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52: A Gentle Approach to Picky Eating in Childhood

While there is no exact definition of picky eating, children who frequently refuse vegetables, eat a limited variety of healthy food, have restricted intake, are unwilling to try new foods (neophobia), are slow eaters, or have strong food preferences are often identified by parents as picky eaters. Picky eating is a very common problem in early childhood, affecting up to 50% of young children. Picky eating habits may become a source of parent-child conflict. Along with making mealtime feel like a battlefield, picky eating can lead to constipation or other health issues.  

What can parents do to prevent the development picky eating? One comprehensive study concluded that offering fruits and vegetables early (at 4-6 months of age), repeating them frequently, and providing a rich variety of food in general are important strategies for avoiding picky eating. Note that when it comes to green vegetables, 8-15 exposures may be required for babies to accept them. If your child spits out peas on the first or second (or third) try, don’t give up! Patience and repetition are extremely important for training a young palate to accept green vegetables and other healthy foods.

In my office, a small unpublished study suggested that giving green vegetables to babies for two weeks prior to the introduction fruit helps to prevent picky eating habits down the road. A much larger study would be needed to make a definitive statement on the ideal order of solid food introduction.

Importantly, picky eating is not always preventable. Some children are born with strong likes and dislikes regarding food, and these preferences may persist into adulthood. Nonetheless, strategies can be employed to encourage children with rigid eating habits to broaden their horizons. Occupational therapists, for example, have developed programs to desensitize children to different varieties of food. Children are asked to take a tiny bite of the goal food. The size of the bite is gradually increased over time. By offering miniscule “doses,” the food becomes less threatening to the child. Another therapeutic intervention is asking children to “play” with goal foods (i.e. building things out of food or creatively arranging food) to desensitize them to the color and texture of the food. These types of interventions can easily be done at home.

Be aware that bribing or nagging kids to eat healthy food can sometimes backfire. Children who are constantly pressured by parents to eat nutritious foods may act out by rejecting desirable foods. Excessively restricting children from eating “junk” food can have a similar unwanted effect—children may become drawn to the restricted food. The ideal strategy seems to be consistently offering healthy food in a gentle way and allowing the child to make unpressured food choices.

Interestingly, picky eating seems to be protective for preventing at least one health problem: obesity. Because picky eaters tend to eat fewer calories overall, they are more likely to be underweight than obese.

Picky eating in childhood is definitely an arena that is calling for more research. Recently I had the pleasure of collaborating on a whimsical children’s book about picky eating called, PRISCILLA THE PICKY PORCUPINE, with artist Julieta Gomes from Quinnipiac University. The story, which contains plenty of playful alliteration, is perfect for preschoolers. To access the book on Amazon, click the link below:

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51. Revised COVID Guidelines

CDC COVID Guidelines as of January 6, 2022

WHAT TO DO IF YOU OR YOUR CHILD HAS COVID:

Everyone with Covid should stay home and isolate for five days, regardless of vaccination status. If you have no symptoms, then Day 0 is the day of the positive test. If you are sick, then Day 0 is the first day of symptoms. If you test positive and are initially asymptomatic but then develop symptoms, count the onset of symptoms as Day 0.

After five days, if you have no symptoms or the symptoms are resolving, you can leave the house, wearing a mask for an additional five days. If you have a fever, stay home until the fever resolves. Try to avoid travel for 10 days.

WHAT TO DO IF YOU OR YOUR CHILD ARE EXPOSED TO COVID:

People who have had COVID in the past 3 months don’t need a new test, unless a new infection with COVID is suspected.

If you are fully vaccinated, you don’t need to quarantine. Just wear a mask for 10 days. If possible, get a test on day five. Count the most recent date of exposure as Day 0. If you develop symptoms, get a test immediately and stay home.

If you are exposed but not fully vaccinated, stay home for five days. After that wear a mask around others for five more days. If you can’t quarantine, then wear a mask for 10 days. Get a test on day five if possible. If you develop symptoms, get a test and stay home. 

Keep in mind that there can be a high false-negative rate with antigen tests, especially early in the course of illness. Later in the course, when an individual is recovering and is no longer contagious, PCR and rapid molecular tests may remain positive because they are so sensitive.

COVID VACCINATION AFTER INFECTION

Even if you have a natural infection with Covid, you should still get vaccinated. How long should you wait to get a vaccine if you recently had Covid? The CDC has not provided set guidelines on this question. Anyone who is feeling better can reasonably get a vaccine at any time. However, following a Covid infection, natural immunity may remain high for 2-3 months, meaning that it’s probably okay to delay the vaccine for 60-90 days following infection. On the other hand, there is no harm in getting the vaccine early.

COVID AND SPORTS CLEARANCE FOR ATHLETES:

Sports clearance by a doctor following a Covid infection cannot be completed until the isolation period has finished. In light of the revised guidelines, kids with asymptomatic or mild Covid can be cleared for sports participation after the five-day isolation period, as long as the symptoms are resolving. Sports clearance for mild Covid does not require an in-person office visit. A questionnaire focusing on potential cardiac symptoms can be completed over the phone. Children with moderate Covid (fever for more than 4 days, systemic symptoms for more than one week) need to be evaluated in person.

