Easy Tips for Picky Eaters

As we continue to celebrate nutrition month, be sure to check out these easy tips below recommended by the American Heart Association, to help your picky eaters at home.

1. Start by introducing healthier elements into foods that your child already likes. Offer blueberry pancakes, carrot muffins, fruit slices over a favorite cereal, chunks of bell pepper in a potato salad, or shredded veggies over rice.

2. Include your kids in the prep work. By being involved in grocery shopping and food preparation, your kids will have more ‘buy-in.’ If they feel some ownership over the meal, they may be more likely to eat it.

3. Out of sight, out of mind. If the chips and cookies aren’t around, your kids can’t eat them. They may resist at first, but when they get hungry, they’ll start munching the carrot sticks. Keep healthy foods on hand — 100 percent juice instead of colas or sugary drinks, and a bag of apples instead of a bag of chips.

4. Have healthy finger foods available. Kids like to pick up foods, so give them foods they can handle. Fruit and veggie chunks (raw or cooked) are great finger-food options.

5. Don’t cut out treats altogether. Think moderation. A scoop of ice cream or a serving of Oreos is all right occasionally. If you cut out all the goodies, your kids will be more likely to overeat when they do get them. Make sure to moderate the treat consumption.

6. Veg out at the dinner table, not the TV. Eating in front of the TV is distracting, and kids may not notice that they’re full because they’re wrapped up in the show. Eating as a family is a great time to catch up.

Check out more great tips.

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Better Eating Habits Start With Eating Together

Photo courtesy of office.microsoft.com.
In recognition of National Nutrition Month, we want to make sure your family is off to a good start in developing healthy eating habits. Did you know that this can be as easy as eating dinner together as a family? And it doesn’t have to be every night, either, says CHOC Children’s pediatrician Mark Colon, M.D. Studies have shown benefits even when families sat down for dinner just a few nights a week.

Moreover, studies have shown that children whose families regularly eat dinner together are less likely to suffer from eating disorders.

Dr. Colon recommends that parents take advantage of the nightly opportunity to model healthy nutritional habits. “Dinnertime gives parents the opportunity to start teaching healthy eating habits from day one. Also, family meals allow more face-to-face time, which can lead to improved communication and family relationships,” he says. “Including a young child at the dinner table is an excellent way to introduce fruit, vegetables, salads and meats,” says Dr. Colon.

So, before you start planning dinner, remember that setting the table for the entire family may just be what your family needs to get a healthy boost.

For more tips, please click here to read the full story: http://www.choc.org/publications/index.cfm?id=P00303&pub=KH&aid=396

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Shape Up Your Plate for National Nutrition Month & Beyond

March is just around the corner — a perfect time to recognize National Nutrition Month! Check out the helpful nutrition facts and guidelines below, by Sarah Kavlich, RD, clinical dietitian at CHOC Children’s.

Each March, the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) encourages Americans to return to the basics of healthy eating by consuming the recommended amounts of fruits, vegetables, grains, proteins and dairy through a month- long campaign called “National Nutrition Month.”

The Academy of Nutrition and Dietetics, founded in 1917, is the world’s largest organization of food and nutrition professionals. The Academy is dedicated to improving the nation’s health, and advancing the profession of dietetics through research, education and advocacy.

National Nutrition Month began in 1973 as a week-long event known as “National Nutrition Week.” In 1980, the event expanded into a month-long observance as a response to growing public awareness in the area of nutrition. To recognize the dedication of registered dietitians as the leading advocates for advancing the nutritional status of Americans and people around the world, the second Wednesday of each March is celebrated as “Registered Dietitian Day.” This year – 2012 – marks the fifth annual Registered Dietitian Day.

The theme for this year’s National Nutrition Month is “Shape Up Your Plate,” based on the 2011 “MyPlate” campaign launched by the United States Department of Agriculture (USDA) to replace “MyPyramid”. The initiative of “MyPlate” (as seen below) is to divide your plate into four sections: fruits, vegetables, grains and proteins, as well as a glass of a dairy product. Go to http://www.choosemyplate.gov/food-groups/ to find examples of foods for each section of your plate, portion sizes, benefits and helpful tips.

Shaping up your plate is about balancing your calories. You should enjoy your food, but avoid oversized portions. Increase some foods, while reducing others. By ensuring that half of your plate is made up of fruits and vegetables, you will feel full without going overboard on calories. Make at least half of your grains whole by choosing brown rice, whole wheat bread and quinoa.

