Friday, October 24, 2014

Information Underload

My 2 year old daughter can eat. And eat, and eat and eat. And then drink and drink and drink. She has very little discrimination when it comes to eating – she even got my son to eat asparagus when he saw she was downing it like it was going out of style! We won’t talk about how her diaper smelled the next day.

When my daughter was about 8 months old, I started supplementing her diet with formula. I was only getting about 10 ounces a day from pumping, and she was a hungry baby. I can’t overstate the amount of frustration I felt when picking out a formula. My heart has started racing even writing about it. Shouldn’t this have been easy to figure out, particularly for someone with a nutrition degree, and particularly on a product that is designed for a vulnerable population (babies)? I soon found out it wasn’t easy at all. Although formula containers are covered with nutrition claims, they do not have Nutrition Facts Labels like other foods do. They have a list of nutrients that the Federal Government mandates as a minimum standard and health claims on the front of the package. Kind of like dog food. As a health professional, I am wary of claims on the front of packaging and rely on the Nutrition Facts Label to tell me important information.

Back to the choosing process -- I lean toward organic for the kids when we can afford it, so I thought I would simply get the organic kind. After some research, I found that the only easily available organic version for infants was higher in sugar than other versions of the same brand. Be aware: Sugar content is not listed on formula labels. I did not want to be giving more sugar than necessary to the baby. So, after scouring the web for information, what did I choose? I was surprised at what I ended up with. For the most part, I chose the milk based, iron fortified store brand with DHA. I didn't use a consistent brand, and we were lucky enough that my daughter didn't have any digestive problems that required more specialized formula.

Although the transition to supplementing with formula was emotionally tough for me, she is a very healthy and happy (and still hungry) toddler now. Many of us moms use formula - we’re fortunate to have a safe alternative to breastmilk when needed, even when it’s not our first choice.


Tuesday, August 26, 2014

The Car Chorus of Summer

“Car!” This is the nightly chorus you would hear if you were to take a walk in my neighborhood around six o’clock in the evening. Even my 1.75 year-old joins in with glee! I grew up in a neighborhood with sidewalks, taking them for granted. In my current neighborhood, however, my hilly, curvy road does not have sidewalks, bike lanes, or even curbs. This neighborhood design flaw didn’t matter so much when I could walk my son in a stroller or his push tricycle. But now that my five year old is riding a bike, I’ve sprouted a few gray hairs that could have been prevented.
Experts recommend that kids ride on sidewalks until about age 10. Since that’s not possible in our neighborhood, my husband and I do our best to make sure our son is safe on the road. At least one of us is always out when he’s riding his bike. We insist that he ride on the right side of the road with traffic rather than against it, which admittedly is a work in progress. We taught him to use the brakes on his bike instead of using his feet to stop. We make sure he wears bright clothes so drivers see him. He’s worn a bike helmet since age two so that it would not be a big deal when he got old enough to really need it. And we recently improved the fit of his bike helmet. I did the Helmet Fit Test and spent some time fixing the straps—not a fun task, but well worth it. Since the little one does whatever the big one does (though a little more recklessly), she also wears a helmet.
First ride on the big boy bike!
Parents can do a lot to help kids be safe, yet communities also play a role in making it easier for pedestrians and cyclists to be safe. Cities and towns can now bypass an expensive process and lower speed limits on many neighborhood roads thanks to a 2013 Safe Streets Law. Washington’s Growth Management Act calls for cities and counties to promote physical activity through urban planning approaches (such as curbs, sidewalks and bike lanes). Research says that these approaches will actually increase physical activity among residents. Cities and counties also must have a plan for bicycle and pedestrian transportation.
Even though we don’t have anything resembling ideal street designs in my neighborhood, the homeowner’s association has taken some measures to make the roads safe. They added yellow traffic bumps to help slow traffic down throughout the community, and the speed limit of 20 MPH is well-posted. I’ve found that cars have been traveling a lot slower in our part of the street since we started using it more frequently.
Biking is a fun way to get my kids excited about being physically active. I’m excited because my husband and I just got our own bikes all fixed up after years of collecting dust in the garage. We also got a bike seat for the little one. Now we’ll be able to show the kids how to bike safely in our neighborhood, and expand our horizons to some of the great bike trails in our area where we can relax and have more fun doing family biking trips. Maybe this will prevent some gray hairs in the future.
Here’s to a summer and fall filled with safe biking (and fewer gray hairs)!
For more information:
  • See what Safe Streets are all about with Washington State Department of Health’s Safe Streets Fact Sheet
  • Find out the latest in keeping your little cyclist safe with Safe Kids Coalition’s Bike Safety Tips Learn how you can work with your community to make changes with Centers for Disease Control and Prevention’s A Guide for Community Action

