Friday, November 15, 2024

The World could use a dose of Mr Rogers These Days

 I first ran this post several years ago after there was a week that seemed to have one horrible headline after another. It feels like a good time to run it again.

A generation of children grew up to be better people because of the lessons Mr. Rogers taught, but I wonder how many little ones know who he is anymore? 

He was as genuinely kind in person as he was on television. I know this because when I was a nurse at Children’s Hospital of Pittsburgh, he was a frequent visitor there.

He actually had the opportunity to personally console me one day.  I had chopped my waist length hair into an awful perm. I guess I was visibly upset over this bad haircut. What lessons did help me remember?

  • Hugs help 

  • Hair grows back.

Here are some of my favorite pieces of his wisdom:

  • There are three ways to ultimate success: The first way is to be kind. The second way is to be kind. The third way is to be kind.

  • There is only one thing evil cannot stand, and that is forgiveness.

  • There's a part of all of us that longs to know that even what's weakest about us can ultimately count for something good. It is okay not to be perfect!

  • Solitude is different from loneliness, and it doesn't have to be a lonely kind of thing.

  • Accept people as they are.

  • Look and listen carefully.

  • We all have feelings. Talking and acknowledging them is the first step towards finding ways to deal with them that don’t hurt anyone.

  • Anything that's human is mention-able, and anything that's mention-able can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we're not alone.

  • Wonder about things

  • You can’t go down the drain in the bathtub. Don’t be shy about sharing things that might be scary.

  • Be yourself. It is not how you look, what you wear or what toys you have that make you special.

  • What can you grow in the garden of your mind? Use your imagination.

  • You rarely have time for everything you want in this life, so you need to make choices. And hopefully your choices can come from a deep sense of who you are.

  • One of the most important things a person can learn to do is to make something out of whatever he or she happens to have at the moment.

  • Often out of periods of losing come the greatest strivings toward a new winning streak.

  • Often when you think you're at the end of something, you're at the beginning of something else.

  • There are times when explanations, no matter how reasonable, just don't seem to help.

  • Love isn't a state of perfect caring. It is an active noun like struggle. To love someone is to strive to accept that person exactly the way he or she is, right here and now.

  • Look for the helpers. Those might be a person in uniform, or another parent with children. 

People have reached out to ask me how I am faring after the election. Actually, I am on a ‘headline hiatus’ for another week or so.

While I realized that many people are celebrating what they see as a victory, Personally, I am confused, sad and frightened.

At some point, when I am ready, I will  look at the world, roll up my sleeves, remind myself of some of Mr. Rogers' finer pieces of wisdom and see what I can do to make a positive difference

.

Friday, November 8, 2024

The ghost in the Mirror/Leaving your kids alone for the first time...what could possibly go wrong?

 Several months ago, I saw a news article about how old your child needs to be before it is okay for them to be left at home without supervision. The guidelines vary widely from state to state. Interestingly, when it comes to actual laws, most states don’t have a specific age. 

I know that  it feels like just yesterday that your kids were still in diapers, but for most families, comes the time when it is very reasonable to transition from needing a babysitter.

There are obviously a lot of factors to consider.

  • Does your kid tend to be responsible?

  • Are they comfortable being left alone for a bit?

  • Are there neighbors or resources nearby if needed?

It all brings to mind a true story about a time that I left my youngest daughter Alana home for the first time. Things didn't go exactly as planned.

She was somewhere between 10 and 11.

There was no school that day. It may have been a conference day, but I don’t actually recall. In any event, none of the parents were easily able to take the day off. 

We arranged for two of her closest friends Lauren T and Yael to spend the day at our house.

These were very responsible and fairly mature kids. Also, I was only 7 minutes away at the Noe Valley Pediatrics office if they needed me.

All of the parents  would take turns checking in. We felt pretty comfortable with the plan.

I was not expecting any issues, so I was surprised when mid day, Alana called me in a complete panic.

To the best of my recollection the conversation went something like this

Mommy, we need you to come home right away!

Is everyone okay?

There was a ghost in the mirror, please come home!

Um, excuse me? Please take a deep breath and tell me what is going on.

We tried to conjure someone and he appeared. There was a 4th set of eyes reflected in the mirror. We all saw this. PLEASE, just come here and we will tell you the whole story

If I need to leave work for something bizarre like this, I am going to be mighty annoyed.

We will do anything. No allowance for the rest of my life. Please come home.!!!!

I tried one last thing.

Surely Java would bark if there was something creepy in the house

(In all honesty, Java, our golden retriever would more likely bring the ghost her ball and ask him to throw it. She wasn’t much of a watchdog.)

Java is already out with the dog walker. She isn’t here. Please come home!

So, I explained to my office that apparently there was a ghost in my bathroom mirror and I needed to leave. Bless them, they were remarkably supportive.

I got home and the three girls collectively flew into my arms.

They tearfully told me what had happened.

MTV had a show called 2together that featured a fictional boy band. If you are in your thirties, you might remember the show. Both of my girls were huge fans. Lauren’s room was plastered with 2gether posters. (Sigh, they are still up there. Her childhood room is where I do much of my writing and it is frozen in time).

In January 2001, the youngest member of the band had died from leukemia.

All of their young fans were devastated over this tragic loss.

