Happy World Breastfeeding Week 2012

By Cindy Baker-Fox, RN, IBCLC, lactation consultant at CHOC Children’s

August 1-7 marks the 20th annual World Breastfeeding Week (WBW), a yearly event which began in 2002, by the World Alliance for Breastfeeding Action (WABA). World Breastfeeding Week is now recognized and celebrated in more than 170 countries worldwide. It commemorates the joint efforts of WHO (World Health Organization) and UNICEF in their collaboration and development of the Innocenti Declaration, a policy created to protect, promote, and support breastfeeding throughout the world. The Innocenti Declaration remains a cornerstone in guiding public and private breastfeeding policies, practices, and programs throughout every continent and most countries worldwide.

World Breastfeeding Week aims to celebrate this historic event and its ongoing impact on the health of babies and mothers around the world through breastfeeding awareness, education, and support. The theme of World Breastfeeding Week  2012 is “Understanding the Past—Planning the Future.”  It is a time to reflect on the progress made in breastfeeding promotion and education and the ongoing efforts that are still to be made.

In 2002, WABA launched the first WBW with a campaign known as the “Baby-Friendly Hospital Initiative”. This campaign began a worldwide push to provide breastfeeding education, services, support, and trained lactation staff in every delivery hospital, clinic, and birthing center worldwide and to every women and newborn, despite their circumstances and resources culturally, socially, or economically. The goal was to reach every mother and newborn with proper information and skills to promote breastfeeding as a means of reducing infant mortality and morbidity worldwide.

According to UNICEF’s State of the World’s Children Report 2011, 136.7 million babies are born worldwide and only 32.6% of them are breastfeed exclusively in the first six months.  In July 2012, the WHO reported that, “poor breastfeeding rates contribute to over a million avoidable child deaths each year.”  Breastfeeding is a human rights issue that required the development of international policies and practices to assure adequate nutrition for every newborn.  This is truly a week to remember and celebrate.

At CHOC, we strive to support and promote breastfeeding for our patients.   CHOC’s lactation program began in 2001 with the hiring of a full time RN, IBCLC (International Board Certified Lactation Consultant).  Since then, CHOC’s commitment to optimal nutrition for our tiny babies and at risk patients has lead to additional funding for staff to provide lactation services throughout the hospital.  The Clinical Nutrition and Lactation program at CHOC currently employs 3 registered nurses and 2 registered dietitians who are IBCLC’s as well as 4 Certified Lactation Educators (CLE).  Throughout CHOC many staff have participated in various levels of lactation training including the completion of the Certified Lactation Educator training.

To further support our patients’ unique lactation needs, CHOC has hosted several educational opportunities for healthcare professionals, including a joint conference with the American Medical Association in 2009, the La Leche League  Conference in 2012, and the recent annual hosting of the University of California—San Diego CLE course.

CHOC’s lactation program is rich in history and our commitment to the core values and goals set forth 20 years ago by WHO, UNICEF, and WABA will continue to lead us in our pursuit for optimal nutrition for our young patients and further CHOC’s commitment to providing lactation services to all those in need. Join us in celebrating World Breastfeeding Week 2012!

For more information on World Breastfeeding Week and how you can become involved visit http://worldbreastfeedingweek.org.

For additional lactation information or services, visit the Clinical Nutrition and Lactation Department’s Web page.

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July is National Blueberry Month

By Joanne DeMarchi, MS, RD, IBCLC, clinical dietitian at CHOC Children’s

Summer is the height of berry season, and no berry says summer more than the blueberry. Blueberries contain dietary fiber, vitamins A and C and are one of the most antioxidant rich foods in the world.  Here is the scoop on blueberries.

High fiber foods benefit digestive and heart health. 1 cup of blueberries provides 3.6 grams of fiber.  Add that to a cup of oatmeal or other whole grain cereal and your meal will provide almost 20% of your fiber goal for the day.

Vitamin C
One serving of blueberries (about 1 cup) provides 25% of the daily recommended intake of vitamin C. Vitamin C is one of the most common antioxidants and contributes to healthy gums, absorption of iron and healthy capillaries, formation of collagen and a healthy immune system.

Antioxidant activity
Antioxidants work to neutralize free radicals — unstable molecules linked to the development of cancer, cardiovascular disease and other age-related conditions such as Alzheimer’s. Substances in blueberries called polyphenols, specifically the anthocyanins that give the fruit its blue hue, are the major contributors to antioxidant activity.