Tuesday, August 5, 2014

The Breastfeeding Chronicles Part III: The Return of the Mommy

I’m lucky that I got to nurse both of my children. I went for 16 months with my son and 12 with my daughter. I was able to exclusively breastfeed for about six months as recommended by the American Academy of Pediatrics. Both of my kids showed all the signs that they wanted solids at around five months. I had to supplement my daughter with formula starting at eight months – I’ll talk about the process of choosing a formula in a different post.
When I returned to work after six months off with my first child (thanks, old boss!), it was a rude awakening to have to pump two to three times a day. I had issues with supply after a few months back on the job, but I worked with a fabulous lactation consultant who helped me out. Some of her tips might sound weird but they worked:
  • Imagine a flowing river of breast milk that is there to feed hungry babies (to this day I just felt a little “ghost” let-down!); 
  • Look at pictures of the baby – I found that playing little movies of the baby with the sound on really helped, too.
One tip that isn’t as weird sounding is to make sure you use a good pump. Because of the Affordable Care Act, pumps are now covered by health insurance. Check with your insurance company on how to get a free rental or new personal pump. It might be a little more work than walking in to a store and buying a pump, but the savings are pretty enticing. I spent $250 on mine (with a coupon) before this was a law.

The building I work in has a private pumping room with a sink, a chair, and a table. The tabloids were fun too – I read more about the Kardashians than I ever wanted too! But I digress.Worksites that offer comfortable, private nursing areas for moms make it more likely that mom will continue to nurse after getting back to the grind. I have a friend who had to pump in her car or in the bathroom when she went back to work. Twice a day, every day, for nine months! Now, a federal law mandates that many employers must provide reasonable break time, and a private place to pump until the child is one year old. And employers, bathrooms don’t count as private pumping spots.
This post concludes the Breastfeeding Chronicles- at least for now. Don't miss The Breastfeeding Chronicles: Prologue, Part I, and Part II in previous posts!

More information on returning to work and breastfeeding:


Wednesday, July 2, 2014

It's Not Me... It's the Bar!

My favorite sweet treat right now is a chocolate raspberry hazelnut bar made by a local bakery. These three ingredients sit on top of a crust like that of a raspberry bar. To me, this is heaven in a wrapper. Luckily, the bars are available at several stores and delis that I frequent. Unluckily, the bars are really big – about 2.5 x 3.5 inches. One could easily be split into two or three servings. I could do this myself; however, I just love it so much that I eat the whole bar! The wrapper does not have nutrition information on it; my guess is that it’s somewhere in the 400-500 calorie range given the ingredients. I try to keep my snacks around 100-150 calories, so eating one of these throws me out of balance. It would take more than an hour of quick walking to burn off the extra 300 calories provided by this snack – I struggle to have a regular physical activity routine, much less adding an extra hour-long walk.

My only solace is that this compulsion to eat the whole bar is not totally my fault. Studies have shown that people will keep eating long after they really need to, even with foods that aren’t as delicious as a chocolate raspberry hazelnut bar. The way food is packaged and served greatly influences what and how much we eat. For instance, when my husband graciously serves me stir fry, he gives me a lot more than I would serve myself. I’m much too polite (or lazy) to get up and put some back. Research shows that I’m more likely to eat more when I have a lot on my plate than I am when I have less on my plate, regardless of hunger. Portion sizes have grown throughout the last 40 years, which directly influences how much I eat.

