written by Darren Scoggin, M.D.
The Problem
Obesity is recognized as a significant public health threat and is a leading cause of medical conditions such as high blood pressure, diabetes, and decreased life expectancy. Children have not been immune to this emerging problem and are at risk for many of the same complications of obesity as adults. However, childhood obesity is also one of the most encouraging areas of medical care since there remains an opportunity to intervene early in the life of a person before the effects of obesity are developed.
It Starts Early
Early in infancy, babies recognize feedings as an attachment. They develop cues that caregivers can recognize as indicators of when the baby is hungry or full. Many parents wonder, “How will I know when my baby is hungry (or full)?” The answers are subtle but can be learned with good attentiveness and effort. When hunger cues are expressed, young infants will often root (or turn the open mouth) toward the side, making sucking motions. The baby may also be irritable or “squirmy”, moving around and not seeming to be in a comfortable position. When feeding is initiated, he or she should quickly engage with the nipple, latching on and sucking efficiently. The hands often are pulled toward the chest and/or mouth. After a feeding is finished and the baby is full, the sucking motion should be weak and irregular. The gulping noise of a productive feed will have stopped, and the baby will start to pull away or fall asleep.
It is important to not succumb to cultural expectations of how much a baby should take. For breast fed babies whose moms are not measuring intake due to nursing, the gauges of an effective feeding should be how long the feeding lasts, how the baby interacts with the mom during the feeding, and if the breast feels emptied afterward. For formula/bottle fed babies, babies should consume an age- appropriate volume (see this article for more information). In general, babies should consume about one ounce per hour averaged over 24 hours in the first few months of life, and generally should never exceed 32 ounces per day (even in older infants).
It Doesn’t Stop There
We are frequently asked the question, “When does my baby need juice?” The important word in that question is need. Babies (or infants/toddlers/children) never need juice, but it may be given sparingly in older infancy and toddler years. Generally, juice offers no significant nutritional benefit and only provides extra sugar and calories that are not needed, while training the child to prefer a sweetened drink rather than water. At 6-9 months of age, babies may start having water from a sippy cup on a regular basis, and this will increase to be the predominant beverage between 18-24 months of age. While juice may be given in small amounts from time to time, it should never be the main drink that a child has in his or her diet.
Snacks are the next category that often get overlooked when thinking about preventable risks for childhood obesity. It is appropriate for toddlers and children to snack at certain points during the day. Generally, snacks should be a small portion size, varied in content (alternating between proteins, fruits, and vegetables), and not replacing a meal. Items that are processed and high in carbs are less than ideal options for snack time.
Where Do We Go From Here?
Many families have developed dietary habits that are deeply rooted in generational lines and cultural norms. If there are eating habits in your family that are not healthy, resist the temptation to despair or to try to overhaul routines overnight. Pick one item to work on (ex: increasing water consumption, smaller portion sizes, one more vegetable per day), and start there. Big outcomes start with small changes, and it’s ok if things don’t go well to start! Give yourself and your family grace to begin a healthier journey to prevent childhood obesity and the long-term effects that it may cause. Starting now, you have the power to give yourself and your child a longer, healthier life!
