How to Boost Your Child’s Bone Health

Physical activity, calcium and vitamin D are essential for building strong bones, says Dr. Samuel Rosenfeld, orthopaedic surgeon with the CHOC Children’s Orthopaedic Institute. Developing good bone health during childhood helps prevent fractures and osteoporosis later in life.

bone health for kids
Dr. Samuel Rosenfeld, an orthopaedic surgeon at CHOC Children’s, offers tips on how to boost bone health for kids.

Bone is living tissue in the skeleton that constantly changes. Old bone gets replaced with new. The greatest amount of bone tissue grows during childhood and adolescence as the skeleton expands in size and density. It is during this period of active growth when calcium is essential. In addition to requiring a great deal of calcium, the young body absorbs calcium more effectively. For this reason, children need to “bank” extra calcium for bone health.

Some of the most common sources of calcium are from dairy products, such as milk, yogurt and cheese. Note, however, that calcium in dairy products are bound by fat and not absorbed. For that reason, children should get their dietary calcium from fat-free dairy products taken at least one hour away from meals. Other sources include calcium-fortified soy milk and juices, canned salmon (with bones) and sardines, and dark green, leafy vegetables, such as broccoli and kale.

For calcium to be effective in bone growth and development, it is also important that children get enough vitamin D. This can be done through careful sun exposure and eating vitamin D-rich foods such as fortified milk and milk products, cod liver oil, red meat, eggs, mushrooms and some fatty fish.

Calcium and vitamin-D supplements are also important to consider, to ensure children, especially those with certain chronic conditions, are getting enough bone-boosting nutrients. Parents should consult their child’s physician before giving supplements. In this video, Dr. Rosenfeld explains that building healthy bones actually starts while the child is still in the womb, and continues through childhood. Below are Dr. Rosenfeld’s general recommendations:

Age 7 and younger

Calcium intake: 250 mg twice daily

Vitamin D3 intake: 250 IUs twice daily

Ages 8-13

Calcium intake: 500 mg twice daily

Vitamin D3 intake: 500 IUs twice daily

Age 14 and older

Calcium intake: 600 mg twice daily

Vitamin D3 intake: 2000 IUs twice daily

In addition to a calcium and vitamin D-rich diet, children should participate in physical activity, advises Dr. Rosenfeld.

“Ideally, exercise should be part of a child’s daily routine. Parents should help their children find activities and sports they enjoy, so they’ll continue to participate in them,” says Dr. Rosenfeld.

Good bone health is not difficult to achieve and maintain, adds Dr. Rosenfeld.

“It doesn’t take fad pills or fancy supplements,” he explains.
“Establishing a routine of taking calcium and vitamin D, along with a little exercise, is the ‘prescription’ for healthy bones.”

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Year-Round Hydration Tips for the Whole Family

Summer may be around the corner, but hydration is an important part of your family’s health year-round. Keep in mind these easy hydration tips to ensure your family gets the fluid intake they need.

What is dehydration?

Dehydration is a condition that occurs when someone loses more fluids than he or she takes in. Infants and children are especially vulnerable because of their relatively small body weights and high turnover of water and electrolytes. They’re also the group most likely to experience diarrhea, a common cause of dehydration. Vomiting, fever, excessive heat/sweating, and increased urination can also lead to dehydration.

Symptoms of dehydration include:

  • Dry, sticky mouth
  • Sleepiness or tiredness- children are likely to be less active than usual
  • Thirst
  • Decreased urine output
  • No wet diapers for three hours for infants
  • Few or no tears when crying
  • Dry skin
  • Headache
  • Constipation
  • Dizziness or lightheadedness

What does proper hydration look like?

Staying healthy means staying hydrated, since our bodies depend on water to survive. Every cell, tissue and organ in your body needs water in order to work correctly. For example, your body uses water to maintain its temperature, remove waste and lubricate joints. Water is needed for good overall health.

Some of the top beverages I recommended to my patients for hydration include: water, low-fat or fat-free milk, and 100 percent fruit juice.

