Breastfeeding: A Foundation for Life

By Alana Salcido, registered nurse and lactation consultant at CHOC Children’s

If you were to ask me back in nursing school what kind of nurse I wanted to be, I guarantee I never would have said I wanted to become a lactation consultant. I honestly didn’t even know this was a specialty at that time. Helping other moms succeed with breastfeeding is my way of giving back and my way of changing the world, one couple at a time.

World Breastfeeding Week 2018

Today kicks off World Breastfeeding Week, an annual observance to bring awareness to the importance of human milk and to offer education and encouragement to mothers, health care providers, and the community.

Breast milk is constantly changing

A mother’s milk is constantly changing. Her milk will actually change from feeding to feeding, day to day, month to month as her baby grows. For example, the first milk, known as colostrum, is rich in components that prevent and protect the newborn from common and potentially serious infections. Breastfeeding not only provides exceptional nutrition but it also promotes lifelong health benefits.

Benefits of breastfeeding: preventing disease

Breastfeeding is the most economical solution to the biggest threat against children’s health worldwide: malnutrition and preventable diseases. In developing countries, human milk can mean the difference between life or death in children under five because a mother’s milk provides necessary nourishment for babies.

Breast milk-fed infants have significantly lower rates of illness—even in industrialized countries. The longer a mother breastfeeds, the more infection fighting antibodies are passed to her infant through her milk. Just as the womb protected and nourished the developing child during pregnancy, the body was preparing to protect and nourish her baby after birth by stimulating milk production as early as 12-14 weeks gestation.

Lifelong benefits of breastfeeding

Research has shown that babies who receive breast milk have a lower risk of hypertension, type 1 and type 2 diabetes, allergies, cancer, asthma, intestinal and respiratory infections, and obesity both during childhood and adulthood. Health benefits occur not only for the baby, but for the mother as well. Breastfeeding helps reduce the maternal risks of diseases such as hypertension, type II diabetes, high cholesterol, osteoporosis, breast cancer, and even Alzheimer’s Disease. Research has shown that the health benefits, for both mom and baby, are dose dependent. This means that the longer a woman breastfeeds the greater the health benefits she and her baby receive. Because of this, the WHO (World Health Organization) recommends breast milk in a child’s diet for the first two years of life (with the addition of appropriate complimentary solid foods beginning at 6 months of age).

Lactation consultants can help mothers provide the benefits of breastfeeding

Some mothers who wish to breastfeed their babies face challenges. Statistically, 75 percent of moms in the U.S. start out breastfeeding. By the time babies are six months old, only 44 percent are breastfed.

CHOC Children’s has a team of registered nurses who are international board-certified lactation consultants. We work closely with medical teams to provide support to mothers who need assistance in producing lifesaving breast milk for children. We can also help them achieve their lactation goals which may be different for each mother and could include pumping milk for the first six months, or it might be to exclusively breastfeed until the baby is a year old. We want every child at CHOC to receive optimal nutrition. For the newborn, infant and young child, we support breastfeeding and breast milk use. We firmly believe it when we tell our families that breast milk Is medicine.

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Answers to Parents’ Most Common Questions on Healthy Eating for Kids

By Vanessa Chrisman, clinical dietitian at CHOC Children’s

Healthy eating for kids is an essential part of their overall healthy lives. For children, it’s especially important because their growth and development depends on it. Parents play a large role in providing a healthy diet for their children, as well as establishing lifelong habits when it comes to food. In today’s world of fad diets and conflicting headlines about nutrition and health, it can be confusing for parents to navigate how to feed their children appropriately. Here are some of the most common nutrition questions I get from the parents of my patients.

My child wants to eat the same food every single day. Is this okay? How do I handle this?

Typically, toddlers are the ones who go on food jags – wanting to eat the same food at every meal, day in and day out. It often is a show of independence. This can happen with older children too. While it’s okay to eat the same healthy food every day, it’s the parents’ job to choose what foods to offer at meals. As an example, maybe your child wants cereal at every meal. Rather than provide this, offer other healthy foods and tell your child that she can have cereal for breakfast the next day. Your child then gets to choose whether she eats what is offered at that meal. If she doesn’t, don’t worry. Simply be patient and wait until the next snack time to offer more food. When your child becomes hungry, she will most likely eat what is offered.

My child is a picky eater. How can I convince him to eat more fruits and vegetables?