I use a lot of strategies to watch portion sizes and consumption: use smaller plates; put salty snacks like chips in a small bowl rather than eating from the bag; or share treats with a friend. However, I’m not immune to the many environmental and psychological forces that influence my decisions. So my plea to my local bakery (and manufacturers throughout the land) – please give me the option for smaller portion sizes!

Until I hear back from the bakery (and the rest of the manufacturers) on my request, maybe I’ll institute a “No Chocolate-Raspberry-Hazelnut Bar” policy for the car; go inside, cut the bar in half, re-wrap the other half; and place it in the refrigerator far from where I’m sitting.

Mindless Eating from Cornell University
Portion control ideas for adults from CDC
Portion control ideas for kids

Monday, June 9, 2014

The Breastfeeding Chronicles Part II: Journey to the Bed Side

Thankfully my birthing hospital had some good breastfeeding practices in place, which contributed to my success in nursing my son for 16 months and my daughter for 12 months. I experienced firsthand exactly what studies have shown – hospitals can help and hinder how long a mom and baby continue to nurse. In our state, about 90 percent of moms start off breastfeeding. By six months, 54 percent of moms breastfeed, and 20 percent of moms give only breast milk at six months. The rate decreases to 34 percent of moms nursing until baby is 12 months. American Academy of Pediatrics recommends giving only breast milk until about six months, and continuing to nurse until one year or more.
Here’s what the hospital did right in our case with the first baby:
  • Offered a breastfeeding class before the birth.
  • Brought baby to nurse as soon as possible after delivery – my daughter was allowed to kind of crawl up my body – it was so cool!
  • Encouraged rooming in with baby, helping mama bear say “no” to sugar water.
  • Didn’t give a formula bag or formula samples when I went home.
And what they could have done differently:
  • Provided lactation consultants on the weekend. I gave birth on a Friday evening and didn’t have access to one.
  • Not insisted on supplementing with sugar water when I’d made a commitment to breastfeed. They did not end up supplementing because I told them they couldn't unless it was absolutely medically necessary.
  • Helped improve my latch and explained that my mature milk would come in later.
  • Not given us a pacifier – we felt at the time like we needed it for our sanity but didn’t understand how it may have interfered with my milk supply.
As a mom, I’m authorized/required to give unsolicited advice to expecting parents. If you decide to breastfeed your baby, ask your doctor or midwife how the birthing hospital or center supports breastfeeding. Or you can call the hospital’s maternity ward to discuss a short list of breastfeeding needs. If you’re lucky enough to have a choice in hospitals, you can include breastfeeding support in your choice criteria. 
Don't miss The Breastfeeding Chronicles: Prologue and Part I! Coming Soon: Breastfeeding Chronicles Part III: The Return of the Mommy.
Additional information:

Tuesday, May 20, 2014

Bananas for My Shopping List

I usually shop with at least one kid, with the ever-present threat of a breakdown looming over our cart. The 4 year old is alternately asking for a toy car and being drawn to the multitude of kid-targeted products. The 1½ year old is usually trying to worm out of the seat or grab products to chew on. Last weekend we had a typical shopping trip. My son wandered away looking for samples while my daughter played a game of drop it with items from the shelf. About 8 minutes in to the experience, somewhere around the bananas, I lost the ability to concentrate.
One thing that helps me focus under these adverse circumstances is using a shopping list. It saves time and money, and results in healthier choices. Since we don’t often sit down and plan our menus, I created a generic shopping list based on what we eat and drink on an average week. Here’s how I did it:
  • We figured out what major meal types we make in an average week. For example, once a week we have burritos, pasta, fish with rice, etc. It was interesting (and a little sad) to see that we tend to make variations of the same meal consistently.
  • I listed out all the snacks, lunch foods, and drinks I like to have on hand.
  • I downloaded a generic grocery list in Microsoft WORD, and then modified it with the products I usually buy, making sure there were ingredients for the major meal types and snacks. Oddly enough mine has a lot more whole grains than the template I found...
  • I put the products in order of the aisles in the store where I usually shop to avoid the last minute jog across the store with antsy kids.
  • I printed out 10 copies and put them in various places so I’d have one handy (purse, car, jacket pocket, shopping bag stash).
  • Before going in to the store, I review the list using different colors and symbols for different shopping trips because I reuse the sheets. Clearly.
Most recent list
Another option is downloading an app on your phone — I’m a late adopter of technology so haven’t yet explored this option. I’ll confess that I only recently went from a flip phone to a smart phone…
Why does this work better than just going in with a vague idea of what I want? Shocking news: many products in the store are not healthy. When I’m tired, hungry, distracted, or don’t have a plan, I’m more susceptible to my own inner yearning for junk food. Maybe I’ll grab a candy bar simply because I’m surrounded by them in the check-out lane. Or maybe I’ve made it through the cookie aisle safely, only to be tempted by cookies placed near the milk. This is what experts call “behavioral economics” — a theory that our choices are affected by many factors such as price, appearance, convenience, information, state of mind, habit, and expectations. In public health, we’re trying to make sure healthy foods are the ones that sell by putting them in the prime areas. The best example of this work is in schools to create Smarter Lunchrooms. I hope we’ll see the same attention devoted to designing grocery and convenient stores that help people choose healthier foods. Some stores have adopted healthy check-out aisles, for example — this is a nice option for families whose kids (and adults) want to buy candy at the last minute. For now, I will keep using my old school shopping list to help fend off the unhealthy foods when my concentration is compromised.

Friday, May 2, 2014

The Breastfeeding Chronicles Part I: Learn to Use the Force

In hindsight, I realize I was not as prepared to breastfeed my first baby as I could have been. I had read – ok, skimmed – some books, looked on the Web, and taken a one day breastfeeding class. But the information was all so new, it didn’t quite sink in. I had assumed that someone else would guide me through this process. In a way, this was one of my first lessons in parenting. I was now the guide, and I had to be prepared. Here are some of the things I learned in what my grandpa calls “the school of hard knocks:”
  • When I had a lot of pain with nursing, I thought it was normal. I now understand that it was probably due to a latching issue.
  • When my milk did not immediately come in, I thought it was not normal. I now know that a mature milk supply might not come in until about three days post birth, so I didn’t have to be so worried.
  • I should’ve had that baby nursing, not sucking on a pacifier in the hospital room. To be honest, I knew that beforehand but in the intensity of the moment we needed some crying relief since nursing was not going well.
  • I thought I could simply reach out to friends who had breastfed for help when I needed it. Although social support and reaching out to friends (and whoever else will listen!) is incredibly helpful and important, I now realize that they are not trained to recognize when you should seek medical attention. Before giving birth, I definitely should have identified a few trained helpers, such as a local Lactation Consultant or La Leche League volunteer, and reached out for help when I was in pain.
To sum it up, take some time to think beyond the pregnancy and prepare yourself and your family. Although breastfeeding is natural, it is a learned skill.
Here are some resources that provide some guidance on the first leg of your journey:
Stay tuned for future posts on feeding the little one:
The Breastfeeding Chronicles Part 3: The Return of the Mommy
In-formula-tion Underload

Wednesday, April 16, 2014

The Breastfeeding Chronicles: Prologue

I think the most important thing to give a baby is love. Whether you breastfeed or not, your baby will be OK. I was formula fed as a baby and I turned out great, right?
I didn’t know a lot about breastfeeding before getting my original job as nutrition coordinator at the state Department of Health. For those who don’t know, breastfeeding has benefits for both baby and mama. Baby has less risk for asthma, allergies, ear infections, respiratory infections, and other diseases. For mom, the risk for certain cancers including breast and ovarian cancer, type 2 diabetes, and postpartum depression is lowered. Some research has shown that breastfeeding can help mom lose weight more quickly and prevent obesity in older kids. Breastfeeding also has a lower environmental impact since you don’t have to use all the formula packaging.

