Presenting at FNCE

Some of you, if you are Registered Dietitians, are familiar or at least heard of FNCE. The Food and Nutrition Conference and Expo that happens annually around the country. This is the big national convention for Registered Dietitians hosted by the Academy of Nutrition and Dietetics. I have been able to attend FNCE twice, once as a dietetic intern in Boston, MA and then two years ago in Chicago, IL. It was a fantastic experience to be able to listen to speakers, see the amazing exhibit hall and then get to network with fellow RDs. Over the last 7 years of being a pediatric dietitian I have spoken with several other pediatric RDs about the lack of pediatric content at FNCE. There are obviously lots of topics that they are trying to cover and there are normally a few pediatric topics that are addressed, but not a ton. I wanted to make sure that pediatric nutrition continued to have a focus at FNCE and have some quality information to provide to other dieititians. Lots of RDs are being asked to cover NICU/pediatric units in hospitals and some times these RDs aren’t always the best equipped to know how to take cover of these complicated patients.

I decided to put together a presentation proposal for FNCE with a friend of mine in Louisville, Laura Serke. She is an amazing NICU RD in Louisville and also works as a lactation consultant. I thought it would be awesome to provide a presentation focused on how to handle human milk (or breast milk) in the hospital setting. This would centered around the NICU specifically, but we would also cover the pediatric side of it as well. RDs are often the ones that are asked to help provide guidance on how the transportation, storage and feeding of human milk is delivered to infant patients. Laura was in support of putting together this proposal and then with the help of Salisa Lewis as well (another amazing NICU RD with lots of experience) we finalized our proposal and submitted it back in November of 2018. We worked hard over the course of a couple of weeks to create and finalize this proposal and articulate our thoughts in a way that sounded professional and interesting. It is tough to put together an interesting and interactive presentation on human milk in a way that would get a large group of people excited about the topic! I think we did a great job though coming up with a catchy title and putting all those ideas on to paper.

Fast forward to this past week … we got word back that our proposal was accepted and we will be presenting our presentation at FNCE in Philadelphia, PA in October of 2019. If you are attending FNCE this fall make sure to mark your calendar for our session on October 27th at 10am! It will be a great presentation and worth getting up for! This is the best news that I could have gotten. I am wrapping up my maternity leave and kind of questioning leaving my baby to head back to work, but this was just the push I needed. I love what I do and love educating people about my job and supporting other RDs in that field of pediatric/NICU nutrition. It is tough being a mom, working full time, running a side business and at times I question if it is worth the stress to try to do all these things. Then moments like this where a crazy idea works out and becomes a reality and then I realize “yes” it is all worth it!

So stay tuned to hear about about that presentation and of course pictures and documentation of the event in October of this year!

Brain Boosting Lunches

I had the opportunity to teach another class at Mini Minds! I was so excited to have 4 families that signed up for the Brain Boosting Lunches workshop. I have wanted to put together a class where parents'/caregivers can attend with their child and both adults/children can participate, try new foods and learn something about food.

This has been a learning process to figure out the best way to put together a class that is worth the money, provides a unique experience and is also cost effective. The key has been to find the right price point. There isn’t another cooking/nutrition class in the Indianapolis area where parents and kids are together and get to work with a Registered Dietitian. This is a unique opportunity and I want to make sure that families know that this is available and find it worth their time! It can be challenging to put together a fun, learning filled opportunity for families. The workshop lasts 1.5 hours and costs ~$35. If you are interested in participating in the next one that I offer, let me know!

This most recent class was focused on creative ways to put together a healthy lunch for your child. Lots of parents pack lunches for their children and send them off to school. Some times it is easy to get stuck in a rut of making the same thing over and over again. Finding ways to break out of that boring routine and then making healthy meals for your child is important.

During the class we started off talking about the MyPlate model and the 5 different food groups. We talked about what foods would be in each food group and what foods the kids enjoyed or didn’t enjoy eating. I wanted to include some nutrition education so that when the kids see the MyPlate again in school, they are familiar with the concept and willing to have different food groups at each of their meals.

This workshop session occurred during lunch time and so of course all of the kids wanted to eat and make food! So we jumped right into making our lunches for the day. I provided a handout with information about the food groups and then lunch ideas including some recipes as well for the parents to take home with them! Below is the lunch that we made as a group. We did a special twist on a classic school lunch item - the lunch meat sandwich. I wanted to do something familiar that everyone would like, but have it presented in a different way. These sandwich pinwheels did just that! They worked out great and some of the kids tried some new foods, like tomatoes and hummus and others were interacting with a non-preferred food (like cutting it up) which was great. We paired the pinwheels with some fresh veggies - carrots and cucumbers with hummus as the dipping sauce. I had planned on doing a dried fruit with these as well - like raisins, but those weren’t available at the time so we stuck with the veggies and the pinwheels as our lunch for the day.

Overall I think the families had a great time and were able to learn some things. I think this also provided a chance for the parents to interact and get to chat with one another. That can be nice to have some support from fellow parents when it comes with dealing with children. This was another successful workshop and I am excited to brain storm as other ideas for the upcoming 2019 year with Mini Minds and get some other dates on the calendar. If you have any creative ideas or have a topic that you would want to learn more about, leave that as a comment below and I would love your suggestions.

Exciting Opportunity for RD Anna

I wanted share with you all who follow along with RD Anna about some exciting new opportunities. I have had some new endeavors that I am getting involved with this fall. Some of your may remember that I did some outpatient pediatric nutrition counseling at my last job. I really enjoyed working with a feeding clinic and doing some weight loss classes up in Lafayette, IN. I haven't had the opportunity to do any of that in the last several years. I am continuing to work my full time job as a NICU dietitian as well. I wanted to make that abundantly clear as well. This is going to be a fun, side job that I am excited for and have been eagerly anticipating for the past 6 months. 

There was the opportunity to create a partnership with a business in Carmel, IN and I had to say yes! I use to work with Megan, Mini Minds business owner, at St. Vincent. She left her job at St Vincent as a social worker to launch her own private practice as a therapist/counselor. I have really admired her journey and I am so excited to learn from her about owning her own business. Mini Minds has grown and expanded into an amazing therapy office servicing the Indianapolis area. Make sure you check out their website and all the amazing services that they offer. Of course, the newest line of services including nutrition therapy and education options. 

