Last Thanksgiving I announced a bold campaign, spearheaded by an amazing band of volunteers, to upgrade babies’ first foods to real foods – and babies’ first grains to whole grains – and to do this in 2011.

It’s November, and we still have a ways to go, but we also have an exciting reason to celebrate!

Over 10,000 physicians, mostly pediatricians, took part in a July/August 2011 survey by Medscape.com that demonstrated an historic shift in their feeding recommendations this year. The first question in the survey was “What do you recommend for baby’s first food (check all that apply)?” The options were white rice cereal, whole grain cereal, a vegetable, a fruit, egg yolk, meat, or other. Of those who answered as of August 31, the number one choice was white rice cereal – garnering nearly twice as many votes as the next most common.

But after reading an article about WhiteOut Now, our public service campaign the survey results were strikingly different.

Responding to,” What will you recommend for baby’s first food (check all that apply)” only 3% even included white rice cereal among their recommended choices. Physicians were also asked, “Do you think white rice cereal is the best choice for baby’s first food?” About 3% of those who responded had “No opinion” and an overwhelming 93% responded, “No.”

As of now over 12,000 physicians have taken part in the survey, and the change continues to spread. To me this major reversal suggests that the old white rice cereal recommendations were based on well-meaning habit rather than on science or even on careful consideration. When asked to reconsider, an overwhelming majority of physicians were quickly able to see advantages of abandoning the old recommendation.

Evidence is mounting that changing early feeding habits is critical to reversing the childhood obesity epidemic. This stunning survey suggests that first feedings are poised to change. A reason to be thankful indeed!

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 being a child and hearing my parents talk about how fast time was moving. Now I’m the parent and I know what they were talking about. But not only is time moving more quickly for us as adults, today things around us are actually changing more quickly.

Here are five trends (and a bonus trend) that I see emerging now and my predictions for the trends that will continue in 2011:

1) Electronic Connections — Parent communities are bigger than ever, but less local. Families are busier than ever, but finding new ways to connect.

• Video chatting, such as Skype, is becoming the norm for extended families to stay in touch. Look for this to accelerate as it goes mobile on smartphones and tablets.
• Online photo and video sharing through social networking will continue to grow. Again, watch for more mobile, as smartphones replace more cameras and videocameras. Think Qik.
• For older kids playing online, turn based, games with parents will become as common as board games were for the last generation. Games like Words with Friends will take advantage of smart phone and tablet technologies to keep families connected.
• Look for JumpScan and other QR programs to facilitate connections (and even start replacing things like business cards, luggage tags, and identification for lost kids).
• Innovative companies like HealthTap and Quora will become popular ways to use electronic connections to get parents the answers they most want.

2) Real Food for Babies (and other humans) – The 1950s launched us into 60 years of processed foods. It may be slow at first, but 2011 will see some big changes.

• 2011 will be the year white rice baby cereal goes away.

New first foods will be real foods – such as bananas, avocado, and sweet potatoes.

• The family meal will make a resurgence. It won’t be the norm in 2011, but more meals will be eaten at home than in 2010.
• Healthy, quick food options will grow in availability. Look for convenience stores such as Fresh and Easy to do well in 2011.

3) Kicking Out Risky Chemicals (chemical awareness) — Parents are reading ingredient labels more than ever, not just on food. The President’s Cancer Panel presented in 2010 had a major impact, as well as the 2010 study linking ADHD to pesticides. The trend will grow in 2011.

• The green movement got it’s start in organic food, but an increasing number of parents will be looking for hidden toxics in cleaning supplies, gardening supplies, textiles, etc.
• Parents are choosing BPA-free, phthalate-free, PVC-free, plastics. BornFree has been a pioneer in safe plastics for kids even before most parents had heard of BPA. Now BornFree, Ecomom.com, Ikea, and others are becoming trusted leaders for parents who don’t have time to research for themselves, but want safe products.

4) Kitchen Kids — Thanks to Michelle Obama, Jamie Oliver, Chef Anne, Chef Jessie Cool and a host of others kids-food is getting renewed attention..