So here they were, a month or so after his death.. Alana and her friends decided to create some type of ritual. They went into the dark bathroom, stared into the mirror and chanted his name over and over. Suddenly, at the same time, they all swear that they saw a 4th reflection staring back at them.

This was more than 20 years ago but some memories stick with you.

Lauren T. remains one of Alana’s closest friends after all of these years. Here are her recollections in her words:

It was a Jewish holiday (this is what I remember, but you are probably totally right that it was parent-teacher conferences), and Alana, Yael, and I all had the day off. We were at Alana’s house, and it was one of those gray SF days, where the sun perhaps gave minimal effort to bust through in the morning, but had long since given up before the moment in question. 

Michael Cuccione, one of the stars of 2Gether and our mutual tween crush, had recently passed away. We decided to try and contact him through a practice called “Ghost in the Mirror.” In my memory, we were giddy about it, giggling our way to the bathroom, the soft carpet of the Kivowitz’s house on my feet, the coziness of the day still palpable all these years later. 

I stood in the middle, with Alana and Yael on either side, their hands in mine. We turned off the lights. I closed my eyes. We started chanting in unison, “Michael Cuccione. Michael Cuccione. Michael Cuccione. Micheal Cuccione. Micheal Cuccione….” All of a sudden, I heard Yael and Alana screaming. I opened my eyes to two bright yellow eyes making their way down the mirror and out towards us. We all scrambled to open the door. It was stuck. We finally got it open and raced down the stairs. 

I sat in one of the big living room chairs. My finger was bleeding. Was it because I had nicked it on the door handle…or something more sinister? 

I of course remember Judy coming home. Relief, warmth, safety…and I think subconsciously, a sense of understanding. I think back now to what it felt like to have an adult not just hold space for our fear, but also for our mischief, our curiosity…our wonder. It’s a moment that surely changed me, and what an invaluable gift that the adult in the room found a way to both comfort us and also validate us - a line I can only imagine was challenging to toe. 

I’m so grateful that Judy didn’t try to explain away the “logical” reasons why this might have happened, like so many other adults in my life.I know what I saw, but more importantly, I know what I felt. And I will never, ever forget it. 

For the record, I am not sure that I didn’t try (and fail) to find a rational explanation for what had happened. Also, Alana does NOT remember me being quite as warm and fuzzy that day, but I appreciate Lauren sharing her memories!

And yes of course this story will be included in the book that I am working on.

………………………………………………………………………………………………..

If you are at this transitional stage when you are getting ready to let your kiddos stay home alone:

  • Start small, leave them alone while you do a short errand and see how that feels.

  • Have rules and expectations set and discussed in advance such as not leaving the house or opening the door to stranger.

  • Make sure that no one has access to firearms.

  • Until they are old enough that this isn’t an issue, have safe food and snacks available so that they don’t need to be using the stove or doing actual cooking.

  • Make sure they know where flashlights are and that the batteries are working.

  • Have all the phone numbers for emergency contacts written down, don’t rely on a cell phone.

  • Arrange routine check in’s.

  • Oh and……absolutely NO conjuring any spirits

Because you never can anticipate everything, as evidenced by this story, you might consider this game/exercise that I did with my kids. It helps your children work on essential problem solving skills.

I couldn’t help using this photo. Lauren now has an album out on Spotify called Old Haunts and Alana was her ghost.

Thursday, October 31, 2024

Can you love your sibling more than. you loathe their politics? I certainly hope so!

 Are you familiar with optical illusions?

You know the images can be seen in various ways.

A simple one includes different colored arrows. It doesn’t take too much coaching to be able to train someone to see both colors.

Another classic but more complicated one is an image of a young woman or an old crone depending on how you look at it.

If someone sees the young woman, that is their truth; you can not reasonably convince them that that image doesn’t exist. Others can only see the old crone and not for lack of trying, can not see the young woman.

Of course they both exist.

My goal has always been to recognize that there are multiple valid ways to see things and to endeavor to see both sides. Things are rarely simply black and white. There can be more than one truth.

But in this election season I am suffering. Try as I might, I completely and utterly fail to understand how so many people in this country (hopefully significantly less than half) can support a candidate who I see as completely terrifying.

With most every issue that I care about it feels like there is a right and a wrong.

Women’s rights to autonomy over their own body? (I don’t care what state you are in.)

Our climate crisis? (we are running out of time)

Common sense gun control (that many gun owners agree with.)

Freedom to marry whoever you want.

Basic democracy.

This just scratches the surface.

This election feels like it goes deeper than simple politics. There are ethics involved. It's also about standing up for those most affected by these issues, ensuring they feel heard, and, where possible, taking on some of the responsibility to help others understand these impacts.

And yet, here we are. The polls are remarkably close. How is it possible that people, some who I see as good, intelligent, caring, reasonable people somehow see things so completely differently.

I feel like I am living in an alternate universe.

If you are like me, it gets personal. For years it has been very apparent that my older sister and my opinion about most political issues are NOT aligned. It is also clear that no minds are going to be changed. But when the bickering would get heated and the claws would come out thankfully we have been able to take a breath, channel our mom, and simply agree that loving each other has to be more important than our deeply differing opinions.

This past weekend, I was at a cousin’s wedding in New England surrounded by lots of extended family. Although I believe I was in the majority when it came to politics, by no means was my sister the only one on the opposite side of the political aisle.

