US Infant Mortality Rate: What Can We Do?

This week, the CDC reported that the US ranks 29th in infant mortality--a drop from previous years. Higher infant mortality rates provides good food for thought about what we can do better in this country to take care of moms and babies.

The Five Leading Causes of Infant Death are:

1. Birth defects

2. Disorders related to short gestation and low birth weight

3. Sudden infant death syndrome (SIDS)

4. Newborn affected by maternal complications

5. Accidents

A higher prematurity rate is one reason for our higher infant mortality rate; 36% of infant death occurs in premature infants. Prematurity is seen both in poor women who have less access to health care before pregnancy and for women who have LBW infants due to infertility treatments. Also women who are overweight and underweight and/or who gain too much or too little can also be more at risk for a LBW infant.

What Can We Do?

1. Provide better access to programs for low-income women so they start their pregnancies healthier and less likely to deliver a premature infant:

• smoking cessation programs
• drug treatment centers
• weight management programs
• ongoing treatment for chronic disease like hypertension and diabetes
• family planning services to prevent unintended pregnancy

2. Use nutrition first to help with infertility. Infertility is sometimes caused by being underweight or overweight. Fixing those problems before pregnancy could definitely improve the rate of prematurity.

3. Improve access to weight management programs for all women. Women who start their pregnancies at a healthy weight are much more likely to have a healthier birth outcome:

• Provide better access to weight management programs for all women before pregnancy
• Provide insurance coverage for pre-conception counseling, which would include counseling from a registered dietitian

Finally women should be encouraged and given the tools to follow the new weight gain guidelines from the Institute of Medicine which lowered the weight gain recommendations for obese women to 11-20 pounds. Many women, overweight or not, exceed weight gain recommendaitons, which can impact the delivery and have health implications for a child's entire life.

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Protecting Your Baby Against Swine Flu

If you have an infant or toddler, you are probably worried about the Swine Flu and the effect it could have on your child. Young children are less resistant to germs because their immune system is still developing. Those with underlying health problems are at higher risk of becoming sick with any bacteria or virus, not just the Swine Flu. 

What You Can Do to Protect Your Child:

Besides worry, which doesn't do anyone any good, there are things you can do to help protect your baby or toddler from the flu.

1. Breastfeed. If you are breastfeeding, keep doing so! If you are partially formula feeding, try to increase your milk supply so that you can breastfeed more often or pump so that someone can feed your baby breast milk when you are not around. Remember that breast milk provides built-in immunity at every feeding! If you become ill, your body provides your baby with antibodies that protect him from the germs that made you sick.
2. If you are exclusively formula feeding, choose one that has added nucleotides or other additions that promote immune health. 
3. If  you are breastfeeding, make sure you are giving the AAP recommended 400 IU of vitamin D every day. Vitamin D is very important for the immune system. For older children, let their skin see the sun unprotected a few minutes 3 times a week.
4. Let your baby get the rest he needs; it's important for the immune system. Set your schedule so that your baby's nap time is not interrupted.
5. Feed him well. If your baby is eating solids, make sure his diet is full of fruits and vegetables; they provide vitamins, minerals and antioxidants important for the immune system. Also don't forget whole grains, lean red meat and seafood; they provide zinc and iron, also needed for the immune system to function well.
6. Wash your hands; wash your baby's hands--after using the restroom, changing a diaper, blowing his or your nose, etc. Keep lotion by the sink to use after washing to prevent hands from getting dried and cracked; this also lets bacteria in. To be effective against germs, hand-washing has to last 20 seconds--one time through of the "ABC" song. 
7. Wipe down solid surfaces and wash toys. Use a weak bleach solution or put toys in the top rack of the dishwasher. Use an antibacterial wipe to wipe off door handles, telephones at work, etc. 
8. Take your own pen to use when out; you don't know how many people used the pen before you.
9. Watch where you take your baby. Don't take him to crowded areas where there are more likely to be sick people. Stay away from hospitals and Dr.'s offices unless he is the patient.
10. Take care of yourself too. Sometimes parents are so busy taking care of their kids, they don't take good care of their own health. If you get sick, who will be able to take care of the baby?! So eat well--5-9 fruits and veggies a day, take time for exercise and relaxation and get your 8 hours of sleep. The housework can definitely wait another day!

Can Diet Determine Baby's Sex??!!

Lots have things have been proposed over the years to help a parent help determine the sex of her baby, but now there's a dietary twist.

We know that diet definitely plays a role in fertility--but determining the sex of your baby by your breakfast choices may be too much to ask for--or not. Researchers recently reported in the Proceedings of the Royal Society B that women who ate more cereal, sodium and potassium, were more likely to conceive a boy. Fiona Mathews, lead researcher in the study, notes that women who ate more calories, along with more cereal, sodium and potassium  had a 55% chance of having a boy. Those who ate the fewest calories had a 45% chance of having a boy. Either way, it's still close to 50%.