• In 2011 kids will get more and more involved in creating meals together before sitting down to eat.
• 2011 will see more families planting a garden. It may be as small as one tomato plant or one herb on a windowsill, but more kids will get the opportunity to see their food start from a seed.

5) The Natural Connections to the Outdoors — The last generation of parents became afraid to let their children play alone outdoors. This generation of parents is seeing the value of connecting their kids to nature.

• Look for more families in the park, more families playing outdoor sports, and a return to the family bike ride.
• Kids have too much homework. As a result, parents have downplayed the need to do family chores. Look for parents to join their kids for outdoor chores as a way to get sunshine (needed Vitamin D) and connect to the earth.
• Houseplants were big in the 70s and 80s. Don’t expect macramé to come back into style, but parents are becoming aware of the value of houseplants as inexpensive air filters. You’ll see more of them in 2011.
• Plastic toys are about as far from the outdoors as possible. Look for more quality, heirloom wooden toys to make it in the market place in 2011. Tegu is a great example of a young company creating an innovative toy in a sustainable way.

Bonus: Hot New Birthday Party for 2011 — Chef School

• Mom or Dad will accompany kids to the party and participate, making it more interactive than in the past.
• The Chef leading the class will be both teacher and entertainment (no clowns needed).
• Everyone participates in the preparation and at the end of the party they enjoy the food together — including homemade birthday cupcakes.
• If there’s not one in your area, call the local cooking school and ask them to create one for your child’s next birthday party!

All-in-all, I think 2011 is shaping up to be a pretty good year for famiies. What do you think?

Note: Dr. Greene is on the Board of Ecomom.com, the Medical Director of HealthTap, and works closely with BornFree to provide safe feeding products for children. He does not have a financial connection to any of the other brands mentioned.

It’s time to change America’s first food. What if white rice helped trigger diabetes and brown rice helped to prevent it, regardless of lifestyle? That’s just what a 2010 Harvard study suggests. Brown rice is a delicious whole food, packed with flavor and with protective nutrients. But all of the sugar-stabilizing fiber and all of the essential fatty acids are stripped out to make polished white rice, along with most of the magnesium, iron, B vitamins, and lignans, and half of the phosphorus and manganese.   To make baby food rice cereal, the white rice is even further processed. And this depleted, out-of-balance, processed white flour becomes the eagerly-anticipated first bite of solids for most babies in the US.

How we feed babies in those early days matters for years to come. Most core food preferences are learned during critical early windows of opportunity (see Feeding Baby Green). In America we have raised a generation where most children learn to get zero servings of whole grains daily by the time they are 18 to 24 months old.

One in three babies born today is expected to develop diabetes in their lifetime, unless something dramatic changes. If we just made the simple switch from white rice to brown rice for babies we might cultivate a taste for whole grains and prevent millions and millions of people from developing diabetes.

For that very first bite of solids, though, I prefer choosing something that doesn’t come in a box or jar. Let your baby see a real whole food in its natural state, something she’s seen you eat before, such as a banana or an avocado. Let her handle the whole food. Let her smell it. Let her see you eat some, and then let her see you mash up a bit, perhaps with some breast milk. If you are nursing, she will already have experienced the flavor in your breast milk before.

Her strong desire to imitate you and to learn from you, coupled with this powerful combination of seeing, tasting, smelling, and touch creates a profound learning experience that is deeply satisfying and fun. Let a whole food mark this momentous occasion – or a whole grain cereal. But not processed white flour rice cereal.

Researchers at the Harvard School of Public Health analyzed rice eating and diabetes in about 200,000 people. Those who ate white rice 5 or more times a week had a 17% increased risk of type 2 diabetes compared with those who ate it less than once a month. Separately, those who ate 2 or more servings of brown rice a week had an 11 % decrease of type 2 diabetes.  But the biggest difference came in those who chose brown rice or another whole grain instead of white rice – with up to a 36% reduced risk.

If we have a future population of 300 million in the US, with 100 million expected to develop diabetes, a 36% reduced risk represents a huge savings of life, limb, eyesight, money and health.

