10 billion dollars annually.

In other words, we could save an average of $4000 in medical costs for each extra baby where we delay formula to at least six months. To me the take home message of this study is that supporting nursing moms is a wise investment. It’s a smart choice for families, for employers, and for society at large. With health care costs still spiraling out of control, it makes all the more sense to celebrate and support breastfeeding – and to celebrate and support moms and babies whatever feeding choices they make for their family.

Bartick, M. and Reinhold, A. “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis.” Pediatrics. 2010, (doi:10.1542/peds.2009-1616).

Join me in support of California Bill SB 797. My three minute speech at the State Capitol starts 4 minutes into the rally video.  Actress and environmentalist, Amy Smart speaks next.

Like other pediatricians across the United States, today I received an E-Breaking News Alert from the American Academy of Pediatrics concerning news about bisphenol A (BPA), a chemical used in many hard plastic products (including baby bottles and sippy cups) and in the lining of many metal cans (including cans of infant or toddler formula). Now the panel of independent experts convened by the FDA has sharply criticized the previous FDA announcements that BPA is safe for infants and children in common exposure amounts. I agree with this criticism, and while there are many questions that still remain about the effect of BPA on kids, I can’t see a scientific basis for declaring it safe. I recommend that parents take prudent steps to decrease their children’s BPA exposure, such as breastfeeding, using BPA-free bottles, cups, teethers, etc., such as those made by BornFree*, and if formula is used, choosing powdered formula where practical (the BPA is more likely to contaminate a liquid), and avoiding heating any BPA-containing container. I also recommend avoiding phthalates and PVC in plastics. For more information, check out Raising Baby Green.

The FDA now suggests that parents who are concerned should discuss the matter with their pediatricians. While the AAP acknowledges the ongoing controversy about the safety of BPA, it alerted pediatricians and provided them with advice to give parents who want to reduce BPA exposure:

Advice for Parents

Breastfeeding is one way to reduce potential BPA exposure. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a minimum of 4 months but preferably for 6 months. Breastfeeding should be continued, with the addition of complementary foods, at least through the first 12 months of age and thereafter as long as mutually desired by mother and infant.

Parents considering switching children from liquid to powdered formula should be reminded that mixing procedures may differ, so they should pay special attention in preparing formula from powder.

Parents with babies on specialized formulas to address medical conditions should not switch children off those formulas, as the known risks of doing so would outweigh any potential risks posed by BPA.

Concerned parents can take the following precautionary measures to reduce babies’ exposure to BPA:

• Avoid clear plastic bottles or containers with the #7 imprinted on them. Many contain BPA
• Consider using certified or identified BPA-free plastic bottles
• Use bottles made of opaque plastic. These bottles (made of polyethylene or polypropylene) do not contain BPA
• Glass bottles can be an alternative, but be aware of the risk of injury to baby or parent if the bottle is dropped or broken
• Because heat may cause the release of BPA from plastic, consider the following:
  • Do not boil polycarbonate bottles
  • Do not heat polycarbonate bottles in the microwave
  • Do not wash polycarbonate bottles in the dishwasher
  • Risks associated with giving infants inappropriate (home-made condensed milk) formulas or alternative (soy or goat) milk are far greater than the potential effects of BPA

Note: Dr. Greene teamed up with BornFree in September of 2008 to help teach families about important issues concerning BPA, phthalates, and PVC.

Getting plenty of DHA, one of the important omega-3 fats found in breast milk, could help to prevent allergies, asthma, and eczema in young children. Dr. Eileen Birch, who has previously studied links between DHA and improved mental and visual development, followed 89 formula-fed children who received formula with or without DHA included.

Her results were presented at the 2008 Pediatric Societies Meeting. Strikingly, more than half of the children fed standard formula throughout the first year had been diagnosed with some form of allergy by the third birthday. By comparison, allergies, asthma, or eczema had been diagnosed in only 26 percent of those who were fed DHA formula for a year.

This small randomized study does not prove that DHA reduces allergies, but the idea is intriguing. Omega-3 fats including DHA are useful in reducing inflammation. Clearly, babies are designed to receive DHA in their diets.

I enthusiastically support the recommendation of the American Academy of Pediatrics that babies breastfeed throughout the first year, when possible, and for as long after that as both the mother and the baby desire. If nursing stops before age two or three, I recommend that babies get DHA from another source.

DHA is a valuable nutrient throughout life, but it is especially important for developing babies from before birth through age three.

I received a letter expressing concern that some babies do not tolerate formula with added DHA/ARA and that parents are not aware of this possibility. DHA and ARA are important fatty acids, present naturally in breast milk and added to many formulas. About 4 million babies are born in the U.S. each year. Over the last several years, there have been at least 98 voluntary reports of babies who had diarrhea, vomiting, or other symptoms that went away when they switched to a non-DHA/ARA formula.

