breastfeeding, frenulum, inants, newborn, pregnancy, tongue tie

The Basics of Tongue and Lip Tie: Related Issues, Assessment and Treatment

By Melissa Cole, IBCLC, RLC and Bobby Ghaheri, MD., Portland OR.

“Tongue-tie” has become quite a buzz word in some circles and is still quite unknown in others.  Tongue-tie, professionally known as ankyloglossia, is a congenital condition in which the lingual (tongue) or labial (lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding and, in some instances, other health concerns like dental, digestive and speech issues.  Mothers of infants dealing with feeding challenges are often desperate to find solutions; as awareness increases about tongue and lip tie, some mothers wonder if this is something their baby may be coping with.

Parents often want to know what some typical signs of tongue/lip tie are.  Each mother/baby dyad is very unique and therefore tongue/lip tie issues can present differently for everyone.  Some common symptoms that may point to the infant being tongue/ lip tied include: poor latch/inability to latch, sliding off the nipple, fatigue during feeds ,sleepy feeds, poor weight gain, clicking during a feed , maternal nipple pain/damage (can feel like the infant is compressing, chewing, gumming, pinching, scraping the nipple, etc), increased maternal nipple/breast infections, compromised maternal milk supply, dribbling milk at the breast/bottle, digestive issues (increased gassiness, reflux, etc due to extra are being swallowed and poor control of the milk during a swallow), and various other feeding related challenges. Some mothers and babies may cope with some of these issues, all of these issues or even none of these issues when a tongue/lip tie presents. We must keep in mind having a frenulum is not the problem; compromised tongue mobility and functionality that cause problems for the mother and/or baby are the problem!

Mothers are tech-savvy and often turn to the computer first to research what might be causing their feeding concerns. When moms go online, they will most likely encounter some discussion about how tongue and/or lip ties can cause feeding issues.  If parents suspect a tongue/ lip tie then families will often want to see a provider in-person to have their baby evaluated and treated.  Sometimes families are lucky enough to have a local provider well-versed in evaluating and treating oral restrictions like tongue and lip tie.  However, many mothers may not have access to this expertise in their local communities. If you suspect that your infant may have a tongue or lip tie and you’re not able to find a provider in your community to evaluate and treat this condition, consider connecting with a local international board certified lactation consultant (IBCLC) that should be able to help connect you with additional resources. Another resource is the website for the International Affiliation of Tongue-Tie Professionals (IATP) (please note that the website is just about to be launched and may or may not be live at present, do check back if needed).

Tongue and lip ties come in various shapes and sizes and can present uniquely in every baby.  Many providers have only been trained to look for very prominent, classic tongue ties that often create a heart-shaped tongue.  However, tongue ties can be sneaky and restrictions that are more posterior (toward the base of the tongue) cannot be easily visualized.  Proper assessment and evaluation are key when identifying these types of ties because they can easily be missed at first glance.  Not all providers know how to properly assess for all types of tongue and lip restrictions.  While there are various assessment tools and tongue-tied classification scales that have been published, there is still no universally accepted standard of assessment and care when it comes to tongue and lip tie.  This fluctuation in assessment and treatment standards can be extremely frustrating for parents trying to seek evaluation and care for their potentially tongue and lip tied infant.  If you are unsure of whether or not your provider is adept at assessing or treating various types of tongue and lip tie you may want to ask your provider the following questions:

  • How do you assess for tongue/lip tie?
  • How often do you treat tongue/lip tie in your practice?
  • Do you treat posterior tongue ties?
  • How do you perform the procedure?
  • What type of follow-up care to recommend after the procedure?

Providers that routinely assess and treat babies for tongue and lip tie should be able to easily answer these questions and provide parents with enough information so that they can make an informed decision.  Providers that may not be the best to assess or treat your baby include ones that rarely assess or treat for this condition, tell parents that the tongue tie will stretch or that it’s not a big deal, tell parents that they have never heard of it posterior tongue tie, or tell parents that this must be done under general anesthesia.  Parents should always feel empowered to seek additional opinions and advocate for the needs of their child if they are struggling to find a provider that understands and treat oral restrictions.