For the most part, everyone checked their politics at the door and celebrated being together. It can be done. The only party that counted was the one we were dancing at. In fact, not having the news on and specifically NOT talking about politics was a needed respite.

All that being said, how can we simply agree to disagree when so much is at stake? Loving someone with different views involves caring enough to engage respectfully, and if there’s even a small opening for civil, constructive discussion, it’s worth trying to share perspectives that show why these issues matter deeply. In doing so, we hold onto each other’s humanity—even when our politics diverge.

After next week, there will be millions of disappointed people (not me not me please please please.)

 Being angry at people who are close to us, no matter how deeply we disagree on important manners, will not help anyone move forward.

Regardless of where you stand. Please vote and let your children see the process

Addendum: I read this post to my sister before sharing it. She gave it a thumbs up and and says it relates equally to both sides. And then….we started to argue about the issues. It got louder and louder. Did you hear us? Then we stopped and we both said “I love you”

Sigh

Wednesday, October 23, 2024

Halloween safety tips 2024

 There are crunchy leaves on the sidewalk and fun decorations on houses. It is time to update the Halloween post.

Even though Halloween often feels like it is all about  scary things as I list all of the accidents and things to be wary of, my intent is actually NOT to terrify you. Most of the things I mention are completely preventable!

Imagine that getting your children safely through this holiday is somewhat like walking through a minefield, but I am putting a warning flag on top of each mine so that you can avoid stepping on one!

Pumpkins

Carving a pumpkin can be a very fun tradition. Please make sure that your child's level of participation is consistent with their age and ability. Watch out for the sharp implements and make sure you assign your younger child to the safer tasks (young kids can draw on the pumpkin rather than carving.)

Clean up the mess. Pumpkin flesh is slippery and can cause falls and injuries when dropped on the floor. Layer newspaper or an old sheet under your carving work space and clean up spills right away so no one slips or trips. Skip the candles, which may cause fires. A burning candle in a pumpkin may become a blazing fire if left unattended. Instead, use a glow stick (available in many colors) or flameless candle to safely illuminate your jack-o'-lantern.

Of course, while glow sticks are a good option, I once had a patient who bent a stick in order to activate it. She likely used excessive force, but in any event, it  broke and squirted in her mouth. While you do want to avoid unnecessary contact with the insides of glow sticks, the good news is that they are generally non toxic. For the science nerds out there, this link is fun.

https://www.glowtopia.co.uk/news/how-glow-sticks-work/

Choosing a costume

Children are more than twice as likely to be hit by a car on Halloween than on any other day of the year!

Decorate costumes and bags with reflective tape or stickers and, if possible, choose light colors. Have kids use glow sticks or flashlights to help them see and be seen by drivers. Is your dog going along with the trick or treaters? Have them wear a glow in the dark collar!

When selecting a costume make sure it is the right size to prevent trips and falls. Be sure to wear something that is flame-resistant. Even if you have complied, remind your child that they need to pay very close attention to their surroundings and avoid walking near any candles or flames, especially if they have loose flowy costumes.  If a sword, cane, or stick is a part of the costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if they stumble or trip.

Comfortable shoes! Anyone of you who has sacrificed comfort to wear their sexy high heels knows what I am talking about. 

Make sure that no part of the costume is covering the ears so thoroughly that hearing might be impacted.  Masks can sometimes obstruct a child's vision, so assess the fit. Non-toxic face paint and makeup are another option. In past years some face paint made the news for containing toxic ingredients such as lead. Be familiar with the ingredients before you apply anything to your child’s skin. 

Avoid anything in the eye area. Always test the makeup in a small area first. Always completely remove it before bedtime to prevent possible skin and eye irritation.

Double check that your child doesn't have any latex sensitivity before you do too heavy of an exposure. Many Halloween masks are made of latex. I remember once that I actually had a patient who had an allergic reaction to the hair tinsel. You may want to do a test run of the costume and make-up a couple of days ahead of time to rule out any allergies. This dress rehearsal is also a great time to make sure the costume is comfortable and not tight or itchy.

My niece Lena is incredibly creative and when her son was younger she would put lots of time and energy into making fabulous costumes . More years than not, he would opt out at the last minute. The message here is not to get too invested. Take your photo ops early on while the getting is good.

Trick or treat rules

Almost every year there are reports of cannabis laced candy, but last year there also were reports of fentanyl that looked like candy (some humans suck). This is much more serious. 

Ideally you only get candy from trusted sources, but typically this isn’t usually the case.

Make sure that your children know that after trick or treating, the grown up needs to pick through trick or treat bags and toss anything that looks suspicious. Anything that looks like it has been tampered with should get tossed.

Children under the age of 12 should not be alone at night without adult supervision. If kids are mature enough to be out without you, remind them to stick to familiar areas that are well lit and trick-or-treat in groups. Never go into a strangers house unless they are accompanied by a trusted grownup.

If you are on the Next Door app, they have a brilliant map so you can see which of your neighbors are participating in the festivities - https://nextdoor.com/treat_map

Most parents automatically check through the candy of all of the younger kids (pocketing some of the good stuff for themselves.) But sadly, I think it is important to sort through the candy bounty from your older kids as well.

Popular trick-or-treating hours are 5:30 p.m. to 9:30 p.m. so if you are out driving, be especially alert for the trick-or-treaters.

A good meal prior to parties and trick-or-treating may discourage youngsters from filling up on Halloween treats.