Switch to fat-free or low-fat (1%) milk and dairy products. You can reduce your sodium intake by reading food labels on various foods such as soups, bread and frozen meals, and choosing foods that are lower in sodium. Lastly, make sure to drink water or sugar-free beverages in place of sugary ones.

What better time to re-vamp what’s on your plate than spring. March marks the beginning of spring when various fruits and vegetables like broccoli, beets, blood oranges, chard, kale, lemons, mushrooms and strawberries are beginning to wake up from their long winter’s nap and make their grand entrance onto your plate. Planning your meals around fruits and vegetables that are in season will make shopping easier, and lead to better-tasting meals made with fresh ingredients.

Visit http://www.myrecipes.com/recipe/pasta-with-white-beans-kale-10000000223294/  to find a recipe using kale. (*Substitute whole wheat pasta to increase the fiber content.) Serve this pasta with a side of roasted asparagus topped with orange segments to shape up your plate!

Make March your start for simple changes that will last a lifetime.

Resources: www.choosemyplate.gov , www.myplate.gov , www.eatright.org and www.cookinglight.com .

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Heart Murmurs in Children


Nita Doshi, M.D., pediatric cardiologist at CHOC Children’s

As Heart Month comes to a close, check out these helpful facts about heart murmurs in children from Dr. Nita Doshi, pediatric cardiologist at CHOC Children’s.

My pediatrician heard a “heart murmur” in my child.  What is a heart murmur?

A “heart murmur” is an extra noise or sound which can be heard when listening to the heart with a stethoscope.  When blood travels through the veins, arteries, and valves of the heart, the flow of blood can create a sound.  This sound has often been described as having a “swishing” or “whooshing” quality. This sound is frequently referred to as a “heart murmur.”

Does the finding of a heart murmur mean that something is wrong with my child’s heart?

It is very important to remember that a “heart murmur” is simply a noise or a sound.  It is a finding detected by listening through a stethoscope during an examination.  Most of the time, heart murmurs are normal and do not indicate anything is wrong with the heart.

How commonly are heart murmurs diagnosed in children?

Studies have estimated that up to 90% of infants and children will have a heart murmur at some point during infancy or childhood.  But of all heart murmurs, only about 1-3% of children will be found to have a congenital heart problem.

What is an “innocent” murmur?

Innocent heart murmurs have also been called:  “benign,” “physiologic,” “functional,” or “flow-related,” meaning that normal blood flow creates a sound which can be heard during examination.  In younger children, it is often easier to hear a murmur because the distance between the heart and the chest wall is typically closer.  Because innocent heart murmurs are related to blood flow as well as changing chest configuration and heart rate, heart murmurs may disappear and reappear at various times.  As an example, periods of increased activity and fever are common times when a heart murmur may be heard.

What is a “non-innocent” murmur?

Heart murmurs can be termed “non-innocent” or “pathologic,” meaning that the sound may represent an abnormality of the heart muscle, walls, valves, or arteries.  For instance, a pathologic murmur can represent the sound of blockage of outflow from the pumping chambers, which dispenses blood to the lungs and the body.  It may also signify a hole within the wall inside the heart, narrowing or malformation of one of the heart valves, leakage of one of the heart valves, or narrowing of one of the arteries supplying blood to the lungs or body.

What may further evaluation of a heart murmur involve?

Your pediatrician may choose to refer your child with a heart murmur to a pediatric cardiologist.  A pediatric cardiologist is a specialist of heart disease in fetuses, infants, children, and young adults.  Your pediatrician or pediatric cardiologist may decide to order an “electrocardiogram,” which is a non-invasive test that measures the electrical activity or rhythm of the heart.  Your pediatrician or pediatric cardiologist may decide to order an “echocardiogram” otherwise known as an ultrasound of the heart, which is another type of non-invasive test that can further evaluate the structure and function of the components of the heart.

Find more information about programs and services at the CHOC Children’s Heart Institute.

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Heart Imaging Goes 3-D

And no special 3-D glasses are required. Magnetic resonance (MR) angiography gives our CHOC pediatric cardiac specialists an unprecedented, crystal-clear view into our patients’ hearts and surrounding blood vessels.

If a single picture is worth a thousand words, consider the value of a complete 3-D reconstruction of the heart and the major blood vessels that may be viewed from any angle. These images may also be magnified, flipped, rotated, color-enhanced and even animated into a movie, showing every precise detail in motion.