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50. Lead Contamination of “Baby” Food

About a month ago, a mother in my practice, “Mrs. H,” called to discuss the 2021 congressional report detailing the ubiquitous contamination of baby food with toxic heavy metals. The congressional report followed the 2019 Healthy Babies Bright Futures (HBBF) study demonstrating extensive heavy-metal contamination of baby food and infant formula. Mrs. H was understandably upset to learn that a wide variety of baby foods, both organic and non-organic, were contaminated with unacceptably high levels of arsenic, lead, mercury, and cadmium. In older adults, these substances cause numerous medical problems, including cancer, but heavy metals are particularly toxic to young infants because they damage the developing brain. Infants exposed to heavy metals are at risk for ADHD, behavioral problems, loss of IQ points, and long-term cognitive impairment.

Unfortunately, the toxins cannot be avoided by using a food processor at home. HBBF points out, “For parents, the answer is not switching to homemade purees instead of store-bought baby foods. Federal data shows that baby food sometimes has higher levels and sometimes lower levels of heavy metals, compared to comparable fresh or processed food purchased outside the baby food aisle.” In other words, all food is contaminated, not just baby food.

When Mrs. H called, she posed two questions I couldn’t answer. First, she wanted to know which infant formula was the least toxic to children. Second, she asked whether the German formula Holle was safer than American formula, based upon recommendations she had read online. Previously Mrs. H had purchased Earth’s Best Organic Formula, but Earth’s Best was on the naughty list in the congressional report. In fact, all of the brands reviewed by congress had high levels of heavy metals.

To help answer Mrs. H’s second question, I delivered three containers of formula (Earth’s Best Organics, Holle formula, and regular Enfamil) to the Environmental Monitoring Laboratory in Wallingford, CT. Each sample was screened for arsenic, lead, mercury, and cadmium. The results were disheartening but not surprising. All three samples contained detectable levels of lead. Specifically, Enfamil had about 3 parts per billion (ppb), Earth’s Best Organics had 6 ppb, and Holle formula had 15 ppb of powder. When reconstituted with water, the amount of lead for each brand was less than the EPA’s “actionable” lead level (15 ppb in drinking water), but no amount of lead is safe for babies. Based on the results of our small study, I informed Mrs. H that the German formula Holle is likely no better than regular American formula, and possibly worse.

More information regarding the 2019 HBBF study and the subsequent congressional report can be found by clicking the links below. Both documents are worth reading, as they provide guidelines for avoiding the most heavily contaminated food, useful data for humans of all ages.

Lastly, it seems we have a reached a stage of industrialization in which chemical contamination of our environment is incredibly widespread. On a national and individual level, we should be working together to protect the health of our environment and ourselves. This summer, if you see dandelions and clover overtaking my front lawn, you’ll know why.  

Pending legislation:


Read in CNN: https://apple.news/AZ_MouM6USr2XxmuSAsKXOQ 

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49. DPH Connecticut COVID update


Today I received a very useful email from DPH, so I’m posting it here. Stay safe, everyone!

“Hello Connecticut Physicians, APRNs, PAs, and RNs: 

The Connecticut Department of Public Health would like to keep you all informed of the latest developments in COVID-19 on a weekly basis. You can expect weekly emails on Tuesdays with updates on COVID-19 epidemiology, vaccines, testing and evidence-based control measures. 

COVID-19 Epidemiology: COVID-19 rates remain high across Connecticut.  

  • CT DPH is ramping up efforts to obtain genetic sequences for a subset of patient specimens positive for SARS-CoV-2 to detect variants.  
  • 20 cases of the B.1.1.7 (“UK”) variant have been detected in Connecticut.  

For a series of interactive graphs and maps that provide additional data, including metrics related to age, gender, and race/ethnicity, as well as data broken down by every town and city in Connecticut, visit the Connecticut COVID-19 Data Tracker

COVID-19 Vaccines: This week, starting Thursday, February 11, individuals age 65–74 will be able to schedule appointments for COVID-19 vaccination.  

  • All eligible residents are required to make an appointment in advance of receiving the vaccine.   
  • To find available vaccination clinics throughout the state, residents can visit ct.gov/covidvaccine and enter their zip code.  

Appointments can made utilizing the following tools:
 

  1. VAMS online system: VAMS is the Vaccine Administration Management System and can be used to schedule appointments at multiple clinics across the state. To make an appointment using this system, click here
  2. Call Connecticut’s COVID-19 Vaccine Appointment Assist Line: Connecticut’s COVID-19 vaccine appointment assist line is open from 8:00 a.m. to 8:00 p.m., seven days a week. To make an appointment, call 877-918-2224.  Language assistance is available. 
  3. The Deaf and Hard of Hearing can call 7-1-1 to access the Vaccine Appointment Assist Line. 
  4. Hartford HealthcareYale New Haven HealthStamford HealthWalgreensCVS, and Walmart also have online appointment scheduling systems (hyperlinks included). 

More information coming soon (likely March): Scheduling information for individuals with underlying medical conditions at increased risk for severe illness and frontline essential workers. 

COVID-19 Testing: Antigen testing is becoming more popular for COVID-19 diagnosis. Clinicians utilizing point-of-care antigen testing are encouraged to review CDC’s Interim Guidance for Antigen Testing for SARS-CoV-2: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html   

COVID-19 Control Measures: At this time, please continue to emphasize the importance of masking, distancing, and handwashing to prevent the spread of illness. These efforts contribute to reducing illness, hospitalizations, and deaths in our communities. 

Questions about COVID-19? Email COVID19.DPH@ct.gov.