Thanks to my job, I knew all this when I got pregnant with my first child, and made a strong commitment to breastfeeding. Having this commitment and a wicked stubborn streak helped me out when all did not go as planned. My son latched on right away, so I didn’t think that was a problem. The delivery room nurses were great – they brought him up to nurse very soon after delivery, and showed me how to do it. But then, my milk did not come in right away. I felt like a complete failure! The two nights I spent in the hospital are hazy, but I remember that the night nurse kept trying to feed him some kind of sugar supplement and I was like Luke fighting the Dark Side and would not let her. He was crying a lot (poor little guy), which was tough on me and my husband. So, we ended up giving him a pacifier before my milk supply was established. Hospital policy didn’t allow pacifiers; however, the nurse had a hidden supply that we were thrilled with at the time.

A lot of different factors affect whether and how long a woman will breastfeed, and if she will follow the American Pediatrics Association's guideline to provide only breast milk for about the first 6 months. Individual knowledge, cultural background, physical ability, and support from her family, birthing hospital, primary care provider, child care provider, and employers all factor into a woman’s success with nursing. In future “Breastfeeding Chronicles” posts, I will write about my family’s quest to breastfeed, and the internal and external forces that shaped our journey.

May the force be with you!

Friday, April 4, 2014

Kind of Like a Melon

Only three weeks late (yay Amy!), I brought my son in for his four year wellness check. Imagine my surprise when our doctor said that he was in the overweight category based on his body mass index (BMI). If you’re wondering what BMI is and what category you or your child fits in, there's good info online. Anyway, my son has chubby cheeks and is what you'd call a sturdy kid—kind of like a melon that weighs more than you think it will. But I would not have thought he was overweight. My husband didn’t think it was a big deal, but (being a health professional specializing in nutrition, physical activity and obesity prevention) I thought it was important to address. The kid already eats a good amount of veggies, whole grains, and fruit (as long as none of it touches…). The doctor suggested reducing snacks and making sure he gets enough physical activity. We live about fifteen minutes from the in-home daycare the kids go to, and my husband gives him a snack on the way home from daycare. Then, since I don’t get home until six most nights, the kiddo gets another snack while dad fixes dinner and watches the baby. So he's getting three snacks after lunch—definitely too many eating opportunities. You would think I would’ve picked up on this since I have been trained in dietetics!
Since that doctor’s appointment, here are some of the things we’ve been working on:
  • Giving him carrots or smaller portions of the snack on the way home, and then no snack right when they get home. My son is not thrilled about either of these changes, and is sure to express his emotions. It’s tough, but worth it to set up healthy eating habits for a lifetime.
  • Making sure he gets some good wiggle time every evening (well, almost), which he likes much more than the dietary changes. Kids should get 60 minutes of physical activity each day. Some of his favorite indoor activities are imaginary races with various friends; dancing to his favorite music—his current is the soundtrack to a certain blue train #1; kid-friendly yoga that I get at the library; pretend ice skating; Simon Says that includes jumping jacks and other active things (good for a parental giggle); counting to see how many jumps in a row he can do or how many times he can run up and down the hall; and running down the hallway and jumping on a bunch of pillows. The last one makes me cringe a bit, but we have a strict red light (stop)/green light (go) rule so he avoids collisions with his sister and the dog.
  • Working with daycare to avoid giving him a lot of sweets—when my daughter was born we switched from a center-based facility to an in-home daycare. More on that in another blog post!
Our best statistics, which aren’t perfect, say that about 25 percent of preschoolers are overweight or obese in Washington. By the time they are adults, about 61 percent are obese or overweight, and 27 percent are obese. A recent study published in the New England Journal of Medicine that followed kids throughout their early years showed that kids who were overweight by age five were much more likely to be obese by age eight. It is hard to believe my son is in one of these categories. We’re talking about a kid who considers fruit leather to be a really special treat, and asked what soda pop was the other day. I’m so thankful my doctor pointed it out early. If she wasn't reimbursed for counseling on BMI, I wonder if we would have even caught it. Your doctor can now be reimbursed for providing counseling on overweight and obesity because of the Affordable Care Act, so make sure you make your well-visit appointments and ask about BMI at your next appointment.