And whether the "cereal factor" helps determine baby's sex or not, there are many benefits of eating cereal:

• A great way to get your whole grains! Half the grains you eat, should be whole.
• A wonderful way to get a big dose of fiber in your diet. As much as 10-15 grams of fiber can be found in many bran based cereals. Twenty-five to thirty grams of fiber are recommended per day--most of us don't reach that goal.
• Eating cereal is also a wonderful way to get your calcium--either through dairy or fortified soy milk.

Powdered Infant Formula--Not for Premature or Sick Babies!

A few days ago, a baby in New Mexico died--and the culprit was most likely a rare bacteria found in his formula. This is very sad and prompts me to write on the topic of Enterobacter sakazakii, the bacteria thought to be responsible.

What is Enterobacter sakazakii and where is it found? 

Enterobacter sakazakii, also called E. sakazakii, is a type of bacteria most recently associated with the use of powdered infant formula in hospital neonatal units and the subsequent death of some premature infants. The bacteria is also found in the gut of humans and animals and the environment.

Who is at risk for the infection?

 According to the US FDA, "premature infants and those with underlying medical conditions are at highest risk for developing E. sakazakii infection."(1) Several outbreaks of the infection have occurred in neonatal intensive care units worldwide. There is compelling evidence that the use of powdered infant formula had served as the source of the infection.

How could powdered infant formula contain bacteria?

According to the World Health Association, "Powdered infant formula is not a sterile product--even when manufactured to meet current hygiene standards. This means that it may occasionally contain pathogens that can cause serious illness."(2) 

Bacteria can enter a food during processing in 2 ways--through the raw material the food is made from and through contamination through other means. A food can also be contaminated with bacteria when the food is prepared for eating--in this case, when the powdered formula is reconstituted with water. Bacteria can enter the formula through dirty water, a dirty bottle or nipple or dirty hands. Small amounts of bacteria can grow to larger amounts that can cause illness when held at room temperature too long.

What can be done to prevent an infection from E. sakazakii?

• Breastfeeding is the best way to feed babies--especially those that are premature or have medical problems. (No cases of E. sakzakii have ever been associated with breastfeeding!) Even if breastfeeding needs to be done by a tube or eye dropper at first with milk that is pumped, the baby still gets all the hundreds of nutrients and immune building components of the breast milk. Also, ANY amount of breast milk is helpful in building the immune systems of infants--even if it is just for a few weeks or months.
• If breastfeeding is not possible, premature infants, low birth weight infants and those with medical issues should not be given powdered infant formula. Instead they should be given formula that is available in liquid form. 
• If circumstances don't allow the use of liquid formula, certain preparation practices can help reduce the risk of illness from E. sakazakii and other food borne illnesss. Keep in mind that the following preparation method should be used for infants that are at higher risk of infection--premature, low birth weight, immunocompromised infants--especially those under 2 months of age. Ask your doctor about formula preparation steps that are right for your baby.
• These safe food handling practices, summarized from the World Health Organization can also help decrease the risk of any type of food borne illness: They can be found at: www.who.int/foodsafety/publications/micro/pif2007/en/ 

1. Wash hands with soap and water and dry.
2. Wash bottles, nipples and bottle rings with hot soapy water and use a brush to remove dried milk from bottle and nipple.
3. Sterilize bottle by covering with water and bringing to a rolling boil. Turn off heat and leave pan covered until equipment is needed.
4. Clean and disinfect surface to prepare formula. Wash hand with soap and water and dry with clean or disposable cloth.
5. Boil some safe water. Add hot water (no cooler than 158 degrees F or 70 degrees C) to bottle and add correct amount of powdered formula.
6. Immediately cool bottle to feeding temperature by running cool water over it or by putting in a container of ice water. To avoid contaminating the bottle, make sure the cooling water is below the lid of the bottle.
7. Dry the outside of the bottle with a clean or disposable cloth.
8. Check the temperature of the formula by dripping a little on the inside of your wrist. It should feel lukewarm, not hot.
9. Feed the baby.
10. Discard any formula that the baby did not drink within two hours.

FOR MORE INFORMATION ABOUT BREASTFEEDING, SEE:

www.womenshealth.gov/breastfeeding/inc

(1) Health Professionals Letter on Enterobacter sakazakii Infections Associated with Use of Powdered (Dry) Infant Formulas in Neonatal Intensive Care Units. Food and Drug Administration. Center for Food Safety and Applied Nutrition. October 2002. www. cfsan.fda.gov/~dms/inf-ltr3.html

(2) Safe preparation, storage and handling of powdered infant formula-Guidelines. World Health Organization 2007. www.who.int/foodsafety/publications/micro/pif2007/en/

Healthy Breakfast at Starbucks!

What could be a better way to start your day than with a cup of vanilla latte or flavored steamed milk from Starbucks? A breakfast treat to go along with it that won't undermine your goals of healthy eating.

