nutrition

The scoop on poop…Could your kid be constipated??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 2 Comments

From infants to teenagers, constipation seems to be a problem for so many kids! I had a visit with a 9 year old and her mom about her stomach pain related to constipation problems. As soon as I left the room I realized that Dr. M was seeing a 2 month old for ongoing constipation issues. Then, at the end of the day, Dr. T’s first call of the evening came in before we ever left the office, and it was about a 3 month old with constipation problems. So, you see, this is a daily problem in pediatrics. Anyone that works in pediatrics will tell you that we talk about poop everyday, sometimes all day. Inadequate nutritional intake and hydration is usually the problem. 

In my house, my kids are 2 for 2 on this topic. Drew Elizabeth has been as regular as clockwork until just a few months ago. I’m sure most of you remember my Paranoid Mom post about Drew Elizabeth’s chest pain. She has never had a problem in the past, but in the past few months she hasn’t been eating her veggies as she should, and as she used to for the past 5 years. Kids…I can’t always explain why they do the things they do… I usually have more problems with my own than with yours! 😉

My poor Joshua has had constipation problems since he was an infant.  Joshua is the child that taught me all about children’s constipation. Well, Joshua and a PNP GI specialist ;-)!  Joshua eats an apple almost everyday. He loves apple slices with cinnamon; I highly recommend this, it’s great for the bowels.  Even with adequate fruits and veggies, Josh still doesn’t drink enough water (hence, the importance of hydration) to keep himself regular.

Most kids do not eat enough fruits and vegetables. For proper nutrition information, you can check out Let Them Eat Cake…For Breakfast??  Not only do most kids need to eat more fruits and veggies, they need to drink more water. Yes, I’ve tried to cover that too, you can read more about hydration in The Importance of Hydration. If adequate amounts of fiber and hydration don’t help your child with their constipation problems, I would recommend an evaluation with your child’s medical provider. Ongoing constipation can cause the large colon to expand and cause nerve damage and leaky gut and multiple other systemic problems that don’t even seem related to the bowels, but they are. Our immune system is centered in our gut, a healthy gut really matters.

By definition, constipation is having 3 or fewer bowel movements in a week that are hard, dry, and usually hurt.

A few facts about constipation:

  • When kids are constipated, they usually eat less.
  • When kids are constipated, they will usually have stomach pain, and usually on the lower left side.
  • When kids are constipated, they may have nausea and vomiting.
  • When kids are constipated, they may have more urinary incontinence (accidents), urinary frequency, and bedwetting.

So, what can you do to help your child with constipation? 

  • High fiber foods: fruits and vegetables (the crunchier, the better), beans, fresh popcorn, baked potato w/skin, berries, oatmeal. (The one fruit to avoid with constipation is bananas, they can make stools harder.)
  • Drink more water!!
  • Decrease processed foods, like carbohydrates made with white and wheat flour.
  • Getting normal exercise can help with bowel movements also.
  • Do not rush potty time. Children will often not take the time that they need to sit and eliminate their bowels.
  • Infants will frequently have temporary constipation problems when they are transitioning to new foods such as cereal, or  from breastfeeding to formula feeding. Do not give cereal under 4 months unless instructed by a medical provider.
  • In infants, try a couple ounces of 100% apple or pear juice, if this doesn’t work, you can try prune juice. Baby juice does not need to be diluted, adult juice should be diluted with half water.
  • Abdominal massage. I recommend abdominal massage to all the infants I work with that have constipation issues as a first line treatment! Massaging clockwise around the belly button and then doing the I Love You massage can work wonders for infants. With the I Love You massage, start with a few strokes of the I (left of belly button), then the L is upside down (above and to the left of the belly button), and then the U (around the belly button). This helps massage the large bowel, and can be quite helpful. Be sure to use mineral oil and apply a moderate amount of pressure. Most babies will enjoy this once they start to relax.
I hope you found some of this information helpful! Constipation can definitely make this parenting  journey a little painful for you and your child!
The ‘I Love You’ massage works! Ask the massage therapist that taught me about it when Joshua was an infant. 😉

Let them eat cake…for breakfast??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 3 Comments

Two thumbs up for cake for breakfast!! I was lucky enough to spend the morning taste testing wedding cake with my brother and future sister-in-law, Yummmm!!! We laughed about having cake for breakfast.  Sarah said, “this would be a good one for your blog”…I think she was right.  The smart one was Sarah’s mom, who ate an egg before our mini cake marathon.  Eggs are a great source of protein, so that was a good idea.  So,  when I thought about today’s daily dose of helpful hints, I figured I would write a bit about some nutrition basics.

So, is it really OK to eat cake for breakfast??  Not regularly, but I believe anything and everything is acceptable in moderation. Cake for a special occasion, birthday, or on vacation is no big deal no matter what time of day as long as we follow healthy eating habits and live a healthy lifestyle most of the time.