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Wednesday, February 26, 2014

Space Ranger

This weekend over breakfast, my son asked me if I was a space ranger at work. Apparently, I remind him of a certain character from a certain movie (I can’t mention copyrighted things since this is affiliated with state government, but you know who I’m talking about, right? To infinity and beyond?) He wasn’t enchanted with my response about helping people be healthier and went off to have an imaginary race with his cousins (who live in South Carolina) after being excused. The whole exchange gave us a chuckle, and provided some insight into his view of the world. Although we don’t always eat breakfast together since the kids eat at daycare, my family is lucky that we eat almost every dinner together at home. Eating meals together without the TV on is important for many reasons!
  • Meals eaten at home are generally healthier than dinner out
  • It can be cheaper to eat at home (as long as you stay away from lobster tail every night)
  • Kids who eat dinner with their families are likelier to do better in school. It’s true! Kids in all grades who report not eating dinner with their families are more likely to have worse grades
I’m lucky. My husband likes to cook and does so often. I’ve even influenced him over our ten years together and am happy to report that butter usage is down; olive oil usage is at an all-time high. It isn’t easy—it’s a challenge to get those dinners on the table and get the dishes cleaned up every night. We try to modify dinner to suit three different needs instead of serving entirely different meals. Our four year old is picky, just like his mama was. He does not like food mixed together, no casseroles, only tomato soup with no chunks or specks, no melted cheese, and especially important is that foods shall not touch one-another. But we keep putting “adult” food on his plate as well as things we know/hope he will eat. For example, mom and dad’s meal: chicken and bean burritos with veggies. Four year old's meal: whole grain tortilla heated just right; raw carrots and red pepper, kidney beans rinsed and right out the can, chicken to try even though I know he won’t like it, one percent milk. Eighteen month old's meal: avocado, cooked carrots, chicken, beans, some leftover whole grain pasta, whole milk. My daughter loves all things food and has been eating chunky food since she was physically capable. We used to call her the Buzzsaw for a charming noise she would make if she didn’t get food fast enough.
One thing that has helped my son try new (or just un-liked) foods is that at his daycare they read a book about a girl named Anna who tried just two bites of her food. To this day I don’t know what the book is, but he mentioned it one evening and in tough times, I pull out Anna and it actually works. Having a “just try it” policy makes for a more relaxed dinner—dad is happy the boy tries the food he slaved over and the boy is happy he doesn’t have to clear his plate. I believe (and studies back me up, here) that at his age, dinner is really about creating that atmosphere of trust and connecting as a family every night; not about clearing the plate.
Happy cooking!

Wednesday, February 12, 2014

Adventures in Health: The Beginning

Hi, my name is Amy. That’s how my 4 year old son starts a conversation with any “new friend” aged 2-12, so I thought I would take his lead to start out this new blog. The next thing he usually says is “I’m four.” I won’t go there though except to say that I’m in my mid-thirties.

So, you know my name, and that I have a 4 year old son, but why read this blog? I work at the WA State Department of Health as the program manager for the Healthy Eating Active Living (HEAL) Program. I have a bachelor's degree in Nutrition and a Master's in Public Health. My team works to make it easier for people to eat healthy and be active where they live, learn, work and play. Our goal is for kids and adults to be at healthy weights and have less risk of chronic disease.

At home, I have two kids, a husband (who also works full time) and a dog. I strongly believe that our environment greatly influences our decisions and our health, and I spend a lot of time thinking about how the environment shapes the lives of my son and 1 year old daughter. In this blog, I will explore everyday situations I encounter as a super busy working mom, share some statistics, ponder why it’s so hard to be healthy, and share with you some of the ways I’ve managed to make it easier for my family to eat better and be more active.

I look forward to hearing from you about your strategies for raising a healthy family in this world that doesn’t always make it easy.