Bring plenty of water along when you go trick or treating. Just trust me on this one.

Some candies are real choking hazards. If you have a younger child in the house, make sure they don't have unsupervised access to the stash.

If you have a child with nut allergies (I am sure this is NOT your favorite holiday) make sure that they turn over ALL the candy so that you can separate out anything that might cause trouble. It’s a good idea for allergic kids to know how to recognize the nuts that they have problems with, but a careful look at all of the ingredients is needed.

If your child has diabetes, make a plan with them to see how much candy they can safely eat without seriously impacting their glucose levels.

Expecting trick-or-treaters or party guests?

Consider purchasing non-food treats for those who visit your home, such as coloring books, stickers, tattoos or even hand sanitizer. Provide healthier treats for trick-or-treaters such as low-calorie treats and drinks. (Okay, fine...maybe you don't want to be "that" house, but I had to put it on the list.) Be sure walking areas and stairs are well lit and free of obstacles that could result in falls. Keep candle-lit jack o'lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.

Covid tips

By no means is Covid the only game in town these days. Flu, RSV and all sorts of colds usually start to  ramp up this time of year.

So how do we stay healthy and still have fun? As with all activities there is a risk/benefit analysis. Trick or treating outdoors with a small group should be pretty safe. Have some hand sanitizer spray that you can easily spritz if you are grabbing candy from a communal bowl. If you are going to be in a crowd, see if you have a costume that includes a nice protective mask as part of it.

Now what do we do with all this candy???

Make a plan about how much candy they can eat at one time. It is okay to be a little more liberal than usual for a day or two, but come to an agreement about a reasonable candy intake over the next few weeks. My daughter Lauren was about 6 when she caught on that mom and dad were pilfering through her trick or trick bag and stealing all the snickers. After that she guarded her stash more carefully.

Remember that candy freezes (and some of it is actually better that way; frozen chocolate bars, yum!) Some dentists and orthodontists have buy back programs, where they will give your child a reward for turning in their candy. Check with your dentist to see if they participate.

You can create your own bartering program. The mom of one of my old patients had a system that they could exchange candy for lego pieces. …Brilliant. In any event, you may need to be extra vigilant with teeth brushing this season.

When I updated this post several years ago, I was still working at the start up ‘Oath care’. I had tapped into the wisdom of some of our specialists

Tips from developmental specialist Mona Singhal

www.Spark-wonder.com

Halloween with little ones 

Remember young children can’t always tell the difference between real and make believe. Give your kids a heads up that they may see some things like witches, pirates or ghosts that may look scary but it’s just friends playing dress up. Remind them that they will also see Elsas, Paw Patrol and their other favorite characters too! We want them to know there may be some scary moments but mostly some fun ones coming their way! 

Plan out the day with them. This will be a change in their routine so letting them know who you will be going trick or treating with and even talking about the path together will be helpful! “We are going trick or treating with your cousins and we will visit the pink house on peach street that we pass on the way to school!” A couple of highlights of the route is enough to help them feel like they know what to expect and this helps eliminate meltdowns. 

Wear comfortable clothing underneath their outfits! This way if the outfit gets uncomfortable (which it usually does) they can shed some layers while still sticking to the fun! Get your pictures in as soon as possible this way if dressing up isn’t going as planned you don’t have to stress it! A happy half pirate is better than a crying fully dressed one! 

Tips from a Pediatrician

Tummy aches and constipation from all the extra candy are very common the days after halloween.

There is often an uptick of little pieces of candy being stuck in places that they don’t belong (like the nose.)

And because everyone needs a good laugh…. 

Here are some brilliant suggestions from comedian and author Raquel D’Apice

Haven’t decided on a costume for your toddler for Halloween?

Let your toddler’s own personality be your guide. Here are three last-minute suggestions that are tried and true, and by “tried-and-true I mean “I came up with them on a whim, but I think they seem feasible?”

For shy, overly clingy toddlers:

Consider dressing your toddler up as a moth and then you yourself can dress up as literally any light source. (old fashioned lantern, candle, the moon).  You won’t be upset that they spent literally the entire evening trying to get you to pick them up, you’ll just be thrilled that they committed to the costume so well.

For non-clingy toddlers:

Dress your toddler up as a gray sphere labeled “wrecking ball” and let them loose wherever the Halloween festivities are taking place. 

For toddlers that like to explore, but lose their nerve after a few minutes and come back to you:

Boomerang or yo-yo costume is the way to go. If we’re being totally honest, the yo-yo costume is basically just a frisbee costume with a child leash attached to it, but it’s super practical if you’re worried about your toddler getting lost and it meets the requirement of “Can I throw this costume together frantically in an hour after the kid has gone to bed?”

Happy Halloween and best of luck

!

Friday, October 11, 2024

Dr Ted and Nurse Judy's Solid Food Guide

 As a pediatrician and advice nurse, we are familiar with many of the common questions that most parents have when it comes to starting food. The goal of this post is to answer those frequently asked questions as well as sharing tips and tricks (some from other parents) that you might not have thought about.

While we are not dietitians we have a lot of input about the ABCs of starting to feed your baby. 

We recognize that there are lots of opinions when it comes to solids. Our approach  tends to be on the more relaxed side of things. We hope this document offers information without adding stress to the equation.

Relax and have fun!


Timeline

Birth to 4 months

Why should babies start solids around 4 months (and not before)?