As you may remember I made RD Anna a LLC this past year and then I also worked to get my NPI so that I could start charging insurance companies for nutrition counseling services. This has been a big step for me, because I have never owned my own business before or offered nutrition services for payment before. I am really excited to partner and work with Mini Minds and get to provide nutrition education/counseling for those clients and their families. We are getting started with a workshop class this upcoming weekend on Back To School: Putting Together Healthy Snacks for Your Family. That should be a fun session trying new snacks, talking about healthy options and then even making some delicious recipes. I also have plans for launching a 3 week cooking class series in October focused on shopping and cooking healthy family meals with your children. There are lots of neat things that I am hoping to do in the fall with this opportunity. So stay tuned for those exciting announcements about RD Anna! 

Writing a Nutrition Care Note

So I totally understand that this blog post may not be super interesting to a lot of people. I know most of the people who read this blog are not necessarily clinical dietitians, but this has been something that has been on my mind. I never thought that I would feel passionately about how you should write a nutrition note for a medical record, but now after being a dietitian for 7 years I have opinions. I didn't want to go into clinical nutrition initially, but after working in a hospital for the past 7 years, I definitely feel strongly about a well documented nutrition note. 

I am not going to go through the whole note writing process, because that is boring to most people, but I do want to touch on the last section - The Nutrition Intervention. This is where you get to write what you did to intervene in the nutrition care of the patient, what goals you have moving forward, what you want to monitor and how you plan on evaluating what you monitor (like your professional opinion on the situation). This section I feel strongly about because it is the one place in your nutrition note, where you get to put on display your nutrition knowledge. It is where you outline how you plan to treat this patient and what you anticipate might transpire in the future. It is where your professional opinion is able to be shared. Lots of times I feel that some RDs just put the minimum information in this section. They just put that the goals are met and what they might like changed. They tend to leave out the part about their professional opinion, they might omit details that better description the nutrition problem listed earlier or they might not share what they anticipate might happen during the next week. That is what I feel like detracts from a well writing nutrition note. 

Example - (1) Diuresis has been as anticipated. Weight was down 1.9% from birth weight. Weight gain goals are ~19g/day.  (2) Infant is on TPN support and we are aiming for 92kcal/kg/day, 4g PRO/kg/day and GIR Of 4-6mg/kg/min. Currently the lipids have been turned off as we work up on enteral nutrition. (3) Infant has been having issues with bilious emesis. Infant does have Gastroesophageal Reflux and will have an upper GI done. Slowly working up on enteral nutrition. Feedings are running continuously to help with tolerance. We are using maternal breastmilk. Encourage and support Mom with pumping. Infant may also get donor breastmilk and this is appropriate as a back up plan through 34 weeks gestation/1500g. Total fluid goals are 130-150mL/kg/day and currently tolerating 142mL/kg/day. Monitor tolerance with feedings and working up on volumes and down on TPN support.

Now if you are not a dietitian, this may not directly apply to you, but this idea about sharing your professional expertise is important for anyone. If there is an avenue through which you can share your career expertise in a specific way in your day to day activities ... you should always take advantage of that chance. Taking the time to thoroughly share that knowledge helps to justify your job and show how you are an important member of the team. I know as a dietitian, I want to be respected and valued as a member of the nutrition care team and how I write my notes plays into that. I know there are similar examples for other jobs. When talking to my husband about writing code for data pipelines that he works with that is something that he can do in a neat and well organized fashion. Taking the time to write "clean code" shows his skills has a computer scientists and shows that he cares about the "product" or code that he creates. 

After going through 4 years of school, a year long unpaid internship and now working for 7 years, you better believe that I am going to highlight my nutrition knowledge in that Intervention section of each and every nutrition note I write! Hopefully this encourages you to find ways to highlight your expertise at your job and take pride in the work that you do! 

Breast Milk Versus Formula

I decided to delve into this controversial debate about breast milk versus baby formula. I thought this might be an interesting blog post for a couple of reason. First of all it had been in the media quite frequently after President Trump tweeted "The failing NY Times Fake News story today about breast feeding must be called out. The U.S. strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty." 

So if you are wondering about this article that President Trump said was Fake News you can find it HERE.  I would encourage you to read through it and see what your thought are. The main accusation against the United States is the reported situation as follows ... "American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children." That might not have been that big of an issue, but when other countries didn't come to back the United States' proposed changes then things got more heated. "When that failed, they turned to threats, according to diplomats and government officials who took part in the discussions. Ecuador, which had planned to introduce the measure, was the first to find itself in the cross hairs. The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced." That is the part that bothered me. I don't think we should go threatening countries to get policy changes. That is something that I think is wrong and seems to be behaving kind of like a bully. 

So that was kind of a crazy response to something like breast feeding. I honestly was quite surprised to read that article. Then there started to be more articles and other opinions written. and I wanted to make sure to share those with you too. I really liked this article by VOX because I thought it did a good job at outlining the main issue that was being debated by the United States and other countries. "The UN group responsible for setting the standards on how countries should regulate food products, the Codex Alimentarius, hasn’t yet decided whether follow-up formulas should be treated like infant formulas — as “breastmilk substitutes.” Calling them a substitute for mother’s milk would mean heavier scrutiny and regulation — something public health advocates want. The US wants to call it a food, not a breast milk substitute,” said Elizabeth Zehner, project director for Helen Keller International’s child feeding project, who was present at the Codex negotiations. “That will leave the door open for all countries to call these products as non-breast milk substitutes, so they will get advertised on TV — and they look just like the infant formula.” 

So that is the main part of the debate ... how to categorize this formula products. I know it seems like a simple issue, but it can have big ramifications. Food is a complicated thing and when it is regulated different can lead to a large variance in products. The supplement industry is that perfect example. That is the under the Food and Drug Administration and anything classified as a supplement doesn't meet the same scrutinized criteria as other actual food items. So companies can put whatever health claims on those products and they aren't held to the same regulations as the food industry. I would say most of the time that can be ok, but I understand the concern voiced in the VOX article about how toddler formulas are regulated, because if they are labeled as "breastmilk substitutes" that would change their nutrition make up and how they are marketed to families. 

There was another story published on NPR on this topic and I wanted to make sure you had access to that as well, CLICK HERE. I think that this debate is not other and the formula industry does have a lot more money to lobby with compared with advocates for breast feeding. They are pushing a product and want to make money. That being said I believe in a baby being fed and healthy and that can be accomplished through either breast milk or baby formula. The debate here isn't necessarily which is better nutritionally, the debate comes down to money and how these formulas are categorized. That will then have a big influence on the products that are manufactured and then marketed to families. I would say our country has come a long way in encouraging mothers to breast feed and educating families on why that is the best thing for your baby. I think like any basic mothering skill, there are so much emotion that gets ties into this topic and can lead to guilt and regret. That is another blog post, but I wanted to make sure that you got some information on this debate and maybe some more insight as to why the President cared if women were breast feeding or using formula. 