If a tongue or lip tie is present and parents wish to seek treatment, what can parents expect?  Various types of providers treat tongue and lip tie including: ear nose throat doctors (ENTs), pediatric dentist, oral surgeons, pediatricians, naturopathic physicians, and others qualified to do minor surgery.  In most all cases, releasing the frenulum for infants is an in-office procedure, with no sedation needed.  In some rare cases, or in cases with older children, sometimes light sedation is used if the parents or provider feel that the older child would be too stressed while alert, but in infants this is usually not necessary at all.  Some providers release the frenulum with sterile scissors, others use laser technology. The availability and types of providers in any given community will vary as will the course of treatment.  In general, this is what we tell parents coming to our practice to expect (please note that other providers may perform the treatment slightly different ways):

What to expect when your baby needs a frenotomy/frenectomy:

In general, the procedure is very well tolerated by babies.  We take every measure to ensure that pain is minimized.

1)    For a typical frenotomy (an incision of the frenulum), a topical numbing gel is applied once or twice and occasionally, if a frenectomy (frenulum tissue is removed) is needed, a small amount of local anesthetic is injected.  Often, ice chips are applied directly to the area before (and sometimes after), as this helps numb the area.

2)    Crying and fussiness are quite common, and most children lose only a small amount of blood.  They will frequently drool afterwards until the numbing medicine wears off.

3)    Pressure and ice are held to help minimize any bleeding, and the child will be returned back to you, where you have the option of immediate breastfeeding, bottle feeding or soothing depending on your preference.

4)    Tylenol may be used afterwards but is often not even needed.

5)    You may notice some dark brown stools or spit-ups afterwards as some blood may get swallowed after the procedure.

There is very little risk involved with the frenotomy/frenectomy procedure.  The biggest risk of the procedure is the potential for re-attachment to occur.  In order to prevent this from happening, we work with the patient’s in our practice to keep the newly-released area open and healing well by encouraging specific mouth-work after the procedure.  We encourage gently massaging/stretching the incised area, targeted oral motor work to help the tongue and mouth learning patterns, supportive bodywork, and other complementary healing modalities.  By incorporating this type of gentle aftercare, we do see a reduction in reattachment and better progress overall.

Over the decades, it is no doubt that many breastfeeding relationships have probably suffered greatly due to undiagnosed tongue or lip restrictions.  While more providers and parents are becoming educated about ties, we must be mindful not to think that every feeding challenge is created by a tongue or lip tie or that releasing restrictions will immediately improve the feeding situation.  Sometimes there is immediate improvement after the procedure and sometimes it is a gradual process as the tongue is supported in moving in new ways.  Feeding challenges can be complex and involve layers of issues.  In addition, tongue/lip tie can create other issues that may need to be proactively addressed.  Infants and mothers may cope with muscular tightness, nipple damage/pain, milk supply issues, infant weight gain concerns, etc. that need further support before and after a tongue/lip tie is evaluated and treated.  Working with a qualified, experienced board certified lactation consultant or other care providers that are familiar with oral restrictions is highly suggested.  Coping with feeding challenges in a tongue/lip tied infant can be an emotional and physical roller coaster for families.  It is our goal in writing this article that all mothers and babies receive the care they need and that awareness in regards to tongue/lip tie issues will continue to increase worldwide.

For additional resources on tongue and lip tie, please visit Luna Lactation’s website resource page and scroll down to the tongue tie section.

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add/adhd, adhd, hood river midwife, hood river naturopath, mental health, pediatrics

ADHD Not a Real Disease, Says Leading Neuroscientist

adhd

What do you think?

Alex Pietrowski, Waking Times One of the world’s leading pediatric neuroscientists, Dr. Bruce D. Perry, M.D., Ph.D, recently stated publicly that Attention Deficit/Hyper-Activity Disorder (ADHD) is not ‘a real disease,’ and warned of the dangers of giving psycho-stimulant medications to children.Speaking to the Observer, Dr. Perry noted that the disorder known as ADHD should be considered a description of a wide range of symptoms that many children and adults exhibit, most of which are factors that everyone of us displays at some point during our lives.

“It is best thought of as a description. If you look at how you end up with that label, it is remarkable because any one of us at any given time would fit at least a couple of those criteria,” he said.