Feeding babies solids before 4 months isn't recommended for several reasons.

  • Young infant digestive systems aren't mature enough yet to handle anything other than breast milk or formula. Their tiny tummies are still developing the necessary stomach acids and enzymes needed to digest solid foods properly. Interestingly, these stomach acids are also a component of the body’s immune system that kills harmful bacteria in the gut. One of the reasons we are so careful keeping things sterile for the first couple of month is that infants produce less stomach acid than adults

  • Infants are also born with a “tongue thrust,” a reflex where they stick out their tongue. This helps them push out food that gets into their mouth by accident and is nature’s way to prevent choking. 

  • Introducing solids too early can increase the risk of digestive discomfort.

Once babies are around 4 to 6 months old, they are more physically ready and often start to show signs of being interested in trying new foods.


4 months: An Introduction

There are so many thoughts about all of this!  Some people believe not a morsel until 6 months, others are fervent that the benefits of starting early are not to be missed. At 4 months, parents have the option of starting solids. It’s by no means mandatory. There is no right or wrong. There are some advantages which we will discuss below.

Why start sooner? 

  • It can be fun.

  • Early feeding is more about exploration than it is about nutrition. This becomes important later on. Toddlers brains are very complex but in some ways they are very simple. When it comes to food they recognize that things are familiar or unfamiliar.  By exposing them to plenty of colors, textures and tastes early on, you may be avoiding picky eating later.

  • Recent research has proven that, for infants with eczema or a family history of food allergies, introducing allergens regularly between 4-6 months significantly reduces the likelihood that they will develop food allergies in the future. There are even companies that make products like allergy packets” to streamline this process. The most common food culprits are nuts, fish/shellfish, milk, eggs, wheat, and soy. There is a lot to say about introducing allergens to these kids safely, so we encourage you to read up here for how to do it.

How can you tell that your baby is ready for solids?

There are some basic signals that your baby is ready for solids:

  • Starts to lose the tongue-thrust reflex 

  • Has the ability to sit up with minimal support and reasonable head control (this can be on your lap)

  • Opens mouth for oncoming food

  • Keeps tongue flat and low so that spoon fits into mouth

  • Keeps most of the food in, although some is usually going to be dribbled back out

  • Likes to imitate you

  • Shows interest in food (this could be staring at you intently while you eat)

  • Reaches for the food in your hand

  • Turns their head away when they’re no longer interested

Rememberthere is no “one-size fits all” with this. Some kids are very interested at 4 months, while other 7 month olds are driving their parents nuts by showing no interest whatsoever.

If you are offering food in this 4-6 month window, remember that they don’t technically need anything other than milk at this time, so it is no big deal if they don’t want it. 

How to start

There are a million ways to introduce solid foods. Below, we outline one approach to starting this journey. These is only one absolute rule! Aside from that, anything goes. You could follow some pieces but not others. After each suggestion, we provide an explanation for why we think you might consider it:

  • Here is the one firm rule: no honey for kids under 12 months.

    • Why: there’s a risk of botulism poisoning. This can be lethal (Dr. Ted has managed it with his patients twice).

  • Start with purees or cereals.

    • Why: There are definitely kids under 6 months who can handle soft foods like sweet potato and avocado, but many babies will do better if it’s fairly liquidy, while they’re just learning. You can mix a food with breast milk or formula to get that smooth consistency.

  • Time the solids mid way between milk feedings.

    • Why: A baby who’s already full from milk won’t want to try new things. A baby who is ravenous wants their milk now and won’t settle for anything else. Mid way between feedings is a good sweet spot to be open and curious.

  • Put one food “on trial” at a time if you’re doing whole foods or purees.

    • Why: this is to monitor allergens. If there’s a reaction, it’s easy to identify the culprit. Imagine you start with hummus and there’s a rash: was it the sesame? Or the chickpeas? If you opt to start with multiple foods at once, your life is just a little harder if there’s a reaction because it won’t be as obvious what caused it. In a family with no history of allergies, eczema, or asthma, the concern is very low for an allergic reaction and you can mostly do what you want. We will discuss allergen “packets” below.

  • Offer the ingredient at least three times before moving on to the next one.

    • Why: Allergic reactions almost never occur on the body’s first exposure (it happens, but it’s very rare). It takes multiple exposures for the body to develop an allergic reaction.

  • Introduce new foods on weekday mornings.

    • While anaphylaxis from a first food exposure is extremely rare, you don’t want to offer something and then put them right down to sleep. It is preferable to time it so that you can keep an eye on them for a bit. If you’re worried about allergies, Dr. Ted suggests trying foods on Tuesdays or Wednesdays: reactions are often worthy of being seen (without actually being an emergency), and it’s easier to get a call into the doctor’s office on those low-volume days.

  • It doesn’t really matter what foods come first with regards to vegetables versus fruits.

    • Why: there's no strong evidence that introducing vegetables before fruits will make a big difference in their long-term food preferences or prevent a sweet tooth. Babies have an innate preference for sweet flavors due to the naturally sweet taste of breast milk or formula, so introducing fruits isn't likely to create an issue. What matters is offering a variety of foods, including vegetables, can help them develop a diverse palate.

  • Don’t get discouraged if your baby rejects certain foods initially.

    • Why keep trying: Research shows that it takes between 8 to 15 introductions before a young baby will happily accept some new foods, even if they don’t seem to like them initially.