My Week at Diabetes Camp

I have had the privilege to get to volunteer at the Diabetes Youth Foundation of Indiana’s Summer Diabetes Camp in Noblesville, IN. This is the 4th year that I spent a week at camp serving as the Registered Dietitian on staff. My job isn’t super glamorous, but it is fun. I get to work in the kitchen to organize and prepare the meals for the campers with food allergies. One in sixty Type 1 Diabetic patients also have another auto immune disease like Celiac Disease. So this means that these campers require gluten free options and often other Type 1 Diabetic people have other food allergies (issues with peanuts, dairy, soy, etc). To help accomodate these special needs, I work to provide options for these campers. Throughout the week, I work to prepare meal and snack items that accomodate those dietary restrictions our campers and some staff have. 

I worked in a camp kitchen before, back in 2008 I was a cook at Camp Lakeview for a summer. There is a special place in my heart for camp kitchen staff. I enjoy being able to give back in this way and help to make some of these speciality food items. I love being at Diabetes Camp, because it provides a place where these Type 1 Diabetics get to be “normal.” Checking your blood sugar is normal. In fact, if you are at camp and don’t have diabtes, that is more abnormal. I have really enjoyed getting to know the staff and campers. It has been fun to go back year after year and see these kids grow up and get to help them learn to love camp as well. 

Like I said it isn’t a glamorous job, but I think it is super important. All of us have to eat and we do it at least 3 times a day for meals and hopefully 1-2 other snacks included in there as well. For someone with Type 1 Diabetes that means that they have to account for everything they put in their mouth, dose their insulin and track what their blood sugars are. That can make meal time a stressful experience. I have to imagine that spending a week at camp where you have medical staff helping to track and manage your diabetes has to be a welcomed relief. A chance to be surrounded with all of these other people with Type 1 Diabetes and get to have fun while knowing your diabetes is being taken care of. 

All in all it has been a great week. Lots of early morings and long days, but it was a ton of fun and I really enjoyed the chance to volunteer. It is always a great way to spend a week! 

Baby Led Weaning FAQ

I felt lead to write another Baby Led Weaning post and I thought I would answer some commonly asked questions that I often get from parents about Baby Led Weaning. This is a topic that I really enjoy discussing with people. I love food and I think that teaching that love to food to our children is important. I believe that Baby Led Weaning is one of the best ways to help instill within children a love of food. 

• When can you start Baby Led Weaning? You can start giving your child soft, solids when they are 6 months old, have good head control and can comfortably sit up in a high chair. You also want your child to be showing signs they want to try to eat (reaching for foods that you are eating, watching you eat, etc). You want them to be able to do these things first, because then you know that they have the strength and stamina to handle solids.

• What do I feed my child? Anything that you are eating. Especially at the beginning start with soft solids (fruits, cooked vegetables, beans, tofu, etc) and then as they get older you can move onto harder food items. There is no need to purchase "special" baby food items, give your child what you are eating!

• What if my kid chokes? There is a difference between choking and coughing. Coughing is normal for every child. The key is not freaking out. Your child coughing is sign that they took too big of a bite, and they are trying to clear their airway. Do not pat them on the back to “try and help.” That could actually make them choke. Choking is when your children stops coughing and is no longer making noise. That is a sign their airway is blocked and that is the time to intervene. This would be the time to do the strongly pat their back over your knee and help to dislodge that food item. Choking is not common with Baby Lead Weaning. Coughing is common, especially at the beginning. Your child has to learn how to manipulate that food in their mouth to chew, swallow and breath. It is an acquired skill and takes practice.

• You don’t use store-purchased baby food? No purees? Nope. Don’t spend more money on commercial baby food. It is a gimmick and your child doesn’t need it. Offer your child foods that you eat at the dinner table. Start with soft foods, cut in long pieces so they can grab them with their hands and feed themselves. It is great to teach your child independence and encourage them to try new foods. Begin with cooked vegetables, soft fruit, soft grain items like puffs or mumums. These items turn into purees in their mouth and they can safely manipulate them. This also means that you make 1 meal and everyone gets to eat it!

• My kid has no teeth, how can they eat table food? Children want to eat what you are eating, why feed your child something different. Yes, your child may not have teeth, but that is why you start with soft food items that they can eat on their own. This teaches them how much food they can fit in their mouth and how to properly chew and swallow. They don’t need teeth for these soft food items you are feeding them.

• What if my kid gets messy? Your kid will get so messy, but that is part of learning. Eating is more than just putting the food in your child’s mouth. It involves the smell, the texture, the taste and the different flavors. This also allows the whole family to sit down together at the table. You don’t have to feed your child separately. Family meal times have been proven to help strengthen those family connections and help child grow into better, more well-rounded individuals.

• What if my child doesn't like the food? That is fine. It takes children upwards of 15 times of being exposed to a food to really determine if they dislike it. Always offer foods that they like and new foods as well. Remember, if you child chooses not to eat, that is fine. There will be another meal in a few hours and they will not starve.

• What is the biggest challenge with Baby Led Weaning? Trying to work in variety. I think it is so easy to get in a food rut, but trying to mix things up and trying new recipes is key. Getting your child to try 100 foods by the time they are one is totally possible.

This is from the Fortified Family website and Katie Ferraro's website/books are amazing!

I think a lot of times as parents we are the ones that end up holding our kids back. We are the ones who limit their creativity or keep them doing crazy things. Yes, some times it is merited to protect them, but with food I feel that it is so important to let them explore, get messy and learn to eat all the different food items. If you have any other questions about Baby Led Weaning, feel free to reach out to me!

My Nutrition Journey

I thought that it might be fun to have today's post focus on my nutrition journey to where I am today. Most of the time I am writing about interesting nutrition topics (that are near and dear to my heart), but I thought I might give you a little back story about my own journey to becoming a NICU dietitian.