Dr. Perry is a senior fellow of the ChildTrauma Academy in Houston, Texas, a highly respected member of the pediatric community, and author of several books on child psychology including, The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook–What Traumatized Children Can Teach Us About Loss, Love, and HealingandBorn for Love: Why Empathy Is Essential–and Endangered.

His comments are quite refreshing at a time when diagnoses for ADHD in the UK and the US are sky-rocketing and prescriptions of stimulant medications to children are also rising rapidly, with many parents and concerned activists growing suspicious of the pharmaceutical industry’s motivations in promoting drugs to children. Ritalin, Adderall, Vyvanse and other mind-altering stimulant medications are increasingly prescribed to children between the ages of 4 and 17.

Dr. Perry noted that the use of medications like these may be dangerous to the overall physical and mental development of the child, remarking on studies where these medications were given to animals and were proven detrimental to health.

“If you give psychostimulants to animals when they are young, their rewards systems change. They require much more stimulation to get the same level of pleasure.

“So on a very concrete level they need to eat more food to get the same sensation of satiation. They need to do more high-risk things to get that little buzz from doing something. It is not a benign phenomenon.

“Taking a medication influences systems in ways we don’t always understand. I tend to be pretty cautious about this stuff, particularly when the research shows you that other interventions are equally effective and over time more effective and have none of the adverse effects. For me it’s a no-brainer.”

Given that the problem of ADHD is complex and the term is more of a blanket term used to describe a wide range of behavioral symptoms, it is important to consider what the root causes of many of the symptoms may be before pharmaceutical intervention should be considered. Citing potential remedies, Dr. Perry suggested an approach that focuses attention on the parents and the child’s environment, while also recommending natural remedies like Yoga, and improved diet.

“There are number of non-pharmacological therapies which have been pretty effective. A lot of them involve helping the adults that are around children,” he said.

“Part of what happens is if you have an anxious, overwhelmed parent, that is contagious. When a child is struggling, the adults around them are easily disregulated too. This negative feedback process between the frustrated teacher or parent and dis-regulated child can escalate out of control.

“You can teach the adults how to regulate themselves, how to have realistic expectations of the children, how to give them opportunities that are achievable and have success and coach them through the process of helping children who are struggling.

“There are a lot of therapeutic approaches. Some would use somato-sensory therapies like yoga, some use motor activity like drumming.

“All have some efficacy. If you can put together a package of those things: keep the adults more mannered, give the children achievable goals, give them opportunities to regulate themselves, then you are going to minimise a huge percentage of the problems I have seen with children who have the problem labelled as ADHD.”

Many people may disagree with the assertion that ADD/ADHD should not be considered a disease, however, the fact remains that the myriad symptoms that are associated with these increasingly common ‘disorders’ can often be addressed and relieved without creating an addiction and dependency on pharmaceutical medications, which disrupt the mind and body in ways that are not fully understood or even researched.

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add/adhd, mental health, pediatrics

Can Attention Deficit Drugs ‘Normalize’ a Child’s Brain?

Recent research that says that A.D.H.D. pills like Adderall, above, can “normalize” a child’s brain over time has drawn criticism.

By KATHERINE ELLISON Credit Elizabeth D. Herman for The New York Times

Recent research says that A.D.H.D. pills like Adderall, can “normalize” a child’s brain over time has drawn criticism. What are your opinions and what has worked for you?  As a naturopathic physician, I believe by balancing neurotransmitters, and discovering the root, initial insult that led to any developmental imbalance is key to finding health.   Where can energies be channeled, how can brain’s truly be ‘normalized’?  Consult your local naturopath or learn more at http://www.gorgenaturalmedicine.com

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The Pleasantville, N.Y., developmental pediatrician won’t allow drug marketers in his office, and says he doesn’t always prescribe medication for children diagnosed with attention deficit hyperactivity disorder. Yet Dr. Bertin has recently changed the way he talks about medication, offering parents a powerful argument. Recent research, he says, suggests the pills may “normalize” the child’s brain over time, rewiring neural connections so that a child would feel more focused and in control, long after the last pill was taken.

“There might be quite a profound neurological benefit,” he said in an interview.