Things to Keep in Mind

Allergy Packets

There are a lot of potential allergens. Introducing them all in small amounts at the youngest age possible is intimidating. Some companies make packets of tiny amounts of these foods in powdered form (Ready, Set, Food! SpoonfulONE and Little Mixins are popular examples). You can sprinkle the powder into breast milk, formula, or onto cereals daily to ensure the body’s immune system learns about it. The idea here is that using very tiny amounts of these foods is safe to do just for this “teaching” phase. If there is an allergic reaction (like full-body hives, vomiting, or trouble breathing), you’d need to stop the packets and move forward with the supervision of your pediatrician.

Note: if your baby already has very sensitive skin or eczema, it’s possible the powders will make those rashes worse. If that happens, decrease the packets (to ¼ or ½ packets daily). 

Iron Supplements

At this stage, babies have lost their maternal iron stores. What does that mean? They’re born with iron from mom and the placenta, which remains in their blood for the first 3-ish months. If you’re mostly breastfeeding after 4 months, the American Academy of Pediatrics recommends supplementing with iron between 4 months of age and whenever iron-containing foods are introduced (including iron-fortified cereals), usually around 6 months. This is much more important for anemic mommies, because those babies started with lower iron levels. Read more here about how to make sure your kids are getting enough iron.

What about cereals?

As is typical with American parenting, there are strong opinions. We think that cereals, like oat or rice cereals, are an easy way to give your kids iron. Years ago when rice cereal was making headlines due to arsenic levels, Nurse Judy did a blog post titled ‘Food heroes and villains’. There is indeed more arsenic than we would like in some foods like organic rice. Balance is the key. Rice cereal is fine to offer several times a week, some of the other cereals like Oatmeal and Barley, don’t share the arsenic concerns.

Good starting foods

When doing single-ingredient solids introductions, there are lots of questions about which ingredients make good first foods. Below is a list of a couple easy ideas.

  • Applesauce

  • Oatmeal

  • Plums

  • Avocado

  • Peaches

  • Pumpkin

  • Banana

  • Pears

  • Rice

  • Barley

  • Peas

  • Squash

  • Green beans

  • Prunes

  • Sweet potato

Keep Things Relatively Clean

Because babies younger than 6 months are especially susceptible to food-borne illnesses, it is important to keep things as clean as possible. Once you introduce saliva to the food and they don’t finish up what’s in the bowl,  it might not be safe several hours later. To avoid waste, only put small amounts into a bowl at a time, and keep adding more using a clean spoon.


6 months

There is nothing wrong with waiting until your child is 6 months before starting to introduce anything. In fact until several years ago, that was the recommendation of many pediatricians.

Frequency

At 6 months, all kids should be starting some solids. It should happen at a minimum once per day. If you have a child who wants to eat more often, by all means go ahead and offer more frequent meals. If you have a child who has reflux, many gastroenterologists recommend solids at least twice a day.

Quantity

Many parents express concern that their child is eating either too much or not enough. It is normal for there to be some days when kids will eat just a spoonful of something and other days when they’ll pile it on – their appetites can be erratic. This is typical! You are NOT alone.

Here is the Nurse Judy magic equation:

X amounts milk + X amounts solids = A happy/growing/peeing/pooping/sleeping baby

You don’t need to ‘solve for X’ unless there is an issue with the right side of the equation.

In other words, if you have a child that is growing, peeping, pooping, sleeping, and happy, then you can feel pretty confident that  the amount of food and milk that they’re getting is sufficient. You can trust your baby. Your job is to offer what you think they should eat, but it is their job to accept what they actually need. They usually get it right. If you aren’t feeling confident, then go back up to that equation and see if something is off.

At about the 8 month mark, if you feel like you are not having any success with solids, and you’ve been diligently trying, it’s worth checking in with your pediatrician.

Form

At this stage, we can move from simple purees to a combination of purees and “baby-led weaning.” Baby-led weaning is an approach to giving solids that involves offering food to babies in a way that allows them to pick it up. The term can be confusing, but it has nothing to do with weaning milk. The broad philosophy of baby-led weaning is that there are no singular ingredients (except for honey) that can’t be prepared for babies safely at six months. 

It is not our intent to reinvent the wheel when there are other excellent resources that can hold your hand with some basics: The Solid Starts App gets a big thumbs up from us for how to introduce a variety of foods. With any app or programs that you find, remember that you can pick and choose to follow whatever parts feel helpful.

Things to keep in mind

Drinking Water

It’s technically not necessary to offer water if your child is pooping lots and peeing clear, but instinctively, now that we’re adding solids consistently, adding at least an ounce or two of water into your child’s diet seems like a good habit to incorporate. Water can be in a straw cup, a sippy cup, or a bottle. Pay attention to their pee and poop and adjust the amount accordingly. The honey bear cup is an easy way to introduce the concept of drinking from a straw. Scroll down for more info about cup choices

Pouches and Rusks

Another form of food that parents find very easy to serve are pouches. Kids love pouches. The unfortunate thing is that most pouches are akin to bags of sugar water. No wonder they love them! Rusks are dried teether crackers for babies that share a similar problem. If a pouch or rusk advertises itself as kale and apples, it’s often mostly concentrated apples with smaller amounts of kale. It’s wise to read labels closely here. The order of the ingredients is related to their relative amount. You want to see that the healthy ingredients, like kale or other low-sugar vegetables, are listed before the apples, pears, and sweet potatoes. Remember, something can be labeled as organic, but that alone does not make it a healthy food. Think of pouches and rusks as tools: they’re convenient if you’re stuck in the car or can’t get out of the stroller and need something to eat (and you need your sanity). But try not to overuse them.