In children with complex, congenital heart disease, no two hearts are alike. MR angiography has become an indispensable diagnostic tool, providing unparalled views into the deepest abnormal, anatomic structures within a child’s heart. And best of all, this procedure is noninvasive and free of radiation. It is better tolerated by patients than diagnostic cardiac catheterization and does not usually require sedation or anesthesia.

Pierangelo Renella, M.D., CHOC Pediatric Cardiologist

“When standard imaging is not enough, MR angiography offers a way to obtain critical information needed to make complex cardiac diagnoses,” says Pierangelo Renella, M.D., pediatric cardiologist and advanced cardiac imaging specialist at CHOC Children’s. This technology helps surgeons plan safer and more effective procedures, and can be used to follow patients over time as it provides details for making decisions about medication and possible future surgeries.”

“State of the Art” is Our Standard of Care

Pictured is a 3-D volume rendered MR angiogram of the major blood vessels of the chest and abdomen.

The CHOC Children’s Heart Institute is the only center in Orange County providing pediatric MR angiography. Our hospital has two magnetic resonance imaging systems, featuring 1.5 and 3 power Tesla magnets — the strongest magnets available for MR magnetic resonance imaging. Just two more reasons why when it comes to caring for infants, children and adolescents with complex, congenital heart conditions — there’s no place like CHOC.

Find more information about the CHOC Children’s Heart Institute‘s programs and services.

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Protect Your Little One’s Smile


I bet you didn’t know that in addition to Heart Month, February is also National Children’s Dental Health Month! This is a great time to teach your kiddos about the importance of oral health. Developing good habits at an early age and scheduling regular dentist visits can help children stay on track in maintaining healthy teeth and gums.

Check out the tips below, recommended by Richard Mungo, D.D.S., a pediatric dentist at CHOC Children’s:

  • Take your child to the dentist by the time he or she is 12 months old – or as soon as he or she gets his or her first tooth.
  • After each feeding, wipe your infants tongue and gums with a wet cloth.
  • When the first tooth appears, begin brushing with water, or an appropriate baby toothpaste. Toothpaste with fluoride is not recommended until your child is old enough to spit and swallow the toothpaste – around age 3.
  • Come up with, or play, a fun song for your kids while they are brushing their teeth to get them used to brushing for a full 2 to 3 minutes.
  • Remind your kids not to eat sugary foods between meals.
  • Instruct them on the proper way to floss – Carefully insert the floss between two teeth, using a back and forth motion. Gently bring the floss to the gumline, but don’t force it under the gums. Curve the floss around the edge of your tooth in the shape of the letter “C” and slide it up and down the side of each tooth.
  • When brushing, have your kids hold their brush at a 45-degree angle against their gumline. Gently brush from where the tooth and gum meet to the chewing surface in short strokes. Brushing too hard can cause receding gums or tooth sensitivity.
  • Lastly, create a calm, positive attitude about going to the dentist. Children can pick up on a parent’s anxiety and associate the dentist with a negative experience.

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Chest Pain – What Parents Should Know

In honor of American Heart Month, check out these important guidelines to help you determine whether your child’s chest pain could be associated with heart disease. In this Q&A, Dr. Pierangelo Renella, a pediatric cardiologist at CHOC Children’s, explains the signs and causes of this common condition, rarely associated with the heart.

Q: What causes chest pain in children?
A:  The most common cause of chest pain in children is pain in the muscles that make up the chest wall and not the heart itself.  This type of pain is usually referred to as “musculoskeletal pain.”  Another common cause of childhood chest pain is costochondritis, which is inflammation in the cartilages at the ends of the ribs.  Other causes may include respiratory infections, asthma, acid reflux (“heartburn”), or a partially collapsed lung, for example.  These are usually not life-threatening.  However, in rare situations, there are serious forms of heart disease that can cause chest pain, and these usually require a pediatric cardiologist’s assistance to diagnose and treat.

Q: How often is chest pain in children due to a heart problem?
A:  Although childhood chest pain is the second most common reason for referral to a pediatric cardiologist, it only rarely means the child has actual heart disease.

Q: How do I know when my child’s chest pain needs medical attention?
A:  Chest pain that occurs with, or immediately after, exercise should be evaluated further, starting with your child’s pediatrician.  In addition, for chest pain that is associated with fast heartbeat, dizziness, or fainting, or if there is a family history of sudden cardiac death, your pediatrician may refer your child to a pediatric cardiologist.