A growing number of doctors who treat the estimated 6.4 million American children diagnosed with A.D.H.D. are hearing that stimulant medications not only help treat the disorder but may actually be good for their patients’ brains. In an interview last spring with Psych Congress Network, an Internet news site for mental health professionals, Dr. Timothy Wilens, chief of child and adolescent psychiatry at Massachusetts General Hospital, said “we have enough data to say they’re actually neuroprotective.” The pills, he said, help “normalize” the function and structure of brains in children with A.D.H.D., so that, “over years, they turn out to look more like non-A.D.H.D. kids.”

Medication is already by far the most common treatment for A.D.H.D., with roughly 4 million American children taking the pills — mostly stimulants, such as amphetamines and methylphenidate. Yet the decision can be anguishing for parents who worry about both short-term and long-term side effects. If the pills can truly produce long-lasting benefits, more parents might be encouraged to start their children on these medications early and continue them for longer.

Leading A.D.H.D. experts, however, warn the jury is still out.

“Sometimes wishful thinking gives us hope that the impressive short-term relative benefits of medication over other treatments will persist beyond childhood, but I haven’t seen it,” said James Swanson, director of the Child Development Center at the University of California at Irvine. Dr. Swanson, a co-author of a landmark federally funded study, the Multimodal Treatment of Attention Deficit Hyperactivity Disorder, said that follow-up research found overall improvement but no greater long-term benefits after three years for children who were treated with medication compared to those who weren’t. One possible reason, as the report noted, was that many children refuse to continue taking medication after a year or so, something most parentsof such children well know.

Research has shown that the brains of people with A.D.H.D. on average look and function differently than those who don’t have the disorder, particularly when it comes to processing two important neurotransmitters: dopamine and norepinephrine. For most people with A.D.H.D., stimulants can temporarily boost focus, motivation and self-control by increasing the availability of these chemical messengers. The question is whether these effects can last once the drugs have left the bloodstream.

In arguing for “normalization,” Dr. Wilens cited a major review in the Journal of Clinical Psychiatry in late 2013, which looked at 29 brain-scan studies. Although the studies had different methods and goals, the authors said that, together, they suggested that stimulants “are associated with attenuation of abnormalities in brain structure, function, and biochemistry in subjects with A.D.H.D.”

But other A.D.H.D. experts challenge this conclusion. Dr. F. Xavier Castellanos, director of research at the New York University Child Study Center, called assertions that stimulants are neuroprotective “exaggerated,” adding: “The best inference is that there is no evidence of harm from medications – normalization is a possibility, but far from demonstrated.”

A.D.H.D. is an exceptionally controversial diagnosis, with particular controversy zeroing in on researchers, including Dr. Wilens himself and some of the authors of the 2013 report he cited who have received financial support from pharmaceutical firms. In an email, Dr. Wilens said he had not received “any personal income” from the pharmaceutical industry since 2009.

As several experts noted, a major impediment to determining the long-term impacts of A.D.H.D. medication is that a “gold-standard” study would require researchers to assign children randomly to groups that either received medication or didn’t. Such a practice has been deemed unethical due to the widespread belief that the medication can help struggling children, at least in the short-term.

And other research has raised new concerns. One peer-reviewed 2013 study co-authored by Dr. Swanson suggested that the stimulants may change the brain over time so as to undermine the long-term response to the medication and even exacerbate symptoms when people aren’t taking them.

Dr. Peter Jensen, the former associate director of child and adolescent research at the National Institute of Mental Health, cautioned that parents should not try to force children with A.D.H.D. to take medication when they don’t want to, adding that “most kids don’t want to.”

Dr. Jensen, who now heads the REACH Institute, a national nonprofit organization concerned with children’s mental health, once surveyed 100 parents of sons and daughters in their 20s who had been diagnosed with A.D.H.D., asking what made the most difference.

“Eighty percent of them said ‘Love your child. Help him or her advocate for themselves, and find a doc who’ll work with you through thick or thin whether you medicate or not,” Dr. Jensen said. “Only a minority of these parents mentioned medication.”

Katherine Ellison is a Pulitzer Prize-winning former foreign correspondent and author and co-author of seven books, including the forthcoming “What Everyone Needs to Know about A.D.H.D.” (Oxford University Press), co-authored with Stephen Hinshaw, Vice-Chair for Psychology, Department of Psychiatry, University of California, San Francisco.