While this percentage is very low (much less than 0.0025%), the real number is inevitably higher, because many parents wouldn’t report it. On the other hand, whenever I see a baby with diarrhea lasting longer than a week or so, like most pediatricians, I investigate it until either the cause is found or the diarrhea has gone away. Looking at what kids eat or drink is one of the first steps. If your child has ongoing diarrhea or vomiting and is taking a formula with added DHA / ARA you may want to mention it to your child’s doctor.

Even though I’ve been looking, I have yet to see a case of DHA or ARA intolerance myself. Still, I think it is important for parents and physicians to be aware of potential intolerance to make it easier to recognize when it occurs.

Clearly, breast milk is the ideal food for babies. I encourage nursing throughout the first year if possible and as long beyond that as both mom and baby desire. When breast feeding decreases or stops while the brain is rapidly growing, I suggest finding another source for the DHA they are designed to get.

You know that it is wise to back up your computer’s hard drive; I recommend backing up your child’s food drive with a daily multivitamin/mineral supplement. This simple habit could improve your child’s health and even intelligence. I’ll explain briefly why I feel strongly about this:

For young babies, breast milk provides an ideal food. The match between their complex nutritional needs and the milk that moms make is spectacular. In their dance of supply and demand, babies are designed with a drive to enjoy just the right amount and moms are designed to make just the right amount. Even so, I do suggest that many breastfed babies take 200 IU of vitamin D daily, as the American Academy of Pediatrics recommends – but not because of any lack in breast milk. We are built to get vitamin D from sun exposure. Because of the amount of time babies spend indoors, and the depleted-ozone-caused need for sunscreen when babies spend much time outdoors, many babies need an extra boost of this important vitamin, linked not just to building strong bones, but also to preventing breast cancer, colon cancer and Parkinson’s disease.

I used to think that when breast feeding was over, so was the age of perfect foods. Now I understand that children are perfectly designed to thrive on a balanced variety of whole foods: fresh fruits, various veggies, whole grains, beans, nuts, and lean sources of protein and calcium. They are even designed to enjoy just the right amounts of these ideal foods, as long as their food drives aren’t tricked by empty calories, added fats, sweetened drinks, etc. Children should be able to get all of the vitamins, minerals, and other micronutrients they need for optimum development by eating the right combinations and right amounts of healthful foods.

But the reality is that most kids today do NOT get the micronutrients they need from what they eat. Not by a long shot. By some estimates, only 2% of kids regularly eat the recommended number of servings of different food groups. The result is that, even though the typical American child eats too many calories, the typical child is getting suboptimal levels of many key nutrients, including thousands of food components (phytonutrients) we are just beginning to learn about. And there are thirteen major, named micronutrients, that I”ve labeled “the Greene 13”, that concern me the most: calcium, fiber, folic acid, Iron, magnesium, omega 3 fatty acids (especially DHA), phosphorous (except for kids who drink carbonated beverages and get too much), potassium, vitamin A, vitamin C, vitamin D, vitamin E, and zinc. Most kids don’t get enough of at least one of these. One in six girls get iron at levels low enough to affect their test scores. Seven out of ten boys and nine out of ten girls don’t get enough calcium at key times of growth. A daily multivitamin is more than a safety net for occasional nutritional accidents. It is more similar to spackle to fill in the nutritional holes, gaps, and cracks that many children develop every day. And beyond this, it can help a child thrive the way we all want.

A June 2001 study published in Neuroscience and Biobehavioral Reviews, compared the results of 13 double-blind placebo-controlled trials of multivitamins and their effect on the intelligence of children. Ten of the studies analyzed were able to measure a boost in non-verbal intelligence in those children who got a daily multivitamin. I’m not surprised. We know these nutrients affect our intelligence, our growth, our behavior, and our immune systems, and that typical American children do not get enough.

I recommend starting the supplement spackle at the first birthday, unless the child is on a toddler formula that already has the extras added. The body and brain are growing especially fast up to age 3, when many kids are notoriously picky eaters (with French fries the most popular vegetable, apple juice the most popular fruit, and white flour the most popular grain).

So what should you look for in a multivitamin? Depending on how your child eats, you probably want to supplement with 50% to 100% of the age-appropriate recommended doses of at least “the Greene 13” (listed above). You may not find all of these in one place. In fact, it can be a great idea to look for other sources of calcium, fiber, and omega 3’s (DHA), either in foods or in supplements.

Most children probably do not need or benefit from extra-large supplemental doses of vitamins or minerals, and especially not vitamin A or iron. Most children certainly do not benefit from artificial colors or preservatives, or from extra helpings of sugars or artificial sweeteners found in some children’s vitamins. Look for vitamins with low-sugar, or healthy sweetener options. I suggest not starting with gummy or candy vitamins, because daily candy is not a lesson kids need to learn, and it can be a hard habit to break. Where possible, food sources of the vitamins and minerals in the supplements may contain many more nutrients than named on the label. Don’t settle for pop-culture standards. A healthy food store is a great place to ask for help selecting the best vitamins for your child.

But whatever vitamin you choose, the simple habit of a daily multivitamin/mineral can be an important back-up to your child’s food drive, a smart idea in a culture that seems bent on enticing children with foods that undermine their body’s wisdom.