Shortly after babies begin to walk, neophobia begins to set in, the fear of new flavors, textures, or sources of food. Let’s teach a love for whole grains (and other whole foods) while they are still so eager to learn!

Sun Q, Spiegelman D, van Dam RM, Holmes MD, Malik VS, Willett WC, and Hu FB. “White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women. Archives of Internal Medicine. June 2010; 170(11):961-969.

Most new mothers are inundated with formula samples and coupons everywhere they turn.  Signing up for those free baby magazines can automatically place your name on a mailing list that formula companies use to target new mothers.  Several free cans will probably show up in the mail, and many hospitals give out free bags full of formula upon discharge.  The latter violates the Baby Friendly Hospital Initiative set for by UNICEF and the World Health Organization, so beware of any maternity ward that sends mothers home with formula bags.

Even mothers who plan to breastfeed may keep these samples hanging around “just in case,” but the mere presence of infant formula can sabotage even the most committed mother’s intention to nurse her baby.  In the first few days of life, babies are designed to live on colostrum alone, but many mothers fear their babies’ are hungry.  Because the mother’s milk may not have come in yet, she thinks she needs to formula feed and breaks into her free samples.  On the contrary, the best she can do is to keep breastfeeding, which stimulates the milk supply.  Some mothers are simply exhausted and stressed, and think that giving the baby a bottle, or two, or three, will help her get some sleep.  An even better way to get some sleep is to learn side-laying nursing.  Breastfeeding is a supply and demand system, and every bottle of formula the baby gets is one less feeding the mother’s body is told to make.

Soon, all that supplementing has caused the mother milk supply issues or plugged ducts, and the breastfeeding relationship is heading out the door.  Not long after, the formula samples run out, and the parents find themselves gulping at the $23-$28 price tag of those cans of powdered formula.  New babies go through approximately two cans of the powdered stuff per week, which quickly adds up to nearly $200 per month to feed the little bundle of joy.  Formula companies do send new parents checks or coupons for huge discounts off infant formula, but only for the first few weeks.  Before you know it, those checks stop showing up, leaving new parents to eat the full retail price of that formula.

At the end of the baby’s first year, the “free” formula samples have now cost the parents around $1,500 just in formula alone.  If your town’s water is questionable, you will also need to buy nursery water.  Because breastfeeding helps protect babies from illness and infection, we also must factor in the costs of any extra doctors visits or medicines the baby may need.  It also takes time to mix bottles, along with washing and sterilizing them, which requires more time and energy than simply feeding baby straight from the tap.

After two children, I learned the hard way the very best thing I could do for the breastfeeding relationship was to reject any offers of “free formula” and remove all samples or coupons from the house.  I found that if it was not there, I was not tempted to use it, and we worked out our nursing struggles by breastfeeding more, not less.

What was your experience with formula samples? Did you use them or throw them away, and how did it impact breastfeeding?

The long crying spasms of colic can be exhausting for parents and babies alike. Because babies with colic have been shown in some studies to have fewer species of beneficial bacteria in their intestines, researchers in Turin, Italy wondered whether giving babies probiotics (beneficial bacteria) might help solve the colic. Ninety breast-fed colicky babies were randomly assigned to get either the probiotic L. reuteri  (0.8 billion cfu per day) or another colic remedy, simethicone (60 mg per day). The breastfeeding moms avoided cow’s milk in their own diets to reduce complicating factors. They recorded the total minutes of crying each day.

At the start, the babies in both groups averaged a parent-exasperating 197 minutes a day of crying spasms.  They were rechecked 7, 14, 21, and 28 days after starting their remedy. By day 7, those who were getting the probiotics were crying and average of 38 minutes less than they were before, about twice the improvement seen with the other remedy. At each check-up, those given the probiotics fared better. The colic had resolved for 95 percent of those receiving probiotics and for only 7 percent of those receiving simethicone.

The results are consistent with what you might expect based on the The Colic Bacteria I discussed yesterday. But other studies showing benefit from probiotics for other conditions, a dose of 5 billion to 10 billion cfu is often used in young children. Perhaps the relatively low dose used in this study is a reason that the benefit was small at first and slow to take hold.