Keep in mind these tips for choosing healthy beverages:

  • Avoid drinking your calories
  • Avoid drinks that are high in sugar, such as soda, fruit drinks, punch, sweet tea, etc.
  • Choose beverages that have low or no added sugar
  • Remember that water is the source for hydration
  • Read nutrition labels and choose a beverage with less than 6 grams of sugar per serving
  • Be sure to double-check the serving size and number of servings in a bottle.

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Healthy Meal Prep Tips for Busy Parents

By Elise Harlow, registered dietitian at CHOC Children’s

When life gets busy, making homemade meals can fall to the bottom of your to-do list. Drive-through or take-out dinners may sound more appealing and time-friendly! While there is nothing wrong with the occasional fast-food meal, by cooking meals at home you can reduce the amount of added fat and sodium, and have control over the types of ingredients going into your family’s food.

To increase the amount of homemade meals you have on hand during busy times, meal planning and meal prepping can be your best friend. This can also be a great way to involve your kids in the kitchen and increase their interest in healthy foods.

Meal planning: this means taking one day out of the week to sit a down with a planner and plan out your meals for the upcoming week. After your meals are planned out, make a grocery list for all the ingredients you will need for the week.

Helpful tip: use leftovers from dinner for lunch the next day. For example, a roasted chicken for dinner can become a chicken salad sandwich for lunch the next day

How to involve your children: Let your children help you in planning meals by letting them choose what is for dinner one night a week. Maybe one day they can choose a meal that they know they like, and one day they get to pick a new food that they would like to try. You can even bring your children along with you to the grocery store to help pick up the ingredients needed for the week. Children tend to be more likely to try new foods when they have some sort of say in what they are eating.

Meal prepping: this means that once a week you pre-cook whatever meals from your meal plan that allow for this. For example,  roasting a chicken on Sunday and using the chicken in dishes for the rest of the week, or making lasagna on Sunday for dinner during the week, or portioning out yogurt and fruit in single-serving containers for easy grab-and-go breakfasts each day of the week.

How to involve your children: assign your children age-appropriate tasks that they can do on their own. Again, this will increase their interest in the food and could make them more likely to try new foods. Some ideas include scrubbing vegetables, counting ingredients, measuring, or mixing ingredients together.

A crock pot or slow-cooker can be your best friend during busy times. The beauty of a crock pot is that you can throw the ingredients in the crock pot in the morning on your way out the door to work and arrive home to a warm, homemade meal for you and your family. Looking for ideas? Below is a recipe for steel cut oats, that could even be cooked overnight, which means waking up to warm cooked breakfast!

Slow Cooker Steel Cut Oatmeal

Recipe adapted from
2 cups steel cut oats
6 cups water

2 cups milk of any type
2 tablespoons butter
2 to 3 peeled apples
¼ cup honey
2 teaspoon salt
1 tablespoon cinnamon
Optional add ins: flax seed, chia seed, almonds, pecans, shredded coconut, hemp seeds, pepitas, etc.


  1. Spray the slow cooker with cooking oil or brush with cooking oil to prevent sticking.
  2. Put all ingredients into the slow cooker. Cook on low for 8 hours or high for 4 hours.
  3. Top with optional add-ins of your choice.

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Tis the Season for Healthy Holiday Eating

By Lindsay Rypkema, registered dietitian at CHOC Children’s

The holidays are a time filled with family, friends and food. It is important for parents to model good eating habits as well as provide healthful meals and snacks in a season often filled with overindulgence. Eating healthy doesn’t mean you have to forgo all the holiday goodies your family loves, but small modifications can make a big impact. Below are some tips for healthy holiday eating.