I initially was interested in OT/PT in high school, but after job shadowing several PTs and working in a nursing home once a week for a semester in high school, I decided that wasn't for me. It didn't really enjoy touching people that much. I kind of preferred keeping my distance from the patients that I was working with. My mother encouraged me to look into nutrition and specifically dietetics. She kept telling me that having a credential, like the letters RDN after my name, would open up lots of doors for me. She was right! I went to Purdue and double majored in Dietetics and Nutrition, Fitness & Health. I was most interested in sports nutrition and that is where I wanted to work. I wanted to help athletes optimize their nutrition to improve their performance. After completely 4 years at Purdue, I did my internship through the Purdue Coordinated Program and graduated in August of 2011. After the completion of my internship, I took the RD Exam and passes and started working at St Elizabeth Hospital in Lafayette, IN. I originally wanted a job in sports nutrition, but quickly realized those positions were few and far between. Lots of them preferred a Master's degree as well. I decided that getting a job, starting to earn money and gaining work experience would be most worth my time. Unfortunately, a Master's in nutrition doesn't guarantee that you make significantly more money.

I started working at St Elizabeth hospital and covered the cardiac, pediatric and NICU units. I also worked in outpatient pediatrics. This is where my love for pediatric nutrition started to develop. I really enjoyed being able to make nutrition changes and see the changes within a few days. I really loved working in pediatric outpatient and developing a relationship with those patients. After almost 3 years, I took a new job in Indianapolis, IN at St Vincent Women's Hospital working in the NICU. This was a huge leap of faith for me, but it has proven to be such a blessing. I knew that I enjoyed the NICU, but I being able to work in pediatric critical care full time has been such an amazing experience. I love being able to work with these critically ill patients, provide them with the best nutrition and then watch them grow, over come the odds and thrive to go home with their families. 

Photo taken by our pediatric surgeon (Evan Kokoska) for an album The People of Peyton Manning Children's Hospital.

I have been able to do so many neat things over the years. I have been at St Vincent's Women's Hospital now for almost 4 years (as of April). I have had the opportunity work with lots of amazing people. I was able to give a talk at the Indiana Academy of Nutrition and Dietetics Conference (IAND) last year on NICU Nutrition and the role of the RD in the NICU. I have been able to serve on the Academy of Nutrition & Dietetics (AND) Test Writing Committee for the new Certified Specialist in Pediatrics and Critical Care Exam (CSPCC). I had the opportunity to write a chapter in a Nutrition Communication book that will be published in the next year through the Academy of Nutrition & Dietetics. I have been able to serve on the IAND State Board on the Nomination Committee and exited to be on the local CIAND Board this upcoming year. I have been able to mentor lots of interns and excited to see them pursue their dreams as RDs. I have worked with amazing people and I am so excited for what is ahead for my career. 

Looking back on it, I am so thankful to have parents who cared about my future. Who pushed me to pursue my interests, paid to put me through school and supported me as I took leaps of faith with job and opportunity that has come my way. I have been a Registered Dietitian for 6 1/2 years and it has been such a fun journey! 

First Birthday Party

It is hard to believe that we are now celebrating William's first birthday. It has been awhile since I have posted about William. I did several pregnancy posts throughout my pregnancy and then some breastfeeding and baby lead weaning posts over the last year. I wanted to take a moment and put together a fun post highlighting William's First Birthday. William was born on 12/23 and yes it is SUPER close to Christmas. We wanted him to have a separate birthday celebration and so we officially celebrated his birthday on 12/16. 

This party was mainly for use (William's parents), family and friends. William won't remember this party, but I know he will lose seeing the pictures when he is older. I wanted to do something fun and have this get together as a "thank you" for all the support from our amazing friends and family. 

Photo was from William's 12 month photo shoot we did with Karre Ann Photography in Noblesville, IN. 

So here are the party details. The theme - Dr Seuss! It kind of started with Cat in the Hat and expanded to include all Dr Seuss characters. We held the party at our house and there able to get some cupcakes made that we super cute. Shout out to Abby's Cakes for her amazing work. The menu included deviled eggs (green eggs/ham), cheese sticks (with the cat in the hat on them), relish tray, fruit salad, cheese ball. 

For the decorations we put up a wall decal of the Cat in the Hat that my Mom had used at a baby shower she hosted previously. It was great to have that to use again. I also got Dr Seuss books that we used on the table as decoration. I painted the letters "ONE" for some other decorations. We got a little Cat in the Hat plush toy to serve as a decoration. I also made the Christmas tree Dr Seuss themed. I had the ornaments all red, white and blue and then made some fabric embroidery hoops with Dr Seuss fabric on the inside.  

I put together a few goody bags for the 3 kids that were able to come to party. I used blue bags with a hat on the front of them and filled them with some goodies (Dr Seuss pencils, stickers, playdough and snacks). It was an easy and fun way to send the kids home with some treats. 

It was such a great day to get together with family and friends and we have been so appreciative of everyone's love and support. It is so special to get to have William in our lives and get to celebrate him on this special first birthday. 

Halloween Goodies

Crunchy leaves, spooky decorations and lots of sweet treats. That basically sums up this time of year. Halloween is just around the corner. With a little 10 month old running around our house, Halloween is even more exciting. We have a great family costume planned - it includes a farmer, a pig, a spider and a spider web. Any guesses ............... if you were thinking Charlotte's Web you would be right! 

When it comes to Halloween goodies we tend to reach for lots and lots of candy. In fact, Americans will end up purchasing 600 million pounds of candy on Halloween. For those trick-or-treaters that come to your door, their number one choice for Halloween treats is chocolate. About 157 million people participate in Halloween and 141 million purchase Halloween candy. That equates to 45% of the US population handing out candy to trick-or-treaters (source). So it is obvious that lots of people are purchasing candy, the kids that are trick-or-treating love it and we are eating lots of extra calories around this time of year. 

Have you ever wondered how many calories are in some of your favorite candy bars? Want to know more - CLICK HERE for the article. 

• Reese's Cup (110 calories) - You would need to run 7 minutes (at 10 minute per mile pace) 
• Butterfinger (85 calories) - You would need to do 10 minutes of Zumba
• Regular M&Ms (67 calories) - You would need to do 9 minutes of jumping jacks 
• York Peppermint patty (60 calories) - You would need to do 25 minutes of yoga
• 3 Muskateers Bar (63 calories) - You would need to do 26 minutes of pilates 

Do you have to hand out sugary treats? No, there are lots of options for things that you can pass out at your house. I love highlighting the Teal Pumpkin project every year, because for lots of families Halloween ends up being stressful. For families who have food allergies or food intolerances this is tough to have to sort through all the candy and pick the "unsafe" treats. The Teal Pumpkin Project has some great resources in terms of signage for your house, ideas for non-food related treats and spreading the word about food allergies. Last year I put together a great blog post with more treat ideas and a video about the Teal Pumpking Project - CLICK HERE to check it out. I loved this infographic and just had to share it with you. 

