Beyond the Table 4: An Ice-Cream Tale and Recipe

At my sister's wedding this week, the kid-friendly photographers were coaxing my son and his cousins to smile. They would use the kid's names instead of the traditional "cheese," have family members make funny faces behind the camera-crew, and the like. During one of my son's solo shots, the photographer said "say ice-cream," and "what's your favorite ice-cream flavor?" Thinking that my son, who is 2 1/2 years old and still not smiling for his shot, did not understand what "flavor" meant, he then moved on to "what's your favorite ice-cream color?" It was at that point that I thought I should jump in and help the photographer out since my little boy has never tasted ice-cream. In the interest of honesty, I wish I could say this was for nutrition reasons, and maybe that would be true as well, but the real reason is that he is allergic to eggs and most ice cream contains eggs.

So I jumped in and said "he has never had ice-cream, say oatmeal." And the smile came across his face as he thought of his favorite breakfast food. Or maybe he was just laughing at us trying to get him to smile. I would like to think it was the former.

Before you feel bad for him for never being able to eat ice-cream, you should know that he has tried ices (Sharon's Sorbet and Frozefruit) and I think he once tried Soy Dream ice-cream. And lately we have also discovered an excellent use for our immersion blender:

Ice-Cream Pops

Recipe:
1. Place plain or vanilla yogurt (full-fat or low-fat) into the immersion-blender cup.
2. Add any of the following: frozen fruit, real fruit, coconut shreds, orange juice, a drop of vanilla extract, etc...
3. Blend it up so that some fruit pieces are still visible.
4. Pour the concoction into freezer pops and freeze for a few hours.
5. Get ready to clean up messy faces.

We made these pops with vanilla low-fat yogurt, frozen blueberries, and coconut shreds. We made it before lunch and they were frozen after dinner.


Beyond the Table:
I hope you enjoy making these "ice-cream pops" as much we do.
If your kids are about two-years old and older, they can even help you pour the yogurt into the cup, place fruit in the cup, push the blender power button while you hold it steady in the cup, and place the freezer pop tops on them (below). They will be delighted to see the yogurt change colors as it blends and even more delighted to eat the colorful pops in a few hours.
A note about BPA: I have no idea whether the freezer molds pictured here contain BPA, since I bought them years ago. But if I buy new molds, I will make sure to buy BPA-free molds such as these pictured here from Amazon. However, I am still searching for BPA-free molds with straws. For more information about BPA read this post.

My Quest for the Perfect Prenatal Vitamin

It may seem odd to my readers that I invested my time in a prenatal-vitamin quest. After all, a prenatal vitamin is just a bunch chemicals, devoid of any synergy that naturally exists in food, and seriously lacking in the research arena with a few exceptions (such as folic acid). Proper nutrition must go beyond prenatals, and supplements in general. Hence the name of this blog. However, every pregnant woman should take prenatal vitamins in addition to eating well. Also, based on my first pregnancy, I was pretty sure I would I would be terribly nauseated and exhausted and just in case I was not eating all that well or all that much, I wanted to have a "back-up." I also wanted to have a good prenatal vitamin to recommend to pregnant women. During my last pregnancy, I took Freeda's Prenatal One a day and a separate DHA but I noticed some shortfalls and I wanted to see if there was a better option.

My search started much like any search for an item...a Google search, a discussion with a few colleagues, various trips to stores in NYC...and an Excel spreadsheet for comparison. I became frustrated when I found that some prenatals were ridiculously high in vitamin A, a known teratogen, or beta carotene, a possible cancer risk in supplement form; some contained herbs that have not been proven safe for pregnant women and are known to cross the placenta; some contained prescription-required doses of folic acid but lacked other essential nutrients and anyway might cause wheeze in babies if taken in excess; some contained parabens and food colorings; some contained algae-based DHA but not fish oil; few contained choline or iodine; and on and on.

I finally found one that I thought was almost perfect. Jarrow Preg-natal + DHA seemed to be pretty good. It has lots of vitamin D3, calcium and magnesium in a 2:1 ratio, plenty of iodine and choline and zinc, and DHA from fish. To its detriment, it contains 200% of certain nutrients but none that exceeded upper limits, and some beta carotene, which I prefer not to take at all. But I was willing to turn a blind eye because everything else seemed so good. Plus, I found a website that sold a one-month supply for only $12. $12 a month for the perfect prenatal? That is too good a deal to pass up. I did think it was slightly suspicious that the serving size listed "One packet" as the dose. How many pills contain all these precious chemicals? But I clicked "confirm order" anyway.