Start by serving a fruit and a vegetable with every meal. Serve the foods that he already accepts and eats. Introduce one new fruit or vegetable at a time. Make new foods more appealing by cutting them into fun shapes and sizes. Vegetables can be spiralized to look like pasta. Fruits can be cut into stars or dinosaurs with cookie cutters. Set a good example by eating fruits and vegetables regularly as a family. As parents, you are powerful role models for your children who are always watching and listening. Let your child help pick out fruits and vegetables in the grocery store as well as wash them at home. Fruits can be added to smoothies and yogurt and cereal. Vegetables can be cooked into spaghetti sauce or added to stir-fried rice or soups. Sometimes children will want to try new fruits and vegetables if you serve them with a favorite dip or sauce. Consistently serve fruits and vegetables at your meals and be patient. Limit grazing between meals to build hunger and avoid preparing a special meal for your picky eater. Eventually your child will come around and try some of these new foods. Praise the behaviors you want to encourage and give less attention to the pickiness or refusal to try new foods.

I don’t think that my toddler eats enough protein. How much is enough?

Many parents worry that their toddler is not getting enough protein in their diet. The truth is that it is quite easy for a toddler to meet his protein needs. Toddlers ages 1 to 3 need 1.2 grams of protein for every kg of body weight. This means that a healthy 2-year-old boy who weighs 27 pounds (or 12 kg) needs about 14-15 grams of protein per day. His protein needs could be met simply by: drinking eight ounces of one percent milk (eight grams protein) and eating two tablespoons of ground turkey or one large egg (seven grams of protein) in a day. If he drinks sixteen ounces of milk, his daily protein intake increases to 23 grams of protein, which is 150 percent of what he needs. Unless a toddler is eating a very restrictive diet, it’s rare for him to consume a diet low in protein.

My child loves to drink juice and soda but barely drinks any water. How can I get her to drink more water?

This is a challenge that many parents face. The first step is to cut back on the amount of juice or soda that is offered and consumed. Ideally, cut out soda and dilute juice with water. Limit juice to eight ounces or less per day. Provide your child with their own special bottle or cup. Consider using a special straw that they can pick out for themselves. Infuse the water by adding sliced lemons, limes, cucumber, berries, or mint to make a “spa water.” Keep water cold in the fridge. Try using frozen berries instead of ice cubes. Be a role model and carry a water bottle around for yourself. Offer stickers as an incentive for every time your young child drinks a cup of water. On a typical day, kids up to age 8 should drink the number of 8 oz. cups of water equal to their age. For example, a five-year-old should drink five 8-oz. glasses of water every day.

My child is underweight so I let her snack all day long. This will help her gain weight faster, right?

While some parents assume that their child will gain more weight if they are eating all day long, this is not often the case. For underweight children, there can be a tendency for parents to offer food to the child all day long, as well as allow them to ask for food whenever they want it. This does not allow for natural hunger or appetite to build. Instead, the child grazes on food throughout the day, often eating enough to tame hunger but not enough to truly feel full. The best approach is to follow a feeding schedule with planned meals and snacks every two to three hours. Only water should be consumed in between eating times. This helps build hunger. To help with weight gain, added fats and high calorie foods can be offered or used with meals. Sometimes an oral supplement is needed as well if the child is unable to consume enough food to fuel healthy weight gain. Speak with your child’s pediatrician and a registered dietitian for more individualized advice.

My child says he isn’t hungry in the morning and refuses to eat breakfast. How do I get him to eat?

This is a common challenge for many parents. Often, their child isn’t hungry or doesn’t have enough time to eat before heading off to school. To minimize the morning rush and make time for a healthy breakfast, prepare the night before. Close the kitchen by 8:00 p.m. to prevent unneeded late-night snacking. Make sure that your child goes to bed on time so that it’s easier for him to wake up in the morning. Have quick, healthy options on hand like low-sugar cereals with low-fat milk, fresh fruit and string cheese, whole grain muffins, or whole grain toast with peanut or almond butter. Consider offering non-breakfast foods as another way of enticing your child to eat. For those who don’t want to eat, sometimes drinking a fruit and yogurt smoothie works instead. For teens who skip breakfast in the hopes of losing weight, let them know that people who skip breakfast tend to gain weight, not lose. If all else fails, send your child with a healthy snack to be eaten at school.

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Gluten-Free Diets: Tips for How to Support Your Child

By Laura Clapper, registered dietitian at CHOC Children’s

Many people assume that since gluten can have such strong negative effects on some of us, that it would be safer if we all just avoided gluten. Wrong.

Gluten-free foods may be safe to eat, but they often come with a cost. Many gluten-free foods and snacks are higher in salt, fat and calories. Also, few gluten-free products are enriched with the essential vitamins and minerals that wheat-containing products contain. This means if you’re on a gluten-free diet not managed by a registered dietitian, you could be missing out on essential nutrients your body needs. At CHOC, our team of pediatric gastroenterologists work in tandem with registered dietitians to care for children who require a gluten-free diet.