Changes to Poop

Poops can be SO strange once you start solids. Before you became a parent, you might not have imagined that you would take a photo of your kids poops and send it to someone. Think again. It is more common than you might think. One of the biggest culprits is bananas. When those are consumed, the poop sometimes contains little darkish threads that can freak people out.

Beets? red. Blueberries? Yes….blue poop. It happens.

Not only does it look different, but spoiler alert, the poop is also going to get much stinkier. 

It is very important to make sure that your kids don’t get constipated as their systems figure out how to handle real food. Hard, pellet, formed stools are a sign that you need to intervene. It could be as simple as adding more water, but being aware of which foods are binding and which ones keep things moving is important.

Please check out this article for some guidance.

Brushing Teeth

The guidelines will tell you to use fluoridated toothpaste as soon as the teeth erupt, but many parents will simply wipe down those early teeth, and that seems adequate. Do a more thorough job of brushing if your child has something sticky and sweet.

https://nursejudynvp.blogspot.com/2023/03/dental-health-2023when-to-see.html

Eating With (or Without) Teeth

While we are on the subject of teeth, it might be worth mentioning that there is a wide range of normal when it comes to tooth eruption. Some late teethers can manage to eat a wide variety of textures by gumming things. 

Do this simple experiment. Put a soft piece of food in your own mouth and try to eat it without using your teeth. You might be surprised what you can manage. If you are curious about the timing of your child’s tooth timing, this teething post has a useful tooth eruption chart.

Shifting away from eating at night

This is a gentle reminder that most babies who weigh more than 12 pounds are physiologically permitted to try sleeping through the night without feeding. 

  • Their bodies need the long stretch of sleep for growing (not digesting)

  • Families who get a good night’s sleep function better in almost every way

  • When babies wake at 1am, they always accept food, which can make it confusing to parents who feel like their child is still hungry overnight. If someone offered you a warm chocolate chip cookie in the middle of the night you would probably say thank you and eat it. I know I would. The hard truth is that no one actually needs the midnight cookie. 

  • We think that it is time to train babies not to expect food between midnight and 6 AM. This does not mean you are not available to offer other types of comfort measures as needed.

Choking

The risk of choking is something that many parents have nightmares about. But regardless of how nervous you are, take a deep breath.  Kids need to learn how to eat.  When babies learn to walk, there are lots of tumbles along the way. When they are learning to eat, you can expect some gagging as they’re learning this new skill.  There is a big difference between gagging and choking.

Gagging is loud. It can involve coughing, gurgling or sputtering. The skin might look red.

Choking is often silent. They aren’t able to give a full cry. Kids look distressed.

It is worth doing more of a review on choking rescue than what we include here. But briefly:

If your baby seems like they are struggling: If you can’t see the food, tilt your child forwards and let gravity do the work. If you can visualize a piece of food and want to do a “finger sweep,” remember to stick your finger into the cheek and side of the mouth, not straight back (which might push food further). Never blindly stick your finger in their mouth.

When the meal is finished, do an “all done” mouth check, making sure there are no pockets of food squirreled away in their cheeks. The solid starts app has an excellent guide on this https://solidstarts.com/gagging/

It is also worth doing a drill where you practice removing your child from their buckled up highchair so you can see how quickly you can do it.

Avoid round hard pieces of food, such as hotdogs, popcorn etc (I am a grape cutter until they go to college). Safe beginning on instagram is a great account that addresses this (along with other general baby safety stuff)

Scroll down for more ‘safe eating’  tips.


9 months

Frequency

At 9 months, kids are ideally doing solids at least twice a day. If life is hectic and you skip a meal here and there, don’t stress about it. If you are generally increasing the frequency and amount from the previous month, then you are on the right track. 

Quantity

The amount that your child takes in may shift at this stage, but the job descriptions remain the same. Your job is to offer what you deem a reasonable amount, and their job is to accept what they want. Ideally, at this age, kids can use the “all done” sign – see below for more on signing. (see link below) This can help them to regulate quantity.

On average, between 6 months to 12 months, there is a steady transition as solids edge out milk for importance, with 9 months representing the inflection point.

Form

It is fine to continue to offer some purees if your baby likes those, but perhaps more baby-led weaning should be encouraged for those who are interested. Mesh bags filled with a piece of fruit are welcome for kids who are actively teething.

Things to keep in mind

Nutrition

Protein becomes more relevant, especially if a large quantity of solids is starting to replace the milk. Milk is very high in protein, so it cannot be replaced with just a bag of peas without missing a lot of macronutrients.

Continue to make sure your kids are getting enough iron. See the link above

Teaching basic signs

Teaching your kids some basic signs can get a jump on their communication and lead to less tantrums. Start with more, all done, milk, and food. Here is a video teaching these signs. 

Pay attention to attention.

Kids crave attention – doesn’t matter if it’s positive or negative. If they are getting more attention from not eating, they will continue with that pattern. It’s good to give them positive attention when they’re eating safely, eating well, etc. If they throw a cup on the floor and you either make a game out of it, or get annoyed..guess what? You have now engaged in the universal favorite activity that drives parents nuts.