  • Snack before you go: Never attend a holiday party hungry! To avoid overeating, consume a light snack at home such as vegetables and hummus or Greek yogurt and fruit. Protein and fiber will keep you full longer.
  • Prepare balanced meals: Choose one item from every food group. Limit the dessert options and always have fresh fruit and vegetables available.
  • Limit sugary drinks: Instead of cider, juice and soda, try infusing water with seasonal fresh fruit such as pomegranate, cranberries or blood orange. Wash fruit, slice and add to water pitcher. You can also use cookie cutters to make holiday shapes.
  • Limit sugar in baking: Baking is a fun holiday tradition but can result in excess calorie and sugar intake. Decrease sugar by 50 percent and add other spices such as vanilla, cinnamon or nutmeg for added flavor. Try replacing the recommended oil with unsweetened applesauce or mashed banana in a 1:1 ratio to decrease calories. This works well in cakes, muffins and breads.
  • Try making a visual and healthy treat: Healthy snacks and desserts don’t have to be boring. For example, you can make a candy cane out of banana and strawberries. Pinterest has some great ideas to make a Santa out of strawberries or a Grinch out of grapes.
  • Get a jump start on your family’s resolutions: Don’t wait until the New Year to increase physical activity. Take a walk or play flag football after your holiday meal. Exercise is an important part of healthy living.
  • Consider simple swaps: Side dishes such as mashed potatoes and stuffing are often a family favorite but can be very high in calories and tempting to overeat. Try offering quinoa in place of stuffing for a healthy, high protein option. Consider using plain Greek yogurt in place of sour cream for added protein. You can also make mashed potatoes out of cauliflower. Try this easy recipe this season:

Cauliflower Mashed Potatoes

2 head cauliflower, cut into florets

2 tablespoon olive oil

1/2 cup Parmesan cheese

2  tablespoons reduced – fat cream cheese

1/4 teaspoon garlic powder

*Salt and pepper to taste


Steam or boil cauliflower until tender. Mix olive oil, Parmesan, cream cheese, & garlic powder in bowl. Use food processor to blend cauliflower on high. Slowly add your oil/cheese mixture until completely blended. Salt and pepper to taste.

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Healthy Eating Tips for the School Year

It’s time to head back to school, and with that comes a fresh opportunity to establish new habits with children and teens. As your family falls into a routine around the school day, be sure to incorporate healthy eating into the mix to ensure everyone has a strong year.

Tips for School-Age Children (Ages 6-12)

School-age children need healthy foods and nutritious snacks to fuel their busy bodies. They have a consistent but slow rate of growth, requiring them to eat four to five times a day (including snacks). Eating healthy after-school snacks is important, as these snacks may contribute up to one-third of the total calorie intake for the day. Remember that school-age children may also be eating more foods outside of the home.

Many food habits, likes and dislikes are established during this time. This makes it a perfect time to experiment with new foods, as school-age children are often willing to eat a wider variety of foods than their younger siblings.

Follow these seven tips to ensure good nutrition habits for school-age children:

  1. Always serve breakfast, even if it has to be “on the run.” Some ideas for a quick, healthy breakfast include fruit, milk, bagel, cheese toast, cereal, peanut butter sandwich and fruit smoothies.
  2. Take advantage of big appetites after school by serving healthy snacks, such as fruit, vegetables and dip, yogurt, turkey or chicken sandwich, cheese and crackers, or milk and cereal.
  3. Make healthy foods easily accessible.
  4. Allow children to help with meal planning and preparation.
  5. Serve meals at the table, instead of in front of the television, to avoid distractions.
  6. Fill half of the plate with colorful fruits and vegetables.
  7. Provide calorie-free beverages (water) throughout the day, to avoid filling up on non-nutritive calories.

healthy eating tips

 Tips for Adolescents and Teens (Age 13 and Up)

During adolescence, children become more independent and make many food decisions on their own. Many adolescents experience a growth spurt and an increase in appetite, and they need healthy foods to meet their growth needs. Adolescents tend to eat more meals away from home than younger children. They are also heavily influenced by their peers.