Q: How can I help prevent my child’s chest pain?
A:  Again, the vast majority of childhood chest pain is not heart-related.  Since the most common causes involve the muscles and bones of the chest wall, the pain should improve with rest and anti-inflammatory medications such as acetaminophen or ibuprofen.  If these treatments do not work, and if the pain is significant, worsening, or associated with other signs and symptoms such as dizziness, fainting, shortness of breath, fast heartbeat, or exercise, make an appointment with your child’s pediatrician immediately.

Learn more about the CHOC Children’s Heart Institute.

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Be Good to Your Heart – And Your Children’s Too!

By Katherine Phillips RD MPH, clinical dietitian at CHOC Children’s

Did you know that heart disease is the leading cause of death for both men and women in the United States? In 2010, heart disease services, medications and lost productivity cost the United States $316.4 billion, making it an expensive yet very preventable disease. The most common type of heart disease is coronary artery disease, which can cause heart attack, angina, heart failure and arrhythmias. According to the Centers for Disease Control and Prevention, heart disease is the cause of death for one in every four adult Americans.

However, adults aren’t the only ones at risk. Children are now developing cardiovascular disease risk factors that were previously only seen in adults. Children who are obese are at a higher risk of cardiovascular disease risk factors such as high blood pressure, type 2 diabetes and elevated blood cholesterol levels. One study estimated that as many as 70% of obese children have at least one risk factor for cardiovascular disease.

Prevention and early action are the keys to decreasing your risk and your children’s risk of developing heart disease.  The highest risk factors for heart disease include inactivity, obesity, high blood pressure, cigarette smoking, high cholesterol and diabetes.  Here are some ways you can reduce the risk of heart disease in your family:

Know your family history
o Genetic factors can play a role in the development of heart disease.

Know your numbers (and your children’s numbers too!)
o High cholesterol, blood pressure and diabetes are three of the six top risk factors for developing heart disease, so keep them under control.
o New guidelines endorsed by the American Academy of Pediatrics state that all children, with or without a family history of heart disease, should have their cholesterol levels tested between the ages of 9 and 11, and then again between the ages of 17 and 21. Doctors think that this early testing and control of cholesterol levels in childhood can help reduce the risk of heart disease in adulthood.

Stop smoking
o Smoking increases the risk of cardiovascular disease by two to four times!

Improve your diet
o Diets high in saturated fats and cholesterol can raise blood cholesterol levels and promote atherosclerosis. High salt or sodium in the diet causes raised blood pressure levels.
o Choose lean meats, low-fat or fat- free dairy products; decrease foods high in saturated fat, cholesterol, sugar, and salt/sodium; and watch portion sizes.
o Increase fruit, vegetable and whole grain intake.
o Plan your meals ahead of time so you aren’t scrambling for something quick and unhealthy at the last minute.
o Do not use food as a reward for good behavior or good grades.
o Limit snacking and be aware of the snack foods your children are eating.
o Know what your child eats at school.
o Eat meals as a family so it is easier to know what and how much your child is eating.

Be active
o 150 minutes of moderate intensity physical activity every week (or just 20 minutes each day) can decrease your risk of heart disease.
o Aim for 60 minutes of physical activity for your child every day.
o Find fun exercise activities you can do as a family.
o Limit the amount of time you and your child spend watching TV and playing on the computer.

Control your weight
o Losing just 5–10 percent of your current weight over 6 months will lower your risk for heart disease and other conditions.
o If your child is overweight and there is no illness or condition causing the obesity, ask your doctor or a registered dietitian to provide you with some resources to help your child either lose weight or control their rate of weight gain while they grow.

Drink less alcohol
o Excessive alcohol use leads to an increase in blood pressure, and increases the risk for heart disease. It also increases blood levels of triglycerides, which contribute to atherosclerosis.
o Drink no more than one alcohol drink per day if you’re a woman and two alcohol drinks per day if you’re a man.

Be a good role model for your children. Parents who model healthy eating and physical activity can positively influence their children’s health.

For more information:
Harvard School of Public Health-The Nutrition Source: http://www.hsph.harvard.edu/nutritionsource/index.html
Center for Disease Control and Prevention: http://www.cdc.gov/heartdisease/index.htm
American Heart Association: http://www.heart.org/HEARTORG/

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Easy Substitutions for a Healthier Heart

In honor of American Heart Month, try these smart substitutions recommended by the American Heart Association, for a healthier heart for the entire family.