If you think the Teal Pumpkin Project is a neat idea, but you also want to hand out candy, that works too. That is what I do every year. I have a bowl of goodies filled with non-food related treats and then another bowel with candy goodies. That way I have options for everyone and I feel better about the large amount of candy that all these kids are eating on Halloween. 

Update on Donating Breastmilk and Breast Pumps

I wanted to do a quick write up about donating breastmilk to the Indiana Milk Bank. I was able to drop off some of my extra milk to the Milk Bank and I was very excited and wanted to share about that experience. I was able to go through the approval process to become a donor. Then I went ahead and donated 687oz of frozen breastmilk. My mother had this milk in her deep freezer and she helped me drop it off at Columbus Regional Hospital. I was so excited to be able to give some of my milk to the Milk Bank to sell to hospital to use for preterm babies. 

If you are a breastfeeding mother and have extra breastmilk, you should consider becoming a breastmilk donor. Check out my first post about this - CLICK HERE. 

I also donated some breastmilk to a random stranger on Facebook .... gasp! I know right? I was torn about it. But here is why I did it ... I had some breastmilk that had been in a refrigerator/freezer for > 6months and I wasn't able to donate it to the Milk Bank. There standards can < 6months in a refrigerator/freezer. This was milk that I didn't need and I wanted it to go to someone that could use it. There was a lady on a Swap Group I belong to on Facebook who was needing donor breastmilk for her little one and she hadn't been able to find anyone with extra milk. I really felt like I could and should help her. I felt like I wanted her to get good, safe milk and I let her know that I was an approved donor through the Milk Bank. I was able to give her over 200 oz of breastmilk. Normally I am not a fan of just giving away your breastmilk to a stranger, but I felt like if you think about it and do what you feel comfortable with that can be the write call. 

I also wanted to touch on breast pumps. I have had several people ask me about my breast pump. I went ahead and purchased a Medela Symphony. This pump is a hospital grade pump and it is what you would use while in the hospital or if your baby was in the NICU. This is a great pump, but is very expensive to purchase on your own. Insurance won't purchase it for you. I was very torn about what type of pump to purchase. I really liked Medela, but there are so many different options and I kept hearing such mixed messages about all of them. I was really stressing about it and that is when my husband suggested we look online for a used Symphony. We found one on Ebay that was ~$600 and it has ~75 hours on the machine. This was a great deal when retail value is ~$1000. I knew that this pump would work well and I wouldn't stress about it. If I had rented the same pump through the hospital it is $60 a month and over the course of 12 months that costs $720. So I knew that I would get my money worth out of that pump if I purchased it on my own. I just wanted to share that story with you, because I don't think people realize that you can purchase a used Symphony pump. Now, please be smart about it when you shop on Ebay. But if you really want that hospital grade pump there are ways to obtain one for less than the retail price of $1000. 

If you are looking at getting a breastmilk pump through your insurance .... do your research, look online and talk to your friends. Try to figure out what pumps have good reviews and evaluate what would work for you. This is a big decision and you need to make sure that you are making the best choice for you and your little one. 

Peanuts and FDA Health Claim

Food allergies are on the rise amongst children. This is a common issue that lots of families struggle with. Peanut allergies are one of the most common food allergies out there. In fact, in the US the incidence of food allergies has increased 400% from 2007 until 2016. The incidence of peanut allergies has increased 450% in that 9 year span. This is an alarming increase in the percentages of food allergies and specifically peanut allergies. Researchers have been looking at ways to combat this alarming trend. For lots of children they tend to out grow their food allergies, but for some it is an issue they struggle with their entire life. 

There was a research study that was done in the UK in 600 infants looking at the exposure to peanut protein powder and their incidence of peanut allergies by 5 years of age. These infants were labeled as "high risk" because they has eczema and issues with eggs. The cohort was between the ages of 4-11 months when they were started in this study and they were followed through 5 years of age. This group of 600 infants were divided into two groups: 1) avoid peanut protein completely and 2) were given 6g peanut protein powder weekly. The research findings showed that there was a reduction in the incidence of peanut allergies by 81% in the group that was exposed to peanut protein. Out of that group only 1.9% ended up with a peanut allergy compared with 13.7% of the children in the complete avoidance group.  This is very interesting research because it definitely leads us towards the idea that early exposure could potentially help to decrease the incidence of peanut allergies. 

Currently the AAP says that you can give peanut/peanut products to children when you start solid foods if there is no family history of peanut allergies. If there is a family history of food allergies then have a discussion with your pediatrician first. With careful monitoring from a pediatrician and a dermatologist, you can still give your child some peanut protein and that small dose, over time could help reduce the incidence of an allergy in the future. There is a product on the market called Hello Peanut. This product is very interesting because it could help serve as a tool for health professional to exposure children to a small amount of peanut protein and with close monitoring could help prevent peanut allergies. The way the product works is you start with the introduction packets and use it for 7 days. Each day you give one packet of the peanut protein and each day the amount of peanut protein in the packet increases in volume. It is kind of like a peanut challenge. If your child is able to tolerate the increasing dose over that week then you can move up to the maintenance packets. One issue with the research study that I mentioned above, is that there is no set length of time that is associated with how long you need to continue this exposure to peanut protein to prevent an allergic response. They are doing a follow up study to look at having those 5 year old, not consume peanuts for a year and see if they are exposed to peanuts after that year, if they elicit an allergic response. 

This is all a neat idea to potentially decrease people's risk of developing a food allergy by giving them some exposure to this protein and letting their bodies adapt to that protein and not elicit an allergic response. 

There was a great write up in the New York Times about the Hello Peanut product and how it can be used. Again, this is best used under the supervision of a health professional to ensure the safety of the child taking this product. If you child already has a diagnosed peanut allergy this is not a fix for that condition. There is no cure of peanut allergies. 

The other really interesting thing about this research study is it prompted the FDA to look at this research and put forth a "Qualified health claim" that says that consuming foods with peanuts could potentially help prevent future allergies. This is the first time that the FDA has made a statement like this in regards to a food allergy. The whole claim is as follows "for most infants with severe eczema and/or egg allergy who are already eating solid foods, introducing foods containing ground peanuts between 4-10 months of age and continuing consumption may reduce the risk of developing peanut allergy by 5 years of age."  Now there needs to be further research in this area and the FDA does knowledge that, but this is a huge step forward for food allergy research and could have a big impact on those of children and their lives in the future.

If you missed the FOX59 segment talking about this research study that aired in Indianapolis, click this link! 