I impatiently waited for the package to arrive. When the box arrived, I could not wait to open it up. I got out the scissors and cut away the tape. I opened up the box...and I gagged. The smell was awful. Worse than awful. And it was strong - I smelled them even before I opened the massive cylinder container.

After I opened it, I discovered that each daily packet contained six smelly pills and one fish supplement. That's right, seven pills! There was no way that I could deal with seven smelly pills each day during the first trimester when I was feeling poorly, but I thought I would give the vitamins the benefit of the doubt and try them out after my nausea subsided. In the meantime, I continued to rely on the Freeda Prenatal and separate DHA.

Yesterday, I took them out again. Maybe the smell would not be so bad now that I was not nauseated all the time. I took the pills down from the cabinet and opened up the box. The smell was overwhelming. But I was not going to let a little obstacle ruin my perfect prenatal. I was going to see this through. I even took one of the packets - all seven pills - with me to work since the recommendation is to take the packet spread throughout the day.

Well, the day is over and I could not bring myself to try even one smelly pill. Not one. I just couldn't do it. I found the perfect prenatal, but it smelled so much that I just couldn't take it.

I'll continue to take my Freeda Prenatal one-a-day vitamin, which meets most of my requirements but not all, a DHA supplement on the days I don't eat fish, and some vitamin D3 on "indoor" days or days when I don't eat a lot of D-fortified foods (my blood levels showed a low-normal range). Certainly, not a perfect arrangement, but it will have to do. And as for my choline, iodine, and calcium, I'm going to have to go beyond prenatals, after all.

Beyond the Table 3: Alongside Mom and Dad in the Kitchen

(Note: You may have noticed a decreased level of activity on this blog lately. This was mostly due to 1st trimester-related pregnancy sluggishness. However, my second trimester has been a big turning point and I hope to start blogging more often so keep visiting! )


The past three months have proven to be more difficult than anticipated, so I have been working on ways to get more done, including making healthier dinners. And while the following solution certainly doesn’t save time, it does combine two activities into one; keeping your toddler actively engaged and getting food on the table.

Research shows that kids are more likely to eat food that they helped prepare, so kitchen activities are a great foray into early childhood nutrition. Even if they only take one bite of the food they prepared, they are one step closer to liking it. It could take up to 15 times of trying a food to actually like it, and many kids won’t continue to just agreeably put food into their mouth they don’t like, so preparing food is one way to get them to take their 7^th or 8^th try.

Here are some ways we get our two-year old helping out in the kitchen:

* Placing fix-ins into sandwiches and watching them melt in the sandwich maker or toaster oven. The sandwiches won't be neat, but they will be yummy.

* Washing vegetables. This is especially great if you have a spray handle- it could easily entertain your child for 10-15 minutes while you prepare something that needs to cook longer than the vegetables anyway. It’s terrible for water conservation but it works! It took some time to convince him not to spray himself or anything else, but now I think he gets it.

(Snacking on a green bean as he washes)

* Pretending to cook. While we don't have a pretend kitchen (yet), we do have this old-school fisher price stove. Additionally, our son has not yet found the start button on our microwave so he is enjoying placing random things inside and pushing various buttons. While doing this, he gleefully exclaims "Making Daddy Mommy," which obviously means that he is making us food to eat. The joy with which he exclaims it must mean that he views making food for someone as an act of love or care.

*Stirring the batter to whatever you are making…it could even be plain flour that you keep in a covered bowl for this very purpose! (Shhh...)

* Pouring ingredients into a bowl.

A few things common-sense things that I have learned from my recent readings in Waldorf education philosophy:

* Kids like to feel able, so it might help to have a small table or high step-stool/chair so they can get right into the action.

* Kids love to imitate household activities, hence the many mini-sized vacuums and brooms on the market. So having them "help" in the kitchen is actually fun for them. For the same reason, it might be a good idea to have some extra measuring spoon, cups, or bowls around so you are not fighting over the same one.

*Lavishly praise them for helping you make breakfast/lunch/dinner. You can even continue to talk about it during and after mealtime or mention it to grandma and grandpa.

* If having your kids help you in the kitchen will only make you more stressed instead of less, or if you would simply rather cook alone, consider a pretend kitchen.

* Give your child some options. For example: "Should we use cheddar cheese or mozzarella cheese?" "Should we cut the potatoes this way or that way?" The results make not be what you anticipated but they we will less fidgety if you keep them involved along the way.

I hope you find these tips helpful!

Debra

Debra@BeyondPrenatals.com

Beyond the Table is a new series on this blog that will showcase the many ways in which kids of all ages can hang out and help out in the kitchen. Going Beyond Prenatals is not just about eating healthy during pregnancy, but about going beyond pregnancy to think about pediatric nutrition as well. Creating positive kitchen interactions beyond the table encourages healthy eating and good memories. You benefit too, by always having an activity on hand! To read more, click here.