Who needs to eliminate gluten from their diet?

Gluten-free diets are essential for anyone who has been diagnosed with celiac disease, or non-celiac gluten sensitivity. Children diagnosed with a wheat allergy are hypersensitive to wheat proteins, but generally can tolerate rye and barley. Learn more about celiac disease, gluten sensitivity and wheat allergies.

The gluten-free diet requires eliminating all foods and ingredients containing gluten. Here’s an easy checklist of foods and ingredients to avoid when removing gluten from your diet:

  1. Wheat (legally required to be declared on food labels)
    • Breads, baked goods
    • Soups
    • Pastas
    • Cereals
    • Sauces, roux
  2. Rye
    • Rye bread
    • Cereals
  3. Barley
    • Malt (malted flour, malted milkshakes, malt extract, malt syrup, malt flavorings, malt vinegar)
    • Soups
    • Cereals, snack bars
    • Brewer’s yeast (commonly used not only in beer but also in breadmaking)

Most people would know not to offer, say a traditional bagel or piece of toast to a child on a gluten-free diet. But parents and caregivers should be aware of the many hidden sources of gluten.

Hidden sources of gluten:

  • Broths
  • Chili sauce, soy sauce, salad dressings and marinades
  • Herbal supplements and teas
  • Deli meats
  • Play-dough
  • Vitamin and mineral supplements

Another important factor in adhering to a strict gluten-free diet is avoiding cross contamination.

Tips for avoiding cross-contamination in a gluten-free diet:

  • Use separate utensils, cutting boards, toaster, colanders and fryers
  • Store gluten-free items above gluten-containing products on shelves
  • Use a color-coded system so everyone in your home can easily identify gluten-containing and gluten-free products and ingredients
  • Use separate condiment jars, squeeze bottles and no double-dipping
  • Avoid bulk bins at a grocery store or farmers market, since utensils can be contaminated
  • Use caution with salad bars because toppings can easily be mixed

Another way to support your child with their gluten-free diet is to encourage them to eat naturally gluten-free foods such as vegetables, fruits, dairy, whole grains and legumes. Gluten-free grains and seeds include: brown rice, corn, gluten-free oats, popcorn, and quinoa. Gluten-free beans and legumes include: black/garbanzo/lima/pinto/kidney beans, edamame, lentils and peas.

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Ideas for Kid-Friendly Beach Food and Kid-Friendly Beach Snacks

By Gina O’Toole, clinical dietitian at CHOC Children’s

Summer is just around the corner, and soon school will be out. Beach days are a great way to spend an active day with your kids and enjoy the great weather of Southern California. With just a bit of pre-planning, you will be on your way to a healthy, hydrating and energy-packed meal plan filled with kid-friendly beach food and kid-friendly beach snacks. Avoid the hot and long lines at the beach food stand, which typically serve highly processed foods that are overpriced and can leave you feeling fatigued and dehydrated. So besides bringing the essential sunscreen, towel, umbrella and swim suit, here are a few tips to optimize your day.

Food safety at the beach

Food safety is key. Make sure you pack food in a cooler to prevent any foodborne illness for items like meat, cheeses and yogurts. You can freeze water bottles to provide ice for the food and a cold drink for later in the day or the drive home. Dust baby powder on sand-caked hands for easy removal, then follow with an antibacterial wipe before your kids dig into their beach eats.

Plan ahead the night before. Decide what snacks and lunch items you will prepare. When packing your picnic, utilize foods that are pre-packaged or easy to pre-pack and do not easily melt. Bring along an empty plastic grocery bag for trash and paper towels and plastic utensils for easy disposal.

How to keep hydrated at the beach

Focus on rehydrating with water, and avoid juices and sodas that contribute unnecessary calories and sugar to your diet.

Consider adding fruit, veggies and/or herbs to spice up plain water and make it more appealing to your kids. Try lime-mint, strawberry-basil, cucumber-blackberry or just plain orange or lemon slices. Avoid juices and sodas that contribute unnecessary calories and sugar