Discuss these nine healthy eating tips with your adolescent to ensure he or she is following a healthy eating plan:

  1. Have several nutritious snack foods readily available. Oftentimes, teenagers will eat whatever is convenient.
  2. If there are foods that you do not want your teens to eat, avoid bringing them into the home.
  3. Drink water. Try to avoid drinks that are high in sugar. Fruit juice can have a lot of calories, so limit your adolescent’s intake. Whole fruit is always a better choice.
  4. When cooking for your adolescent, try to bake or broil instead of fry.
  5. Make sure your adolescent watches (and decreases, if necessary) his or her sugar intake.
  6. Eat more chicken and fish. Limit red meat intake, and choose lean cuts when possible.
  7. Arrange for teens to find out about nutrition for themselves by providing teen-oriented magazines or books with food articles and by encouraging them and supporting their interest in health, cooking or nutrition.
  8. Take their suggestions, when possible, regarding foods to prepare at home.
  9. Experiment with foods outside your own culture.

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No more wire bristles! Keeping your family barbecue safe

With cook-out season in full swing, CHOC Children’s safety experts caution parents to be mindful of an unexpected danger lingering long after the hamburgers are eaten and the grill has cooled.

Bristles from metal brushes commonly used to clean grills can fall off onto the grate and later become lodged into food. Ingesting these tiny metal fragments can cause damage to the throat and digestive track, says Amy Frias, a CHOC community educator and Safe Kids Orange County coordinator.

If parents suspect their child has ingested these remnants, they should seek medical attention immediately.

Parents can avoid this risk by relying on alternate methods and tools to clean up after grilling, Amy says. A host of alternative products are available, including grooved wooden planks that scrape off char; brushes that use scouring pads; pumice stone-like cleaning blocks; and nylon-bristle brushes.

A more natural method uses a halved onion, Amy says. Pierce the vegetable with a barbecue fork and rub the onion’s flat end across a very hot grill. This method should easily remove debris and dirt.

Barbecue tools aren’t the only safety risks when it comes to grilling, Amy says. To ensure the entire family stays safe, she offers a few other tips:

  • Location: Keep the grill away from high-traffic areas and enclosed spaces, such as eaves, overhead tree branches and deck railings. Never grill indoors or in a tent.
  • Perimeter: Create a 3-foot child- and pet-free zone around the grill.
  • Heat sources: Keep matches and lighters away from children. Take caution when using lighter fluid, and never add more fluid to a lit fire.
  • Thorough cleaning: More than the grill’s grate needs to be cleaned. Periodically remove grease from the trays below the grill to prevent fires.
  • Supervision: Never leave cooking food unattended.
  • Tools: Use long-handled grilling instruments to keep the chef at an appropriate distance from flames.
  • Wardrobe: Close-fitting clothes and pulled-back hair are always fashionable and safe when grilling.

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Peanut Allergies: Understanding the Latest Research

The New England Journal of Medicine recently published two studies that strengthen evidence that feeding peanuts and other allergy-inducing foods to babies is more likely to protect them than to cause problems.  Given previous recommendations, focused on food-avoidance, parents may be surprised by the latest research.  In this Q & A, Dr. Wan-Yin Chan, CHOC Children’s allergist and immunologist, offers the following explanation and highlights the newest approach to preventing peanut allergies and other food allergies.

Dr. Wan-Yin Chan

How many children are living with food allergies in the United States?

Food allergies strike approximately eight percent of children in the U.S., with less than two percent dealing with peanut allergies.   These allergies can present in a child as early as infancy, with the most common reactions being hives, itching, skin flushing (redness accompanied by a warming sensation), vomiting, facial swelling, wheezing, coughing, closing of the throat and cardiovascular collapse.

What do you think about the two new studies?

I am not surprised by the findings that early introduction can lead to a decrease in peanut allergies.  The first study demonstrated tolerance to peanuts after an avoidance period of 12 months.  This study is a follow-up to an earlier study last year that found a reduction in peanut allergy at the age of 5 after introducing peanut proteins to high-risk infants from 4 – 11 months of age.