I usually let the kids go a little overboard when we are on vacation…why not, it is vacation. BTW-That’s how I get away with eating Key Lime pie for breakfast! Have you ever heard the song Kenny Chesney wrote about Key Lime Pie? Great song, it used to be the theme song in the Pilates class I taught. A little encouragement while we were exercising. 😉  My, My, My, Key Lime Pie…. (if you want to hear the song, http://www.youtube.com/watch?v=jle9Pe2NWFg)

So, now that I have you thinking about cake and pie (sorry), I’ll tell you about some Daily Nutrition Basics for everyone:

  • Eat 4-5 servings of fruits or vegetables daily.  Fruits and vegetables have essential vitamins and nutrients that our bodies need for good health.  Fruits and veggies add daily fiber, which is necessary for a healthy gastrointestinal system.  Notice this is servings per day, a large bowl of fruit or a large salad may give you multiple servings at one time.
  • Eat 2-3 servings of protein daily.  Protein builds muscle.  Muscle burns fat.  Eating protein and exercising daily can help increase lean muscle mass.  Protein comes from many sources, such as: fish, meat, eggs, beans, nuts, and peanut butter.
  • Drink your milk,  and chocolate is fine with me!! Calcium is crucial for good bone growth and development, and maintaining good bone density.  Milk and other dairy products are an excellent source of calcium.  For optimal bone health, the Institute of Medicine (IOM) recommends:  1 to 3 years old — 700 milligrams of calcium daily, 4 to 8 years old — 1000 milligrams, 9 to 18 years old — 1,300 milligrams.  One 8oz glass of milk or calcium fortified OJ has about 300mg of calcium.  For more information on Calcium intake and sources of calcium, visit. http://kidshealth.org/parent/growth/feeding/calcium.html#.
  • When eating carbohydrates, eat whole grains vs. white flour products.  Whole grains are healthier and better for our digestive system than white flour.
  • Meals should be equally balanced with protein, fiber and carbohydrates.
  • Control your potion size.  An adequate portion is the size of your fist or palm.  Keep in mind, for children, it is the size of THEIR fist or palm.  If your child wants second helpings, encourage seconds of protein and veggies before seconds of carbs.
  • And, of course, if you read any of my post, you know daily water intake is a must for proper nutrition. Check out my post on hydration for more details.

I tell my patients that they should follow these basic rules, everything else is alright in moderation. Living a healthy lifestyle consists of healthy eating habits, as well as staying active and getting regular exercise.  Yes, it’s ok to have sweets, but not all the time.

I hope these basic rules will help you keep your family happy and healthy.

So, while you enjoy the journey…. Let them eat cake!!!  😉

Toddlers and Hydration

/ Katie P. Tolley, RN, MSN, CPNP-PC / Leave a comment

Good morning everyone!

I had someone ask about the proper amount of fluids for a toddler.  I thought others may have the same question, and a short blog is just the answer.

Toddlers will usually self-hydrate adequately if given proper nutrition and a sippy cup of water during the day.  Toddlers usually need half of what school aged kids need, therefore approximately 40 oz/day.  Juice intake should not be more than 4-6 oz/day.  All juice should be 100% juice, with no sugar added.  Juice can be diluted with water, so it can go twice as far.  Dilute half water and half juice for a total intake of 8-12 oz of fluids.  (I’m not going to address the recent issues with arsenic in juice, that’s for another day.)

Having fun coloring, and I have my sippy cup!!

Remember, proper nutrition is always  key to good health.   Adequate amounts of fruits during the day provide extra hydration.  Toddlers should be getting 2-3 glasses of milk a day.  Milk intake should not exceed 24oz/day to avoid absorption problems in the GI tract which can lead to anemia.

Dark and/or strong smelling urine, constipation, and dry skin can all be a signs of inadequate hydration.

I hope this helps you enjoy the journey!

Are you thirsty? The Importance of HYDRATION!

/ Katie P. Tolley, RN, MSN, CPNP-PC / 7 Comments

Tonight’s dinner table conversation landed on the topic of how much water Joshua is NOT drinking during the day.  Drew Elizabeth isn’t much better (but got a reprieve because she was at Bible study).  When Joshua and Morgan asked me how much water he (Joshua) should be drinking.  I told them that he should have at least 60-80 ounces every day.  A surprised Josh said, “What? How is that even possible?”   I took a deep breath….  Then, I told him if he actually drank the water bottle he kept on his desk at school, it wouldn’t be hard at all.  I explained that if he drank one full water bottle at lunchtime, after morning recess and again at afternoon recess he would probably drink most of his daily requirement.  I reminded him this would be the perfect time to have a big drink of water.  After being outside playing for 15-20 minutes, there is no doubt he is thirsty.  The rest of his fluids could be obtained through milk, lemonade, juice, fruits, etc.   “Oh, yeah!?!” was his only response; translation to my ears, “YOU WIN, MOMMY!”  🙂

Encourage your children to drink water starting at a young age.  School aged children should drink approximately 60-80 oz of fluid a day.  Fluid intake can include any fluid that does NOT contain caffeine or carbonation.

Please give a sippy cup of water to your toddler. My children always had a sippy cup of water with them when they were little, even when they went to bed.  Once they outgrow the sippy cup stage, get them their own water bottle.  Kids love to have their own things, and a reusable water bottle is good for our planet!

Newborns should not have water.  They need 100% of their intake to contain calories for proper growth and development.  Children do not need extra water during the first few months of life, they get all they need from formula and/or breastmilk.

During the hot months of summer and during exercise, you need extra hydration. For every hour that you sweat, you should add 16oz to your daily intake.

In future posts I’ll address the importance of hydration for constipation, dry skin, allergies, headaches, and other health issues.

Thanks for enjoying the journey with me!