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BPA, pediatrics, plastic

BPA-Free and Plant-Based Plastics More Dangerous Than We Thought

Ugh!  Glass it is then.foods_bpa-free2In my house, we only permit BPA-free toys, sippy cups, and other plastics while trying to minimize our use of plastic altogether. Doing so is supposed to spare us from hormone-disrupting chemicals found in  bisphenol-A. But these plastic items still aren’t safe (if by safe we mean products that don’t leach other hormone-disrupting chemicals). Research now indicates that nearly every plastic product (including BPA-free) is made up of chemicals that stimulate estrogenic activity (EA) in human cells.

Estrogen made by our bodies in the right quantities at the right time is a good thing. But chemicals with EA have been linked to a whole slew of frightening problems like increased rates of  asthma, obesity, premature puberty in girls, infertility, reproductive cancers, and a number of neurodevelopmental disorders.

To perform the study, University of Texas researchers purchased 455 widely available plastic products. Although most were labeled “BPA-free” it wasn’t possible to determine exactly what chemicals they contained. Apparently this is proprietary information closely guarded by industry. To determine if the products had estrogenic effects, researchers exposed extracted versions to solvents meant to mimic food and beverage items these plastics were likely to contain. Then, they exposed these extracts to a type of human breast cancer cell that’s highly receptive to estrogen. Cells that multiplied in the presence of plastic extracts indicated that those particular chemicals were estrogenic.

The results? Nearly every plastic product they tested leached EA chemicals. Some BPA-free products actually released more EA than other plastics. That included eco-friendly plastics made from plant products, which apparently released EA due to the additives used.

A more recent study by University of Calgary scientists indicates that bisphenol-S, found in many products with the “BPA-free” label, might actually be more harmful than BPA itself. Researchers exposed zebra fish, a good model to study human brain development, to bisphenol-S (an ingredient found in many products deemed “BPA-free”). The results showed abnormally timed growth of neurons in the embryos, the same growth surges found when embryos are exposed to BPA. The disruption of prenatal cellular activity appeared to result in hyperactive behavior. In fact, early abnormal growth of brain cells was specific to male hormones, perhaps indicating why more boys than girls are diagnosed with certain neurodevelopmental disorders.

Researcher Deborah Kurrasch was surprised by the results, especially since the dose used was “a very, very, very low dose, so I didn’t think using a dose this low could have any effect.” Another researcher in the study, Hamid Habibi, said “Finding the mechanism linking low doses of BPA to adverse brain development and hyperactivity is almost like finding a smoking gun.” They recommend pregnant women limit their exposure to products containing bisphenols and say this and other studies support removing bisphenols and structurally similar chemicals from consumer products.

Ninety percent of Americans show trace amounts of BPA in urine, breast milk, and umbilical cord blood. Why are potentially dangerous plastics used in toys, food packaging, and beverage cups (as well as in healthcare)? The  Food and Drug Administration considers compounds safe until proven otherwise.

– See more at: http://www.mothering.com/articles/bpa-free-plastic-evil/#sthash.2IxYoxCu.dpuf

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diets, kids, nutrition

What kids around the world eat for breakfast

<p>Saki Suzuki, 2 ¾ years old, Tokyo</p>
<p>The first time Saki ate the fermented soybean dish called <em>natto</em>, she was 7 months old. She promptly vomited. Her mother, Asaka, thinks that perhaps this was because of the smell, which is vaguely suggestive of canned cat food. But in time, the gooey beans became Saki’s favorite food and a constant part of her traditional Japanese breakfasts. Also on the menu are white rice, miso soup, <em>kabocha</em> squash simmered in soy sauce and sweet sake (<em>kabocha no nimono</em>), pickled cucumber (Saki’s least favorite dish), rolled egg omelet (<em>tamagoyaki</em>) and grilled salmon.</p>

Saki Suzuki, 2 ¾ years old, Tokyo

The first time Saki ate the fermented soybean dish called natto, she was 7 months old. She promptly vomited. Her mother, Asaka, thinks that perhaps this was because of the smell, which is vaguely suggestive of canned cat food. But in time, the gooey beans became Saki’s favorite food and a constant part of her traditional Japanese breakfasts. Also on the menu are white rice, miso soup, kabocha squash simmered in soy sauce and sweet sake (kabocha no nimono), pickled cucumber (Saki’s least favorite dish), rolled egg omelet (tamagoyaki) and grilled salmon.