The second study looked at introducing six common allergic foods in breastfed infants at 3 months of age (alongside continued breastfeeding) versus waiting until 6 months of age. The study showed significantly lower relative risks of peanut allergy and egg allergy in the early introduction group by 3 years of age; however, the risk of milk, sesame, fish and wheat allergies was not significantly impacted.

Will your team make any changes to the way you introduce allergy-inducing foods to patients?

We plan to allergy test high-risk patients (history of severe eczema and/or egg allergy) before deciding whether to introduce peanut into their diets.

What are different ways to introduce peanut into the diet?

For low risk infants, parents can introduce peanuts at home through peanut powder sprinkled into pureed foods, thinned smooth peanut butter or Bamba (peanut puff snack). Actual peanuts should not be given to children less than age 3 as they are choking hazards.

What do you anticipate will be parents’ reactions to these new guidelines?

Parents will probably be very surprised at first, given the old recommendations.  However, the latest research results provide scientific evidence that early introduction leads to a decrease in the incidence of peanut allergies and sustained tolerance.  Parents should address any concerns with their pediatrician, who may refer them to a pediatric allergist.

What additional research would you like to see conducted?

I’d like to see more research related to other common allergenic foods such as tree nuts and seafood, which can cause life-threatening reactions.

 Dr. Wan-Yin Chan is board certified in pediatrics and allergy & immunology. Prior to joining CHOC Childrens, she attended medical school at the College of Medicine at East Tennessee State University in Tennessee. She completed her pediatric residency and fellowship training in Immunology, Allergy and Rheumatology at the University of California, Los Angeles. Dr. Chan speaks fluent Cantonese.

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Avoid Becoming Thank-“full” this Holiday

By Sarah Kavlich, RD, CLEC, clinical dietitian at CHOC Children’s 

Today, in many American households, the Thanksgiving celebration is centered on gratitude and sharing a bountiful meal with family and friends. The star of the Thanksgiving meal is arguably a stuffed turkey; and often times after a day of feasting, that may not be too far off from the way we feel. You and your family can avoid overeating this holiday season with these easy steps:

  • Eat breakfast! Although known as the most important meal of the day, it is often thrown by the wayside, especially when we anticipate a larger meal to come. Instead, have a light breakfast before your feast, which can help keep you from overdoing it later.
  • Use smaller plates. We eat with our eyes and when we see a large plate with a lot of empty space, our brain has a tendency to think we are still hungry once we are finished. Instead, serve your appropriate portions on a smaller plate. Once you’ve finished your meal, you’ll be able to listen to your stomach when it tells you you’re full.
  • Load up on non-starchy veggies like salad and green beans. These sides can offer plenty of fiber, which can fill you up with out adding extra calories. If you are the cook, try a new spin on green bean casserole (see below), with all of the traditional flavors but without all of the traditional fat.
  • Hold the gravy. Did you know that gravy alone can add up to 170 calories in a half cup? Try your meal without it this year.
  • Skip the seconds. Just because it’s a holiday doesn’t mean your health goals need to take a holiday too. Focus on visiting with friends and family and not just eating. If you are truly still hungry later in the day, have a light snack to hold you over.
  • Stay active. Use this opportunity to spend time with those you love by going on a walk together before or after your meal.

Green Beans with Shallots and Almonds
2 pounds green beans, cut into 1 inch pieces
2 tablespoons olive oil
2 cups sliced shallots (about 4 large)
2 tablespoons unsalted butter, at room temperature
1/2 cup sliced almonds, toasted

Fill a large bowl with ice cubes and water. Bring a large pot of salted water to a boil. Add green beans to pot and cook until crisp-tender, about 5 minutes. Drain and plunge beans into an ice bath. Drain beans again and dry on paper towels.

Warm olive oil in a large skillet over medium heat. Add shallots and sauté until softened and lightly browned, about 7 minutes. Add green beans and butter and cook until beans are heated through, about 2 minutes. Sprinkle with toasted almonds and serve.