More science in this area is needed to confirm whether this is a good way to relieve colic, and if so, what is the best strain of probiotics and the best dose. But it is clear that the health of the ecosystem in our gut is intimately linked to our own health, in ways we are just beginning to understand.

Savino F, Pelle E, Palumeri E, Oggero R, and Miniero R. “Lactobacillus reuteri (American Type Culture Collection Strain 55730) Versus Simethicone in the Treatment of Infantile Colic: A Prospective Randomized Study” Pediatrics 2007;119;e124-e130.

How quickly does being overweight affect health? Overweight babies and toddlers under age 2 already show signs of health problems according to a study in the August 2008, Pediatrics. Those over the 95th percentile in weight (for their height) were more likely to get hospitalized before their second birthday. And more likely to be hospitalized a second time. Even those over the 85th percentile (the definition of overweight) were more likely to have gross motor delays and more likely to snore.

There was also a trend toward more of other types of breathing problems, such as asthma. The connections seemed pretty clear – though not necessarily clear whether the increased weight caused the health problems, or vice versa. Either way, it makes sense to pay attention to the connection. And it’s very possible that the health problems from obesity aren’t something in the far off future, but begin very early. One striking side note in the results of the study: almost 70 percent of the mothers of overweight children didn’t think their babies were overweight. Obesity has become so common in kids that overweight looks normal to most parents, and normal looks skinny.

Shibil R, Rubin L, Akons H, and Shaoul R. Morbidity of Overweight (>85th Percentile) in the First 2 Years of Life. Pediatrics. August 2008; 122:267-272.

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.

Get ready for some surprising recommendations. Eczema, asthma, and food allergies are all on the rise in children, each having more than doubled in the last several decades. This rapid increase has lead to many differing recommendations on the timing and selection of foods offered to babies, to err on the side of caution before scientific studies were completed.

A January 2008 evidence-based policy from the American Academy of Pediatrics turns some of this conventional wisdom on its head.

For preventing allergies, when is it best to start solids for babies?

Previously, it was recommended to delay solids until 6 months if possible, and to limit the choices to things like rice cereal, oatmeal, or barley if they must be started sooner. The new policy reports that solids should not be started before 4 to 6 months, but that there is no convincing evidence that delaying any solids beyond this period helps to prevent allergies.

In fact, with some foods, starting on the earlier side may even help. What about highly allergic foods such as eggs, peanuts, milk, or fish? The previous guidelines were that in allergic families, whole cow milk should be delayed until 12 months of age; eggs until 2 years; and nuts, peanuts, and fish until age 3. The new guidelines say that there is no convincing evidence that delaying even eggs (yolks or whites), fish, milk, nuts, and peanuts beyond 6 months prevents allergies!

A few things to keep in mind: First, this discussion is only about preventing asthma, eczema, and food allergies. There are other reasons to delay certain foods (e.g. honey to prevent botulism, whole peanuts to prevent choking). Second, if a child does show signs of an allergic reaction, removing the possible culprits from the diet is wise — these guidelines are about preventing, not treating allergies. Third, these new guidelines are not the final word, they are just the current state of the science. Other benefits of particular timing may one day be uncovered. Finally, I am a fan of introducing a wide variety of healthy foods to babies between 6 and 12 months old,  but I prefer organic foods for babies in the first year when possible. Particularly, if I were going to give some of the more allergenic foods like eggs, or cheese, milk, or nuts, I would be even more inclined to choose organic.

AAP Clinical Report: Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and the Section on Allergy and Immunology. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics2008; 121: 183-191.

Zutavern A, Brockow I, Schaaf B, von Berg A, Diez U, Borte M, Kraemer U, Herbarth O, Behrendt H, Wichmann H, Heinrich J (The LISA Study Group). Timing of Solid Food Introduction in Relation to Eczema, Asthma, Allergic Rhinitis, and Food and Inhalant Sensitization at the Age of 6 Years: Results From the Prospective Birth Cohort Study LISA. Pediatrics 2008; 121: e44-e52