The Case for Breastfeeding

Although this post is a little late (it's been a busy month), the blogosphere is still buzzing about Hannah Rosin's article so I figure it's not too late for me to chime in since this is the field I work in professionally and a topic I feel very passionately about. I have a Master's Degree in Public Health and I am a Certified Lactation Counselor and Registered Dietitian. I am currently coordinating a breastfeeding initiative in the South Bronx.

I read Hannah Rosin's "The Case Against Breastfeeding" in the April edition of The Atlantic Monthly with great disappointment.

Rosin, a breastfeeding mother of 3, recently decided not to exclusively nurse her third child. She wrote about how she felt duped by society (and Dr. Sears) into believing that all the research regarding breastfeeding proved breastfeeding to be far superior to formula feeding, a belief that was shattered when she read a few studies questioning the benefits of breastfeeding. I wonder what kind of world she lives in to think that research never has its counter-arguments, and that when a few outliers are found, they outweigh the majority of research. Oh wait, I know...a non-research world! Her article was the result of a couple of hours of research she did during an all-night stretch on the internet. She was signed into an online medical journal database using a friend's password; a medical database with which I am sure she was not familiar. I am surprised that the Atlantic published an article based on this scanty and unprofessional research.

Okay, so Rosin is a journalist, a mom, and a mom who sounds like she is under some typical postpartum stress along with some career stress. But any review of breastfeeding research must at least address the findings of the AHRQ review. The AHRQ review is a meta-analysis conducted by the Agency for Healthcare Research and Quality to analyze breastfeeding studies to determine whether and to what extent breastfeeding yields health benefits to mothers and children in developed countries. The review, which covered about 400 studies, found "that a history of breastfeeding was associated with a a reduction in the risk of acute otitis media (ear infections), non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. There was no relationship between breastfeeding in term infants and cognitive performance."

However, as is the case with all observational studies, even the AHRQ states that "...one should not infer causality based on these findings." That means that you cannot say that if you breastfeed your child, he/she will definitely have a reduced risk of disease. Instead, the major medical authorities rely on what the majority of research indicates is likely true for the general population. The result is the generally recognized recommendation that mothers breastfeed exclusively for 6 months and continue breastfeeding along with offering solid foods until at least one year.

Yet Rosin focuses on a few studies, randomly selected, that do not imply that breastfeeding yields medical benefits. Rosin fundamentally does not understand how research is conducted. Furthermore, she blends her personal feelings into a medical topic, which is a little something we like to call bias. When a researcher is found to be biased, whether by accepting money from certain companies or for personal reasons, such research must always be taken with a grain of salt.

Most importantly however, Rosin makes no mention of breastfeeding's benefits to the mother, which include reductions in breast cancer, ovarian cancer, postpartum diabetes, and possibly reduced incidence of post-partum depression among breastfeeding mothers. Huge reasons to breastfeed! Do it for yourself, if for nothing else! If Rosin found the AHRQ review or has been following breastfeeding research, she would have known that. As a Jewish woman, doesn't Rosin know her risk of breast cancer is increased? Breastfeeding for one year can reduce your risk of breast cancer by 11.3% (see my previous post here). While not a guarantee, 11.3% is nothing to sneeze at.

Here are a few more reasons and counterarguments to convince you that breastfeeding is still considered the best way to feed your infant:

* Rosin writes that she became wary of breastfeeding while breastfeeding her 3rd child upon finding an article in a reputable medical journal, which reported equivocal findings about breastfeeding's benefits for obesity. Did she really think she was breastfeeding solely to prevent obesity? Lately, the link between breastfeeding and obesity has become less clear, possibly because so many breastfeeding moms have taken to bottle-feeding expressed breast milk. The bottle is suspected of causing obesity because neither bottle-feeding moms nor pumping moms want to waste the expensive elixir inside the bottle and therefore they usually nudge the infant to finish the remaining ounce or two. Thus, they over-ride the natural tendency to stop eating when full. Likely, it's not the milk, but the package. Additionally, it is a dose-responsive relationship. The longer you breastfeed for, the less likely obesity is to occur. Many women don't make it past the 3 month mark to make a dent in obesity rates. Lastly, the benefits for obesity likely have the ability to affect disadvantaged communities more than Rosin's more affluent crowd.

* Rosin discusses immunity but never mentions ear infections. I guess she didn't find any of the multitude of studies in her all-nighter that showed a 50% reduction of ear infections.