If you are traveling this summer, why not find a farm to go blueberry picking.  Six states account for more than 90 percent of the crop: Michigan, New Jersey, Oregon, North Carolina, Georgia and Washington.  Use this website to find blueberry farms in these and other US states where you can pick your own. http://www.nabcblues.org/index.html

Once you’ve picked your berries pour them over cereal or yogurt, add them to fruit or green salads for a delicious, healthful taste of summer.  Keep blueberries in your diet during the rest of the year by trying this frozen blueberry smoothie recipe.  It makes a great grab and go breakfast treat.

Frozen Blueberry Smoothie recipe

  • 1/2 cup frozen blueberries
  • 1/2 cup low-fat vanilla yogurt
  • 1/2 cup 1% milk
  • 1 tablespoon honey
  •  2-3 ice cubes (optional)

Combine all ingredients in a blender and blend until smooth or to desired consistency then serve.


  • Calories: 243
  • Total Fat: 2.9g
  •  Total Carbohydrates: 43.8g
  • Fiber: 1.8g
  •  Sugars: 40.7g
  • Protein: 11.8g

To learn more about Clinical Nutrition and Lactation Services at CHOC, please visit http://www.choc.org/services/index.cfm?id=P00321.

What is Eosinophilic Esophagitis?

In recognition of National Eosinophil Awareness Week, coming up May 13-19, Shonda Brown, RD, CNSC, clinical dietitian at CHOC Children’s, explains what Eosinophilic Esophagitis is, and how this unique condition is treated.

Imagine having abdominal pain so severe you are taken to the emergency department in fear of yourself having a heart attack, or unable to eat a meal without thinking if you are going to get food stuck in your throat.  These are a few things I have heard from patients to describe their symptoms of Eosinophilic Esophagitis (EoE).  EoE is characterized by eosinophil (a type of white blood cell) accumulation in the esophageal lining creating inflammation and a variety of adverse symptoms.  Some common symptoms are vomiting, abdominal pain, reflux-like symptoms, poor weight gain, trouble swallowing and food impaction (when food gets stuck in the throat).

Currently, the only way to make a diagnosis is by endoscopy with biopsies of the tissue lining the esophagus.  A small tube with a camera at the tip is inserted through the mouth and down through the GI tract.  The doctor looks for any signs of inflammation as well as takes small tissue samples to be examined with a microscope.

Research has shown that food allergies are the most common cause of EoE.  Once a diagnosis is confirmed, children are referred to an allergist for allergy testing to guide treatment.  Treatment options include food elimination diets, specialized formulas, and/or medication therapy (usually swallowed steroids from an inhaler).  A directed elimination diet is one dietary treatment approach that includes food avoidance of those showing a positive reaction on allergy testing.

Another approach is to eliminate the top known allergens; this is referred to as the six food elimination diet and includes elimination of milk, soy, egg, wheat, peanuts and tree nuts, and seafood.  Specialized formulas may be recommended (called elemental formulas) if a child has severe symptoms, if all food allergy testing was negative, or if previous treatment options were unsuccessful.  Elemental formulas contain proteins that have been completely broken down into their simplest form, amino acids, making them non-allergenic.

Treatment doesn’t end after foods are eliminated.  To determine the offending foods, a child must undergo another endoscopy after eliminating the possible allergens for a set period of time to see if the eosinophils have gone away.  After a clear endoscopy, foods are reintroduced in a stepwise fashion while monitoring for return of symptoms and confirmation of disease reappearance with further endoscopies.  Food and eating is much more than just providing our bodies with energy and nutrition.  The diet therapies that are used to treat and identify food allergens can radically change the way of life for a family. It’s difficult for a child to eliminate their favorite foods – think about a child who can’t even eat their own birthday cake!

The process of discovering the causative food(s) and establishing resolution of EoE can be a long, stressful and overwhelming experience.  CHOC Children’s has developed a multidisciplinary team centered approach in providing care for children with EoE.  Our clinic combines Allergy, Gastroenterology and Nutrition services so that our families receive comprehensive care for this chronic disease.

For more information on EoE, visit www.apfed.org  (The American Partnership for Eosinophilic Disorders).

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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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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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