When cooking your favorite recipes, you can use these lower-fat ingredients, which can help cut down on saturated fats and cholesterol, without having to substitute the taste:

Instead of butter (1 tablespoon) —   Use 1 tablespoon soft margarine (low in saturated fat and 0 grams trans fat) or 3/4 tablespoon liquid vegetable oil

Instead of whole milk (1 cup) —   Use 1 cup fat-free or low-fat milk, plus one tablespoon of liquid vegetable oil

Instead of heavy cream (1 cup) —   Use 1 cup evaporated skim milk or 1/2 cup low-fat yogurt and 1/2 cup plain low-fat unsalted cottage cheese

Instead of sour cream —   Use low-fat unsalted cottage cheese plus low-fat or fat-free yogurt; or just use fat-free sour cream

Instead of cream cheese —   Use 4 tablespoons soft margarine (low in saturated fat and 0 grams trans fat) blended with 1 cup dry, unsalted low-fat cottage cheese; add a small amount of fat-free milk if needed

Instead of Egg (1) —   Use 2 egg whites; or choose a commercially made, cholesterol-free egg substitute (1/4 cup)

Snack healthier, too, with these yummy substitutions:

Instead of regular potato or corn chips —   Enjoy pretzels or low-fat potato chips (reduced sodium version)

Instead of ice cream bars —   Enjoy frozen fruit bars

Instead of a doughnut —   Enjoy a bagel or toast

Instead of high-fat cookies and crackers —   Enjoy fat-free or low-fat cookies, crackers (such as graham crackers, rice cakes, fig and other fruit bars, ginger snaps and  molasses cookies)


The CHOC Children’s Heart Institute brings hope to children with heart disease and their families, providing state of the art diagnosis and treatment for an entire spectrum of cardiac conditions in newborns to adolescents. For more information on programs and services at CHOC Children’s Heart Institute, please visit: http://www.choc.org/heart/index.cfm

Teaching Children Good Sportsmanship

It’s Super Bowl Time! – A great opportunity to spend time with friends and family, and to teach kids about the importance of good sportsmanship.

Parents and kids alike love sports, and it’s easy to get caught up in a game and become focused on winning. Yet there is much more to be gained from the sports experience than a winning record. When children and teens are involved in sports, they are able to learn and put into practice values that will stay with them for the rest of their lives.

Good sportsmanship is one of the life lessons that children can learn from sports. You can help your children understand and value good sportsmanship while making sure they have a safe and fun sports experience. Here are some important principles to instill in your children:

• If you lose, don’t make up excuses.
• If you win, don’t rub it in.
• Learn from mistakes and get back in the game.
• Always do your best.
• If someone else makes a mistake, remain encouraging and avoid criticizing.

Parents are important role models, so let your children see you upholding these principles, whether you play a sport yourself or root for your child’s team from the sidelines.

Good sportsmanship also includes following certain guidelines for good behavior. Share these concepts with your children:

• Avoid arguing. Stay focused on the game instead of giving in to anger with teammates, coaches, or referees. Always avoid using bad language and negative words.

 Everyone should have a chance to play. In youth sports, it’s important to encourage even those players who are the least skilled to have fun playing in the game. Parents, coaches, and even other players have an important role in allowing less talented teammates time to participate.

• Play fair. Good sportsmen want to win because they followed the rules and played the best game they could. Never support any effort to win that attempts to go around the rules. Cheating is not acceptable.

• Follow directions. Emphasize the importance of listening to coaches and referees and following their directions while on the field and involved in team activities.

• Respect the other team. Whether your team wins or loses, it’s important to show respect for the effort of the other team. If the other team wins, accept defeat, acknowledge their abilities, and move on. If your team wins, resist bragging—that’s what it means to be a gracious winner.

• Encourage teammates. Team sports work best when each individual supports the team. Praise teammates for what they do well and encourage them when they make mistakes. Avoid criticism and unkind actions. Parents should model this behavior for children by praising them for specific things they have done well, even if they made a mistake or may not have played as well as hoped.

• Respect the decisions of referees and other officials. These people are charged with making difficult decisions about plays in the game. Good sportsmanship requires that you accept a call, even if you disagree with it. Remember that it’s only one call in a long game—get back into play and focus on the game.

• End with a handshake. Good sportsmen enjoy sports and know how to end a game on a positive note, whether or not they won. Threats, anger, criticism, and other negative expressions are not acceptable.

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