Americans tend to lack imagination when it comes to breakfast. The vast majority of us, surveys say, start our days with cold cereal — and those of us with children are more likely to buy the kinds with the most sugar. Children all over the world eat cornflakes and drink chocolate milk, of course, but in many places they also eat things that would strike the average American palate as strange, or worse.

Breakfast for a child in Burkina Faso, for example, might well include millet-seed porridge; in Japan, rice and a putrid soybean goop known as natto; in Jamaica, a mush of plantains or peanuts or cornmeal; in New Zealand, toast covered with Vegemite, a salty paste made of brewer’s yeast; and in China, jook, a rice gruel topped with pickled tofu, strings of dried meat or egg. In Cuba, Brazil and elsewhere in Latin America, it is not uncommon to find very young children sipping coffee with milk in the mornings. In Pakistan, kids often take their milk with Rooh Afza, a bright red syrup made from fruits, flowers and herbs. Swedish filmjolk is one of dozens of iterations of soured milk found on breakfast tables across Europe, Asia, the Middle East and Africa. For a child in southern India, the day might start with a steamed cake made from fermented lentils and rice called idli. “The idea that children should have bland, sweet food is a very industrial presumption,” says Krishnendu Ray, a professor of food studies at New York University who grew up in India. “In many parts of the world, breakfast is tepid, sour, fermented and savory.”

<p>The elaborate Saturday morning spread in front of Doga includes honey and clotted cream, called <em>kaymak</em>, on toasted bread; green and black olives; fried eggs with a spicy sausage called <em>sucuk</em>; butter; hard-boiled eggs; thick grape syrup (<em>pekmez</em>) with tahini on top; an assortment of sheep-, goat- and cow-milk cheeses; quince and blackberry jams; pastries and bread; tomatoes, cucumbers, white radishes and other fresh vegetables; <em>kahvaltilik</em> <em>biber salcasi</em>, a paste made of grilled red peppers; hazelnut-flavored halvah, the dense dessert; milk and orange juice. While certainly more elaborate than weekday fare, this Gursoy family meal is in keeping with the hodgepodge that is a typical Turkish breakfast.</p>
<p>Doga Gunce Gursoy, 8 years old, Istanbul</p>

Doga Gunce Gursoy, 8 years old, Istanbul

The elaborate Saturday morning spread in front of Doga includes honey and clotted cream, called kaymak, on toasted bread; green and black olives; fried eggs with a spicy sausage called sucuk; butter; hard-boiled eggs; thick grape syrup (pekmez) with tahini on top; an assortment of sheep-, goat- and cow-milk cheeses; quince and blackberry jams; pastries and bread; tomatoes, cucumbers, white radishes and other fresh vegetables; kahvaltilik biber salcasi, a paste made of grilled red peppers; hazelnut-flavored halvah, the dense dessert; milk and orange juice. While certainly more elaborate than weekday fare, this Gursoy family meal is in keeping with the hodgepodge that is a typical Turkish breakfast.

Parents who want their kids to accept more adventurous breakfasts would be wise to choose such morning fare for themselves. Children begin to acquire a taste for pickled egg or fermented lentils early — in the womb, even. Compounds from the foods a pregnant woman eats travel through the amniotic fluid to her baby. After birth, babies prefer the foods they were exposed to in utero, a phenomenon scientists call “prenatal flavor learning.” Even so, just because children are primed to like something doesn’t mean the first experience of it on their tongues will be pleasant. For many Korean kids, breakfast includes kimchi, cabbage leaves or other vegetables fermented with red chile peppers and garlic. A child’s first taste of kimchi is something of a rite of passage, one captured in dozens of YouTube videos featuring chubby-faced toddlers grabbing at their tongues and occasionally weeping.