Donating Breastmilk

I wanted to write up a blog post on a topic that is near and dear to my heart .... breastmilk donation. As many of you probably know I work in a Neonatal Intensive Care Unit (NICU) here in Indianapolis. We purchase and use a lot of donor breastmilk for our premature babies. There are lots of studies that show that using donor breastmilk in a preterm infant can be a good alternative when there isn't enough maternal breastmilk available. We specifically use this donor breastmilk for infants who are less than 34 weeks gestation and less an 1500g (3lbs 5oz). 

Breastmilk is an amazing food. It contains protein, carbohydrates, fat, fat soluble vitamins and has immune boosting properties. This makes it the perfectly designed food for babies. Donor breastmilk can be a good substitute for small, infants who don't have enough of their own mother's milk to eat. There are two negatives of donor breastmilk, that I commonly see in the NICU. First, it is a pasteurized product and during that process you end up killing off some of those immune boosting properties and denaturing some proteins. Secondly, you are giving term breastmilk (the typical milk donor is has a term infant and is donating mature milk) to a preterm baby. It is not the perfect make up of fat, protein and carbohydrate for that gestational age. It has been found to be helpful in this preterm population. Mother's own milk is best, but if needed donor breastmilk comes in as a great second option.

So how does the process work? I have had parents in the NICU be grossed out by the thought of using someone else's breastmilk for their baby. There is a huge system in place to help ensure that breastmilk being donated is safe to use for your child.  

Step #1 - The donor speaks with someone at the Milk Bank and they are screened to see if they could potentially donate. There is a whole list of questions - CLICK HERE for Indiana's Screening Criteria.  The Milk Bank wants their donors to be in good health (you have to get signed off on by your OB and pediatrician), taking no medications, be willing to get your blood drawn and commit to donating 100 ounces of breastmilk. 

Step #2 - After speaking with someone at the Milk Bank you will fill out an application that will get turned back into the Milk Bank. You will also get your blood drawn. They want to make sure that you don't have any blood borne illnesses that could be transmitted in your breastmilk. 

Step #3 - Take your breastmilk to donate to your nearest Milk Depot. There is a list of Milk Depots available online. 

Step #4 - Once you donate your breastmilk, it is pooled together and then pasteurized. That milk is then combined in bottles that are frozen to be distributed to the buyers. The bottles are bottled with lot numbers and the have bar code that is attached to them. This would allow for tracking of milk if there ever was a problem.

There are a few things that you have to do to be a donor, but honestly that time that it takes is minimal and you are doing so much good for lots of babies out there. The NICU at St Vincent Women's and at Riley get their donor breastmilk from the Indiana Milk Bank. They are also the two largest purchasers in the state. There are lots of other NICU units that are purchasing that donor breastmilk as well. If you are interested in becoming a donor check out the Indiana Milk Bank website and give them a call. If you want to donate money to help support this non-profit check out their About Us section to learn more. 

Baby Led Weaning Part 2

I wanted to do another follow up post about Baby Led Weaning. Besides encouraging your child to use their hands and feed themselves, finding utensils/sippy cups that work for your child can be overwhelming. There are lots of products out there, but I wanted to take the time and highlight a few items for you. I have heard about these items from Katie Ferraro who is an amazing dietitian who has some great education on baby lead weaning.

What to use? This has been one of my biggest struggles since starting solids with William. Breast feeding is easy because you don't have to use anything special. But with starting solids it is a whole new ball game.

Products I Love!

Grabease

These are a great product that I discovered through Katie Ferraro. I ordered a set for William and I think they are great. William loves holding them and putting them in his mouth. I can't say he has mastered the art of using utensils, but he has a ton of fun playing with them. These utensils are ergonomically designed to fit little ones hands. It allows for a natural vertical grasp and has a choke protection barrier to allow for safe self feeding. These also work great for baby led weaning. They can easily be cleaned in the dishwasher and are BPA free.

Ezpz Mat

I have to confess I have used this only a few times, but I love the concept for this utensil. This all in one placement and plate works well to contain food. It also sticks to the table and it is hard to pick up and toss to the floor. The compartments can hold two 4oz portions and then one 10oz portion. That would work for a fruit/veggie, protein and carbohydrate. This is easy for a small child to use and work on developing their fine motor skills. You can wash it in the dishwasher, use in the microwave and it is oven safe up to 350 degrees. 

Take and Toss Sippy Cup

I had two packages of these given to me from a friend and William loves them. I love this because it is durable to use again and again, but if it is lost it is not the end of the world. The colors are fun and they travel cap works great. They also don't have a valve, which I really liked. I want William to be able to gain the skills to control the flow of the milk out of the sippy cup and this will allow him to practice that skill. These are dishwasher safe as well and BPA free. 

What products have you used that you like? Are there any  brands or types of baby feedings products you really liked? There are so many types of feeding utensils out there it can be overwhelming. If you are on the hunt for some great products to try, make sure you check these out! 

If you missed my first blog post about Baby Led Weaning - CLICK HERE to learn more about how this is a great way to teach your child to love food! 

National Breast Feeding Month

In case you didn't know, August is National Breast Feeding Month. Many of you probably already know that I am breast feeding my first child. We have been going strong for the last 7 1/2 months. It is a big commitment. I haven't really talked about breast feeding here on the blog since William was first born. That first post was entitled The Gift of Breast Feeding. I think that is such a good way to look at breast feeding. It is A LOT of hard work and it is truly a gift that you are giving to your child. I made that choice for William and I try not to complaining about breast feeding/pumping, but instead look at it as a wonderful opportunity that I GET to do and I am giving to him. 

I have been volunteering with the Breast Feeding Support Group at St Vincent Women's Hospital for the last several weeks. I am working towards getting experience and hours for my IBCLC certification. This credential stands for an International Board Certified Lactation Consultant. This credential is a great way to get continued education about maternal and infant health/development and how to help mothers trouble shoot breast feeding. I have really enjoyed being able to work with some Moms on Fridays in an outpatient setting. It is so neat to see these mothers band together, lift one another up and support each other in this journey of motherhood and breast feeding. I was talking with one mom who said that the support of the lactation consultants and this group has helped her so much that without that support she wasn't sure she would still be breast feeding. That is a huge testament to supporting and educating mothers on how to trust their bodies to provide milk for their babies. I think lots of times we have the false idea that we, as the mothers, are in control of the feedings for the baby. In all actuality, the baby determines how much they want to eat and how they are going to do it. Trusting your baby and body is a tough thing to learn. Getting to work with some of these moms and encourage them has definitely been the highlight of my Fridays. 