On a recent trip to Starbucks, when I inquired about the oatmeal, the guy in line in front of me offered up his opinion: "I eat the oatmeal every day--it's great! But today I'm having a chocolate donut!." And that's a healthy eating attitude, my friends--eat healthy most of the time with that occasional splurge...He was not the only guy to order oatmeal during my visit either--a few suits, joggers and students also ordered it. Maybe we should say "Real Men eat Oatmeal!" 

OK, so back to those new items for those watching their waist, cholesterol or general health--in other words, all of us! Here are my two cents on the items I've tried:

Vivanno: Here's the scenario--you're on the road to a meeting and you need something to tide you over until your early dinner. You don't want to spill ketchup on your suit from a burger--or smell like a fast food eatery either. Best choice for a tasty, meal to sip: Vivanno, which is a healthy smoothie containing real banana, whey protein and fiber. I've had the Orange Mango Banana Blend as a lunch replacement and it's filling as well as tasty, which I can tell you from personal experience, is sometimes difficult to achieve when concocting with whey powder!! I've heard from other dietitians that moms with morning sickness have found the Vivanno to go down really well, too. It's also a perfect mid-morning or afternoon snack for Moms-to-be, people trying to gain weight, or as an after workout replacement.

Vivanno Nutrient Breakdown: 270 calories, 5 grams fat, 16 grams protein, 5 grams fiber

Chewy Fruit and Nut Bar: Imagine one of those little fruit and nut granola bar that comes in a little package and leaves you wanting just a little more. Now imagine it baked fresh with the dried fruit still moist and tangy. That's the Chewy Fruit & Nut Bar-great to go with your morning java.

Chewy Fruit and Nut Bar Nutrient Breakdown:  250 calories, 4 grams fiber, 5 grams protein

Perfect Oatmeal: I'm an oatmeal kind of gal, while my husband is not--he says it's because I always put cinnamon and spice in it. Well, what he liked about this oatmeal was it's purity--no extra spices, unless you put your own! I liked the fact that the brown sugar was pre-measured in a little packet, which ended up being the perfect amount of added sweetness. The dried fruit, also in a little pouch, was nice and moist and contained raisins, currants and cranberries-which again added the perfect touch of sweet and sour.  A nut medley pouch also came with--giving the customer the option of putting it or not. This is great for those allergic to nuts, because there is no chance of cross contamination.

Perfect Oatmeal Nutrient Breakdown: up to 390 calories, depending on the toppings, and 1.5 servings of whole grains.

Apple Bran Muffin: OK, so if you have ever tried to bake with whole grains, you know that it's an art. Consider this a masterpiece! It's made with whole wheat flour, oats and wheat bran and has apples, tart cherries and honey. I like the nutrient balance--being high in fiber and protein for a muffin--which means it's probably going to carry you until lunch! Bran muffins tend to be either very dry, or greasy--this was neither, telling me that while not fat-free, it probably has a moderate but not excessive fat content.

Apple Bran Muffin Nutrient Breakdown: 330 calories, 7 grams fiber, 7 grams protein.

The Bottom Line: Do your diet a favor this holiday season--eat regular meals and snacks starting with breakfast to keep your energy up and your stress level down. Starbucks makes it easy with their healthy new breakfast options.

New MyPyramid for Preschoolers!

There's good news for parents--it's a new interactive tool to help parents feed their little ones. It's the MyPyramid for Preschoolers. Developed by the USDA Center for Nutrition Policy and Promotion (CNNP), it was developed in record time under the direction of the new director Brian Wansink, PhD, with guidance from Madeleine Sigman-Grant from the University of Nevada Coopeand Trish Britten from the USDA CNNP.

Here's what you can find on the site:

Customized Eating Plan: Simply plug in your child's height, weight, age and sex and you get a customized eating plan specifically for your child. Pretty cool!

Growth during the Preschool Years: You can find information about typical growth patterns as well as create a custom growth chart for your child.

Developing Healthy Eating Habits: A Wealth of Advice about Common Questions

Physical Activity: Lists ideas for family activities, age-appropriate activities and more

Food Safety: All you need to know about food safety as well as choking hazards.

Sample Snack Patterns: Gives 2 examples of meal and snack patterns

Check out the new MyPyramid for Preschoolers at: www.mypyramid.gov/preschoolers/index.html

Exploding Eggplant!

I'm sure if you spend any time in the kitchen, you've had at least one major mess up or accident that made you laugh--if not at the moment, then later!

Well, recently I had such an event happen to me as I was grilling some eggplant. (It's been a common pastime for me lately as we've got a bumper crop of it in our garden and I grill it to make Baba Ganoush for my husband.) Anyway, I was grilling whole eggplants on one side of the grill and steak on the other. After using the fork to turn the steak, I nudged the eggplant over to it's other side.

And powey--it exploded on me! I am not making this up! It would have been worse had I been closer to the grill, but I did have pieces of cooked eggplant on my shirt, on my arm (ouch!) and in my hair! I screamed but only my dog Ginger appeared to notice, as she looked out the sliding glass door at me. So let this be a lesson to all you who grill eggplant (which by the way is a really tasty way to eat it!) Please use tongs and not a fork to move it around on the grill!