In the modern United Kingdom, about 12 percent of all normal, healthy, full-term babies are hospitalized at least once in their first 8 months of life. Many of these hospitalizations are for pneumonia, bronchiolitis, or other chest infections; many are for diarrhea or other gastroenteritis.  How big a difference might breastfeeding make in preventing these kids from being hospitalized?

The results of a huge study of almost 16,000 babies were published in the April 2007 Pediatrics. Researchers from Oxford and University College London looked at the outcomes of babies who were exclusively breastfed for 8 month, those who were exclusively formula-fed for the same period, and those who received a combination. After accounting for other factors,* the investigators calculated that exclusive breastfeeding could prevent more than 50 percent of all diarrhea and gastroenteritis hospitalizations each month! Even breastfeeding just partially could prevent more than 30 percent of them. Similarly, exclusive breastfeeding could prevent 27 percent of pneumonia and chest infection hospitalizations each month; partial breastfeeding could prevent 25 percent of them. The effect disappeared soon after the child was weaned.

What a gift when babies can breastfeed at least some throughout their entire first year! Even if they can’t, I’m very happy for every month they get.

*The profound effect of breastfeeding held up after researchers accounted for many other variables including birth weight, gestation, mode of delivery, infant’s age in months, infant’s gender, maternal age, whether the infant was firstborn, maternal smoking, maternal socioeconomic class, maternal occupation, maternal education, maternal marital status, and whether the infant lives in a rented accommodation.

Today in the United States, 1 in 6 children suffers from  a disability that affects their behavior, memory, or ability to learn. More than  $80 billion dollars are spent each year in the U.S. to treat neurodevelopmental  disorders. Diagnoses of Attention Deficit Hyperactivity  Disorder (ADHD) alone up are up 250% since 1990¹. How much of a role does modern food play in this increase?

Children’s brains are built differently depending on  what they are fed when they are rapidly growing. Healthy brains are about 60%  structural fat (not like the flabby fat found elsewhere in the body). As the  brain grows, it selects building blocks from among the fatty acids available in  what the child eats. The most prevalent structural fat in the brain is DHA  (docosahexaenoic acid), one of the omega 3 fatty acids. DHA is also a major structural component of the retina of the eye. A large number of studies have suggested that low DHA levels are associated with problems with intelligence, vision, and behavior².

DHA is the most prevalent long chain fatty acid  in human breast milk, which suggests that it’s intended for babies to consume a lot of it. Studies have shown that babies who have not gotten DHA in their diets have significantly less of it in their brains than those who have³.

My point (at the moment) is not about the superiority  of breast milk, but that  growing children quite literally are what they eat.  When you think about this, you begin to feel differently about “cheap” food.

Read More From This Series:
Part 1 – Brain Food For Your Kids: How Do You Score?
Part 2 – From Backyard Gardens to Kindergartens
Part 3 – Brain Building
Part 4 – How is your food grown?
Part 5 – Antioxidants – Extra Credit
Part 6 – How Our Food Is Processed
Part 7 – Refined Sugars and Flours
Part 8 – School Fuel: Homework for Parents
Part 9 – How Much Does a Child Need Each Day?

¹Szpir M. 2006. New thinking on neurodevelopment. Environmental Health Perspectives. 114(2):a100-107
²Anderson GJ, Connor WE, Corliss JD. 1990. Docosahexaenoic acid is the preferred dietary n-3 fatty acid for the development of the brain and retina. Pediatr Res 27:89–97. Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. 2000. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev Med Child Neurol 42:174–181. Makrides M, Neumann MA, Byard RW, Simmer K, Gibson RA. 1994. Fatty acid composition of brain, retina, and erythrocytes in breast- and formula-fed infants. Am J Clin Nutr 60:189–194. Makrides M, Neumann MA, Simmer K, Gibson RA. 2000b. A critical appraisal of the role of dietary long-chain polyunsaturated fatty acids on neural indices of term infants: A randomized controlled trial. Pediatrics 105:32–38.
³Farquharson J. 1994. Infant cerebral cortex and dietary fatty acids. Eur J Clin Nutr 48:S24–S26. Farquharson J, Cockburn F, Patrick WA, Jamieson EC, Logan RW. 1992. Infant cerebral cortex phospholipid fatty-acid composition and diet. Lancet 340:810–813. Farquharson J, Jamieson EC, Abbasi KA, Patrick WJA, Logan RW, Cockburn F. 1995. Effect of diet on the fatty acid composition of the major phospholipids of infant cerebral cortex. Arch Dis Child 72:198–203. Jamieson EC, Abbasi KA, Cockburn F, Farquharson J, Logan RW, Patrick WA. 1994. Effect of diet on term infant cerebral cortex fatty acid composition. World Rev Nutr Diet 75:139–141. Jamieson EC, Farquharson J, Logan RW, Howatson AG, Patrick WJA, Weaver LT, Cockburn F. 1999. Infant cerebral gray and white matter fatty acids in relation to age and diet. Lipids 34:1065–1071.