Breast Feeding Facts 

• Breast feeding helps you save money $$$ 
  • Feeding your baby formula can cost you ~$1,500 a year or an average of $30 a week. 
  • Because breast fed babies are less sick, you will miss fewer days at work to stay home and take care of your baby.
• Breast feedings helps keep your baby healthy.
  • Your child is less likely to get sick when they are breast fed. Your breast milk can help prevent ear infections, diarrhea, respiratory illnesses, childhood obesity and childhood leukemia. 
  • Breast milk and breast feeding your baby helps to decrease the risk of SIDS by > 70%. 
  • Breast feeding if good for your health (as the mother), because your risk of breast cancer and ovarian cancer also decreases. 
• Commit from the beginning. 
  • Mothers who have a plan from the time before their child is born are more likely to stick with it. Breast feeding is tough and can be challenging, but those mothers who are determined are more likely to stick with it. 
  • Getting your support system on board with your plans to breast feed will help you be successful as well. 
• Breast milk nature's perfect food. 
  • Your breast milk is designed for your baby. It is easier for your baby to digest than formula and you pass along your immune fighting agents to your child. You are the mother, have the power to give this unique and perfectly designed food to your baby. 

Baby Led Weaning

It has been a little while since I have share with you about my little one, William. You got to hear all about my pregnancy and how things were going. I wanted to move onto another fun topic that I enjoy ... pediatric nutrition. This is totally my jam. Now my main focus is neonatal nutrition and obviously my child is out of that stage. He is now 6 months old! He is moving and grooving. He started crawling just around 6 months old. He is now obsessed with pulling up on things. When he pulls up and stands on his feet he is SO proud! He is just jumping through ALL of these milestone hoops. Over the last couple of weeks we have also started solid foods.

I am doing Baby Led Weaning with William. I am not sure if you have heard of this approach, but I think it is one of the best ways to teach your child how to love food. The premise is that you use table foods (foods that you would normally eat) and use those to teach your child how to eat. There is no jar baby food involved. Those products are over priced and totally void of much nutritional value. If you want to feed your child is a healthier and most cost effective way ... then keep reading, because this method is for you.

Baby led weaning simply means letting your baby feed themselves from the start of solid foods. There is no force feeding baby food mush. The term was coined by Gill Rapley who was a midwife. Check out her book HERE. Around 6 months or when your baby is able to sit up and is showing interest in foods if when you can start offering table foods. You simply hand your child a suitable size piece of food and they can play with it, smell it, lick it, mash it up, get it all over them and get the full experience of eating. At the beginning a very small portion of the food actually gets to their mouth/into their bellies, but they are learning all about food during this time. There are no purees, no ice cube trays, no food processing, no mashing of foods, no baby cereal or strange jar food combinations. Instead it is your baby eating food that that you eat at your dinner table.  

Baby Led Weaning

• Encourages and teaches family meal time. Everyone comes together at the table and eats together. The baby gets to participate in meal time by being at the time and eating appropriate finger foods that the rest of the family is eating.

• The child gets to choose what, how much and how quickly they want to eat.

• This method gives the chance to explore various new textures and tastes. There is no pressure to have to eat something.

• Continue to nurse or give a bottle just as often as you normally would. Solid foods at this point are made to go with the milk. The baby will regulate and start to eat more solids and decrease milk intake on their one. Usually this will occur later in the first year. For a baby at 6 months old, the main source of their nutrition is either breast milk or formula.

When you think about it baby led weaning ends up being a continuation of breast feeding. When a baby goes to breast, that baby is determining how food milk he is drinking. When he is satisfied he is done. The breast milk will take on different flavors, depending on the mother diet and this is an early introduction of what food tastes like and will increase baby's acceptance of those foods later in life. These concepts are continued with baby led weaning, because the baby is deciding if they want to try foods and how much of foods they want to try to eat. This method encourages that self regulation and exposures to various foods.

If you have questions about baby led weaning or want more information, send me a message. I have various resources that I would love to share with you. I believe that is it so important to build a healthy relationship with food and that starts when your baby first starts solid foods. 

Diabetes Youth Foundation of Indiana Camp 2017

This is my third year attending Diabetes Camp with the Diabetes Youth Foundation of Indiana. The camp is located up in Noblesville, IN and each year for a week I spend my time preparing foods for campers with food allergies. Lots of Type 1 diabetic patients also have food allergies or other autoimmune related diseases (such as Celiac disease). For their week at camp I work to help prepare "safe" foods for them to eat. My week at camp was crazy busy. We had 10 campers that had celiac and had to be gluten free. Then we had several vegetarians and one dairy free camper. With each meal I had to make sure that they had substitutes for the food items that were being served. I had to heat up and prepare 11 gluten free mac n' cheese diseases one meal and then make a pasta with red sauce dish for my dairy free camper. That basically summed up my week. It was great though, because I get to do something different for a week and I love being able to give of my time in that way. 

What I love about DYFI Camp? I think it is so great that these campers (all of which are Type 1 diabetic) can come to a place for the summer and get to feel "normal." Everyone else there as diabetes and checking your blood sugar/giving insulin is the norm. I also love that we support them with food that they can eat as well. We make sure that their food allergies are accommodated for and they are able to eat family style at meals. That is wonderful because they can choose what they want to eat and then their insulin bolus is given accordingly. Having a place where these campers can be just kids having fun is something that is so special.

Another exciting moment for this year was that we were able to donate the extra food to a food pantry/shelter in Noblesville. I was so excited to take the extra dry goods and fresh foods over to Third Phase Christian Center. These food items wouldn't have kept in the freezer until fall camp and so if we didn't take them somewhere they would have to be thrown out. I was so happy that they were able to be given to a group that could use the leftovers. They were very excited to receive the fresh food as a donation. They even were able to take opened food items that they used in their kitchen on site and whatever was unopened they could give away in the food pantry. 

It was a great week at camp. Everyone had a wonderful time. The weather was great. The kids got fed and I would call it a success! 

IAND Spring Meeting

I had the opportunity this last week to attend the Indiana Academy of Nutrition and Dietetics (IAND) Spring Meeting. Not only did I get the chance to attend for one of the two days, I also got be a presenter. I was asked to talk about being a Neonatal dietitian and what my role is in the Neonatal Intensive Care Unit (NICU). I was honored be to asked to speak and was excited to share about my job. I think I have a really neat job and having the chance to talk about nutrition in newborn, preterm babies is like a dream come true. #nerdalert 

The day of conference speakers was fantastic. I really appreciate having the chance to network with my fellow RDs around the state and also have the chance to learn more about nutrition. I thought I would share some of the highlights from my presentation and some of the highlights from the conference as well. 