Or, try sparkling waters with no added sugars

Kid-friendly beach food
  • Peanut butter with sliced bananas and cinnamon on whole grain bread
  • Pasta salad: Whole wheat pasta, diced tomato, bell peppers, shredded carrots and zucchini; drizzle with balsamic vinegar and olive oil; sprinkle with salt, pepper and parmesan cheese (Best when made the night before to allow flavors to soak in)
  • Wrap it up with a whole grain tortilla
    • Rainbow wrap: Cream cheese, spinach and your child’s favorite crisp veggies (Carrots, cucumber, peppers, zucchini or summer squash)
    • Bean and guacamole wrap: Guacamole, black or pinto beans, cooked brown rice and shredded jack or cheddar cheese
    • Eggs for lunch: Sautee peppers, onions and scramble eggs, top with a sprinkle of cheddar or jack cheese
    • Herby turkey: Herbed cream cheese, nitrate free turkey, spinach or romaine lettuce, thin sliced tomato)
  • Pair your main meal with additional sliced and refreshing veggies like jicama, cucumber, celery or cherry tomatoes
  • For desert, try some ripe and sweet summer produce. Sliced watermelon, cantaloupe or honeydew and cherries are all refreshing on a hot day. Although nectarines, peaches and apricots are at their prime during beach season, they bruise easily and need to be packed carefully.
Kid-friendly beach snacks

Pair food groups (protein, fat, carbohydrate) to give you energy and keep you full longer:

  • Pre-cut cucumbers and peppers with a single-serving hummus pack
  • Pre-cut apples or celery and single-serving peanut, almond or cashew butter
  • String cheese and grapes
  • Single-serving cottage cheese and fresh cut strawberries
  • Single-serving plain Greek yogurt with fresh blueberries
  • Pre-packaged nuts
  • Fresh or dried edamame

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Benefits of a Mediterranean Diet for your Family

By Monica Evans, clinical dietitian at CHOC Children’s

If there’s one diet that most dietitians agree is healthy and good for the whole family, it’s the Mediterranean diet. Chock-full of plant-based foods like fruits, vegetables, whole grains, beans, and nuts, the Mediterranean diet has all the makings of nutritious and sustainable way of eating. Research in adults has shown that the traditional Mediterranean diet reduces the risk of heart disease, some cancers, as well as Parkinson’s and Alzheimer’s diseases. In children, the abundance of fruits, vegetables and whole grains in the diet provide important vitamins and minerals that help support growth and development.

Here are some Mediterranean diet basics to get you started:

  1. Center most of your meals on plant-based foods rather than a heavy protein food, like meat. The typical American meal is often created around a higher-fat meat. Switching that meat to a vegetable, bean or whole grain can deliver a healthy dose of fiber and take away the unhealthy saturated fats that can eventually lead to heart disease.
  2. Eat more beans! Red meat is discouraged in the Mediterranean diet, but when you’re craving something similar, try beans. They are full of protein and fiber and are low in fat.
  3. More fish please! Seafood is high in heart-healthy omega 3 fatty acids and protein. Another benefit of fish is that it typically takes less time to cook than chicken, turkey or beef.
  4. Replace butter with olive oil, which contains monounsaturated fat and can help reduce LDL (or bad) cholesterol levels.
  5. Have nuts as a snack or add them on to meals. Small amounts of nuts can help keep you full throughout the day and give your body a hefty dose of heart-healthy fats.
  6. Limit red meat consumption to only a few times per month. Beef, lamb and pork are typically high in saturated fat and the Mediterranean diet discourages consuming them often.
  7. Enjoy low-fat dairy. Dairy products can be high in saturated fat, but choosing lower-fat milk and cheese products allows you to receive the same essential vitamins and minerals important for growth and development without the high levels of unhealthy fat.

The best way to incorporate a new way of eating is to do it slowly and intentionally. Analyze your family’s diet and identify foods that you could easily swap out for healthier, more Mediterranean diet-friendly foods.

Easy ways to incorporate the Mediterranean diet into your lifestyle:

  • If you like cucumbers with ranch dressing, try dipping cucumber in hummus
  • Instead of serving spaghetti with buttered garlic toast, cook whole grain spaghetti served with bread dipped in olive oil and minced garlic
  • Swap beef tacos with tortilla chips for fish tacos with black beans

Try homemade trail mix with nuts and dried fruit for a snack

Mediterranean-friendly family recipes:

Easy Hummus Recipe

  • 1 15 oz can garbanzo beans/chickpeas, drained and rinsed
  • 2 garlic cloves
  • 2 tbsp lemon juice
  • 3 tbsp extra-virgin olive oil
  • 3 tbsp water
  • ½ tsp ground cumin
  • ¼ tsp salt

Place beans, garlic, lemon juice, oil, and water into food processor. Blend to desired consistency. Season with cumin and salt. Enjoy with whole grain crackers or fresh vegetables.

Adapted from

Fig & Honey Yogurt

  • 2/3 cup low-fat plain Greek yogurt
  • 3 dried figs, sliced
  • 2 tsp honey

Top yogurt with fig slices and honey. Enjoy!

Recipe via

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