Yield: 8 servings, 150 calories, 10g fat, 4g protein, 14g carbohydrate, 4g fiber, 8mg cholesterol, 164mg sodium. Source:

Learn more about CHOC Clinical Nutrition and Lactation Services.

Healthy Habits at Home

Childhood obesity remains a prominent health concern within our society. According to the 2000 Center for Disease Control and Prevention growth chart, in 2010, more than one third of children were defined as obese, meaning their body mass index (BMI) was at or above the 95th percentile for age and sex.

CHOC Children’s Community Education department, in partnership with the hospital’s Clinical Nutrition department, provides various classes to parents and children about healthy living. In recognition of National Childhood Obesity Awareness Month, we sat down with two of our educators, Michelle Lubahn and Amy Frias, to discuss this issue. Michelle and Amy advocate that parents are the primary catalysts for change, and that the road to recovery begins at home.

How is childhood obesity determined?
Michelle: Childhood obesity is determined through calculating a child’s body mass index, or BMI. BMI is a calculation that uses height and weight to estimate an individual’s body fat. While the BMI of an adult is calculated with a straight formula, children’s BMIs are based on gender and age, to allow for the change in body composition that happens as a child gets older. Like a standard growth chart, your child will be ranked in percentiles compared to his peers. If your child’s BMI is in the 85th percentile — meaning it’s higher than that of 85 percent of children his age and gender — he would be considered overweight. If he’s in the 95th percentile, he’s considered obese.

What factors contribute to becoming overweight?
Amy: There are several factors that contribute to becoming overweight, but I would say that the biggest factors are lack of physical activity, large portion size, an increase of fast food intake, an increase in sugary drink intake, and an increase in total screen time. Screen time includes all electronics- time spent on cell phones, on the computer, watching TV, and playing video games. Children should have no more than two hours of total screen time a day, which should be in conjunction with a minimum of one hour of physical activity.

What are some of the health effects of childhood obesity?
Michelle: Some of the short-term effects of childhood obesity include a decline in self-esteem, a decline in socialization, and an increased likelihood of depression. It creates a vicious emotional cycle. As the depressed feelings increase, a child is more likely to become an emotional eater, which perpetuates the cycle.

Amy: There are several long-term effects of childhood obesity. Adults who were obese as children may experience health problems much earlier in life in comparison to those adults who maintained a healthy weight through childhood. Some of these health problems include an increase in sugar levels, an increase in lipid levels, and an increase in triglycerides.

What recommendations to do you have for parents trying to implement healthy habits in the home?
Michelle: There are a lot of things that parents can do! The most important thing for parents is to model good eating habits, because they are the first and the best role models for their children. Eat as a family at the dinner table, with the TV off, as often as possible. Keep lots of healthful options available and limit the number of unhealthy options. Also, don’t enforce the “Clean Plater’s Club” at home, meaning don’t emphasize the importance of finishing the entire meal. The best thing to do is work with your child’s needs. I tell my children that they can’t have dessert unless they finish all their vegetables.

Amy: It also helps to plan meals ahead of time and encourage healthy eating throughout the day. For example, bring fruit in the car when you pick your kids up from school, so they eat that rather than choosing a less healthy option once they arrive home. Another tip that works for me is to prepare vegetables before preparing the rest of dinner, so kids can snack on those while they wait for the rest of the meal to be ready. I encourage my children to play outside while I make dinner, which gives them another opportunity to be active.

How can parents encourage a healthy body image?
Amy: Teach kids to feel good about the person they are, not what they look like. Focus on their overall health and promoting good habits rather than focusing on numbers, like weight.

Do you have any other advice for parents?

Amy: I think that the best way to create movement toward a healthier lifestyle is to promote the change as a family unit, rather than trying to encourage your child to change his individual habits. Go for a family hike, or play a game together outside.

Michelle: I think the most important thing is to keep a positive attitude. Learn from your mistakes as a parent and work with your child to make healthy choices. Know that it’s never too late to start living a healthy lifestyle!

Learn more about classes offered by CHOC Children’s Community Education department.

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