Below you will find some of my favorite slides from my presentation. I talked about the history of the NICU and how nutrition plays an important role in the development of these preterm babies. I discussed the various types of formula available and how our goal is to use maternal breastmilk for feedings. I also talked about assessing growth in newborns and how we run our Formula Rooms to prepare feedings for our patients. 

The entire day at the IAND Spring Meeting as fantastic there were several speakers who discussed some very interesting topics. 

• Sharon Palmer, RDN spoke about eating a Plant Based Diet and finding ways to incorporate more fruits and vegetables in your daily meal routine. She did a great job and at highlighting the importance of eating more plant based and how it can taste good. I liked how she didn't put down meat in a negative way, but instead encouraged using meat as a seasoning and less of the main course. 
• Kate Byers, MS, RDN spoke about everything coconut. Kate is a fellow Purdue Alum and we have gotten to know one another on the College of Health and Human Sciences Alumni Board. She had a great presentation talking about coconut - how it is grown, how it can be used, what to look for on labels and some research about how healthy it really is or is not. 
• Sandi Morris, RDN also spoke about Order Writing Privileges for RDs in the state of Indiana. That was a great topic to discuss, because that can change how RDs operate in the hospital setting. 

It was a great day and I was so excited for the chance to attend and have the opportunity to speak! 

The Powers of Breastmilk

I had the opportunity for the past week to attend an amazing 5 day long conference about breast feeding. I know for some people that might not be an exciting topic, but I thought it was fascinating. St Vincent hosted the event and brought in two wonderful speakers to teach us for the 5 day course. The name of the course was Foundations for Best Practice for Lactation Care and the instructors were from Evergreen Hospital in Seattle, WA. Molly Pessl was one of the instructors and she has been a nurse for over 50 years. She has been working with lactating mothers for the majority of that time and is such a wealth of knowledge on the topic. 

I hope that over the next year or so I can work towards completing the course work to become a IBCLC or an International Board Certified Lactation Consultant. I first was exposure to working with women and breast feeding at WIC during my dietetic internship. I really enjoyed that part of the rotation, but didn't think much more about it, until now. I work in a NICU and we are always wanting and needing maternal breastmilk for our little babies. I thought that this would be a great time to start working towards that credential. Then this 5 day course was offered by St Vincent and I had to do it. 

I just thought I would share with you some of the amazing things that I learn during this coursework. I have never attended a lactation conference before so everything that was shared was new to me. We talked about the changes/development that happens for Mom and the baby during pregnancy, delivery and into the 4th trimester. It is amazing how the woman's body is designed to sustain life in the womb and afterwards. We talked about how the mammary glands work and how the hormone changes creates breastmilk for the infant. We talked about child development from in utero through 12 months of life. It was neat to discuss case studies as a group and have this chance to learn from the experience of people in the class. Of course at the end of the 5 days, I was so excited about everything that I have learned. I obviously think breast feeding is an amazing thing and something that every woman should be encouraged to do. It is worth all the hard work and effort to provide this unique food to your baby for a few days to a few years. 

I hope this post helps to normalize breastfeeding. This has been the way babies have been fed for thousands of years. I know that baby formula can help and save lives for lots of children, especially those who are premature, but their own mother's breastmilk helps even those tiny babies. I hope you are encouraged by this post and have a desire to show support and love to those mothers who are out there breastfeeding their babies and giving that gift to their children.

Vitamin D and Your Child

When you have a newborn baby you have probably heard your pediatrician talk about Vitamin D. They have probably asked you if you are giving a Vitamin D supplement to your child. Now you might be wondering why this is necessary and how important is it really? Well that is what I wanted to share with you is the importance of Vitamin D for your growing baby.  

Vitamin D is a an essential vitamin that your need to get through sunlight exposure and your diet. The challenge for all of us, especially in the winter, is getting enough sunlight exposure. This holds true for adults and children. If you are breastfeeding your infant, your breastmilk doesn't pass along very much Vitamin D. If that is solely what your infant is getting for nutrition and it is the middle of winter, your child really needs a Vitamin D supplement.  There was an article that was released this past week that prompted me wanting to write this post - CLICK HERE for a link to that write up. 

Why is Vitamin D important? Vitamin D helps with bone development and if your child isn't getting enough in their diet, sun exposure or via a supplement they can develop rickets. This occurs when the bones are weak, they bend and children have issues walking. This can be prevented through simply making sure your child is getting a minimum of 400 IU (international units) of Vitamin D each day. If your child is taking breastmilk or formula, supplementing with Vitamin D is necessary. There is an estimated 1 IU of Vitamin D in 1 fluid ounce of breastmilk. This is surprising for a lot of parents, but most people hear that breastmilk is the perfect food for your infant. That is true for most nutrients and for all of the antibodies that are passed via breastmilk. The one area where breastmilk falls short for term infants is the amount of Vitamin D available. Fortified baby formula contains 15 IU of Vitamin D in 1 fluid ounce of formula. Again, this surprises a lot of parents, but formula is designed to be nutritionally completely, but it like breastmilk is inadequate in the amount of Vitamin D it provides. As you can see, when the recommendation daily for infant is 400 IU per day, both breastmilk and formula fall short of meeting this goal. That is why providing your infant with a supplement is needed. 

Supplements - Now that we have established that your child, whether breastfeed or formula fed needs additional Vitamin D what are you going to purchase? There are lots of different brands of Vitamin D that are available. The main thing you want to make sure is that when you purchase a supplement you are giving 400 IU per day to meet the recommendations set out by the American Academy of Pediatrics. Most supplements will provide 400 IU in about 1mL of a liquid supplement that you would squirt in your infant's mouth daily. There is a product out there that provides the 400 IU of Vitamin D in 1 drop of this liquid, which can be placed on the mother's breast. This would mean the child would ingest it when they go to breast. This product is called Baby Ddrops. There are a variety of products out there and finding what works for you and your child is important. 

The main take away from this post is to help encourage you to give your infant their daily dose (400 IU) of Vitamin D each day. It is necessary for proper bone growth and development. When possible, make sure you take your child outside and get some sun exposure as well. Being outside for 15 minutes at midday with full sunshine would provide an adult with 10,000 IU of Vitamin D. So being outside for a less than 15 minutes as a child will help to meet their daily Vitamin D goals.