* Rosin also never mentions the CDC's National Maternal Infant Health Study, which found reductions in illnesses such as diarrhea, runny nose, wheeze, vomiting, and pneumonia for exclusive breastfeeder's. The CDC is a big supporter of breastfeeding. I would trust them more than Hannah Rosin.

* Rosin barely discusses the actual composition of breast milk: breast milk contains probiotics, hormones, growth factors, white blood cells, B12 binding factor, lactoferrin, and fibronectin- each of which have their own role such as lowering the Ph of the gut or preventing microorganisms or aiding in digestion; breast milk creates longer villi along the small intestine; breast milk is rich in lactose, which helps increase calcium absorption and teach the body to keep its lactase enzymes; breast milk has more whey than casein, making it easier to digest than formula (that is why breastfed babies need to eat more frequently and have softer stools).

* When Rosin does discuss IgA content of breast milk, she seems surprised that this immunoglobulin does not enter the bloodstream. What she doesn't know is that IgA binds to microbes in the gut to reduce diarrhea; it's not supposed to enter the bloodstream with the microbes. Maybe she meant to talk about IgG or IgM.

* In addition to obesity, Rosin also seems very concerned about the future intellect of her children. She is correct that breastfeeding studies have shown mixed results, so one should no breast feed solely to create smart kids, although that may be an added benefit. However, breast milk does contain cholesterol, which is important for brain growth, and formula does not contain cholesterol. Cholesterol in infants is actually very important for cell growth and it teaches the body how to process it appropriately for when they get older. Breast milk also contains DHA and EPA, which are omega 3 fatty acids that help the brain and eyes. Formula contains chlorinated-algae based DHA (no EPA), and the research about this type of DHA is very iffy. Rosin can research that next.

* Rosin does give credit to the important physical interaction that comes with breastfeeding and the fact that it is something that bottle-feeding moms can imitate if they wish. There is research that this type of interaction (talking, touching, skin-to-skin contact) promotes healthy brain development.

* There are dentists who believe that breastfeeding impacts shape of oral cavity, risk of TMJ, position of teeth, dental alignment, width of posterior nasal space and airway shape.

* Rosin also seems very concerned about the unequal parenting that breastfeeding may foster. Yes, women are the only ones with breasts. But they are not the only ones who can cook, clean, change diapers, bathe, sing, rock, read stories, etc... Additionally, I do not know many breastfeeding mother's (including Rosin herself!) who would give up the bond they have with their breastfed children. Should we give up that bond so we don't make the fathers jealous? They can find their own way to bond, and they do.

* Rosin does bring up a very good point: sometimes our careers suffer because of breastfeeding or we jump through crazy hoops to pump our milk at work. That is true. Maybe one day, we will have better maternity leave and pumping policies and that will change.

* Rosin has stated in her article and on an MSNBC interview, that breastfeeding is not like taking a prenatal vitamin, it is a lot more time intensive. Well, you know how I feel about prenatal vitamins just from the title of my blog: vitamins are an easy way out that may not even be worth it, and certainly not a model for how we should care for the health of our families.

* I would also question Rosin's integrity of her article. She sounds like a mom who has been peer-pressured into believing that breast is best by women in skinny jeans and big sunglasses who hang out at the playground (those are her words!). Well, she is clearly living amongst a certain segment of the population. However, that same segment often also receives free gifts from formula companies. Just as doctors have started reporting free gifts, I want to know if Rosin received any free formula, free diaper bags, free feedings kits, free developmental guides, etc... from the formula companies. If she did, you must question her bias since those gifts are designed so darn well that they could convince almost anyone to formula feed. That is why the formula companies make them. In future posts, I will deconstruct some of these advertisements for you to show you some major loopholes in their argument.

In Rosin's description of her breastfeeding, I hear hints that Rosin could have benefited from a good lactation consultant: she hears sucking sounds (bad sign), she finds herself breastfeeding in public 10 times in a day (total breastfeeding sessions in a 24 hour period should be 8-12; or maybe she is never home); and her mom is worried about how the baby is gaining weight (potentially bad sign). Breastfeeding should be comfortable, with no sucking sounds (only swallowing sounds), efficient, and enough to produce enough wet/dirty diapers and appropriate weight gain in order to get all of the benefits mentioned above. If you think your baby is not drinking enough, contact a lactation consultant or visit a local support group.

I agree with Rosin that families need to weigh the wife's sanity, career, and independence when making decisions regarding how to feed and I wholeheartedly agree that an unhappy breastfeeding mom is not a sustainable or positive life choice. The question for families to consider is how to best remedy the unhappiness while remaining committed to healthiest practicable lifestyle.