Children, and young omnivorous animals generally, tend to reject unfamiliar foods on the first few tries. Evolutionarily, it makes sense for an inexperienced creature to be cautious about new foods, which might, after all, be poisonous. It is only through repeated exposure and mimicry that toddlers adjust to new tastes — breakfast instead of, say, dinner. That we don’t put pickle relish on waffles or eat Honey Bunches of Oats for supper are rules of culture, not of nature. As children grow, their palates continue to be shaped by the food environment they were born into (as well as by the savvy marketers of sugar cereals who advertise directly to the 10-and-under set and their tired parents). This early enculturation means a child in the Philippines might happily consume garlic fried rice topped with dried and salted fish called tuyo at 6 in the morning, while many American kids would balk at such a meal (even at dinnertime). We learn to be disgusted, just as we learn to want a second helping.

Sugar is the notable exception to “food neophobia,” as researchers call that early innate fear. In utero, a 13-week-old fetus will gulp amniotic fluid more quickly when it contains sugar. Our native sweet tooth helps explain the global popularity of sugary cereals and chocolate spreads like Nutella: Getting children to eat sugar is easy. Teaching them to eat slimy fermented soybeans, by contrast, requires a more robust and conservative culinary culture, one that resists the candy-coated breakfast buffet.

To sample the extensive smorgasbord that still constitutes breakfast around the world, Hannah Whitaker recently visited with families in seven countries, photographing some of their youngest eaters as they sat down in front of the first meal of the day.

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heavy metals, kids, nutrition

Why rice is dangerous to feed your children

CONSUMER REPORTS – Consumer Reports has issued new guidelines for limits on how much rice you and your children should eat.

Consumer Reports analyzed Food and Drug Administration data on more than 600 foods that contain rice and found some with worrisome levels of inorganic arsenic, which is linked to several types of cancer. The Food and Drug Administration recommends parents consider other options rather than rice cereal for their children’s first solid food.

Consumer Reports’ analysis found that hot rice cereal and rice pasta can have much more arsenic than its lab saw in previous tests. So Consumer Reports now recommends that children rarely eat these foods, which means not more than twice a month. And Consumer Reports recommends children under five limit rice drinks, rice cakes and ready-to-eat rice cereals. Levels of arsenic vary. Consumer Reports based its recommendations on the higher levels in each food group to offer consumers the best protection.

As for rice itself, Consumer Reports’ lab tests in 2012 found high levels of inorganic arsenic in white rice and even higher levels in brown rice. Consumer Reports has tested other types of rice and other grains and has found several alternatives with much lower levels of inorganic arsenic. Some good choices — sushi rice from the U.S. and white basmati rice from California, India and Pakistan. On average they had half the amount of arsenic as most other types of rice. And brown basmati rice from California, India and Pakistan has about one third less inorganic arsenic than other brown rice. Other good options — bulgur, barley and faro, as well as gluten-free grains like amaranth, buckwheat, millet and quinoa.

In response to Consumer Reports’ investigation, the USA Rice Federation issued this statement: “Research conducted by the Food and Drug Administration and U.S. rice industry shows arsenic levels found in U.S.-grown rice are below safe maximum levels established this year by the World Health Organization. Studies show that including white or brown rice in the diet provides measurable health benefits that outweigh the potential risks associated with exposure to trace levels of arsenic. The U.S. rice industry is committed to growing a safe and healthy product; we continuously test our crop, and research ways of reducing the already low levels of arsenic found in rice even further.

The Food & Drug Administration issued this statement: The FDA’s ongoing assessment of arsenic in rice remains a priority for the agency. Last year, the FDA released what we believe to be the largest set of test results to date on the presence of arsenic in rice and rice products, and we are planning to release a draft assessment of the potential health risks associated with the consumption of arsenic in these same foods.

Until that review is completed, the agency continues to recommend that consumers, including pregnant women, eat a well-balanced diet containing a variety of grains. Parents should feed infants and toddlers a variety of grains as well, and consider options other than rice cereal for a child’s first solid food.

Published studies and ongoing FDA research indicate that cooking rice in excess volumes of water – five to six times that of the rice – and draining the water can reduce the arsenic content, though it may also reduce the nutritional value of the rice.

Complete Ratings and recommendations on all kinds of products, including appliances, cars & trucks, and electronic gear, are available on Consumer Reports’ website. Subscribe to ConsumerReports.org.

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