Throwing Food
If they throw something, I suggest that you just pick it up and don’t give it back without looking at them. 

When they are old enough, consider the concept of a ‘no thank you bowl’ where they can deposit food that they don’t want. More on attention here.

Are they getting enough?

This is also a phase where some kids slow down on their growth curve. It makes sense when you see some of these little athletes rolling, scooting and crawling all over the place…they’re doing cardio.  When you look at the growth chart it is common for some kids to bounce along the curve, ignoring the rules. As long as the length and the weight seem to be in agreement, we are content to have you do a re-check in a month or so. If your child is not eating anything with texture, now is a time to bring it up at your 9 month check up.  At this age we want to see kids doing more finger foods.


12 months and up

Frequency

At 12 months, eating should be with the family, although young kids will often need more snacks. 3 meals and 2 snacks is an oft-cited frequency, but more is ok if they want it. Pay attention to tantrums: a lot of times they can be headed off with a well-timed snack.

Quantity 

Truly, whatever they want. If they want less, that can be okay. Dinner being the biggest meal of the day is more of a Western invention. The rest of the world, and toddlers, tend to eat bigger lunches and smaller dinners, and that’s fine. If they’re growing and happy, we aren’t worried. Note: growth has slowed at this age, and that’s normal. They’re no longer growing at the rapid rate of young infancy.

Form

It’s ok to give almost everything that parents are eating at this time, with a few choking-centric exceptions. Still avoid whole nuts, hot dog rounds, whole grapes, etc. Popcorn also isn't a great snack for a 1-year-old, mainly because little kids don’t have the molars or the chewing skills to safely break down those hard, uneven pieces, which can easily get lodged in their throat. One thing that is now ok: honey. The threat of botulism is now gone.

Things to Keep in Mind

The Milk Transition

Many questions about the transition to other kinds of milk are addressed in this post.

If you are breastfeeding, congratulations for making it this far. Of course, kids' complete nutritional needs haven’t been satisfied by milk alone for several months now, but there remain lots of health benefits from breast milk. Continue to nurse as long as it feels right to you.

Do we have to do full fat cow’s milk?

Many parents think they *have* to switch to whole-fat cow's milk, but that's not exactly the case. Kids do need to have healthy fats in their diet, but there's no biological reason we need to be dependent on bovine milk. The real goal is making sure your toddler is getting enough fats, proteins, vitamin D, and calcium, and cow’s milk happens to be a convenient way to get these. But there are plenty of other options! For instance, three servings of yogurt and cheese, along with plenty of water, will do the trick just as well. You can also explore milk alternatives like oat or pea protein milk, which are often fortified with calcium and vitamin D. If you do decide to go with whole-fat cow's milk, 24 oz per day (about three 8 oz bottles) is enough to cover all your toddler’s calcium and vitamin D needs.

Why not do more than 24oz?

It’s important not to overdo it with milk in the absence of other high-iron foods. Drinking too much, especially more than 30 oz a day, can block iron absorption due to certain proteins in cow's milk, specifically A1 proteins, and even lead to intestinal bleeding (sounds scarier than it is…we all bleed into our intestines, cow’s milk can just increase it). That’s why it’s important to focus on iron-rich foods too. Heme iron, found in meats like beef, duck, and liver, is absorbed most easily by the body. Non-heme iron, which is in plant-based foods like beans, lentils, and tofu, is trickier for the body to absorb, but pairing it with vitamin C (like orange slices or bell peppers) helps boost absorption. Getting that balance between healthy fats, iron, and nutrients like vitamin D and calcium is what matters most, whether that’s through cow's milk or other food.

How can you get enough iron without eating red meat? How do vegetarian kids thrive?

It’s totally possible for a 12-month-old to get enough iron without eating red meat—you just have to be smart about combining non-heme iron sources with vitamin C to boost absorption. Think of how they eat in India: lentils, beans, nuts, and legumes are staples, and they’re often paired with tomatoes, which are high in vitamin C. The vitamin C helps the body absorb the plant-based (non-heme) iron much more efficiently. So, at almost every meal, you'd want to include something like lentils or chickpeas with a little citrus, tomato, or bell pepper on the side. Cow’s milk should be limited since it can block iron absorption, so sticking to alternatives or reducing milk intake is key. While it takes a little planning, vegetarian kids can absolutely thrive if meals are balanced like this. If you want more specific food ideas or meal plans, follow up with your pediatrician. (if that is Dr Ted, then you are in luck)!

What about the bottle and transitioning to a cup?

Our only real rule is not to give a bottle to your baby in the crib. 

The AAP recommends transitioning from bottles around 12 months because using bottles long-term can lead to cavities and affect how a child’s teeth and jaw develop. The constant sucking on a bottle can keep sugary liquids like milk in contact with their teeth, which increases the risk of tooth decay. Orthodontic issues can also come up if bottle use continues for too long. That said, the impact isn’t huge if the transition is done gradually, and there’s no need to rush. You can start introducing a cup slowly and aim for a full transition by 18 months. Try replacing one bottle a day with a cup, and as they get more comfortable, swap out more over time. It's a slow and steady process, so feel free to take it at a pace that works for your child.

They grow too fast not to savor the occasional calming, ‘snuggle bottle’

And because nothing is simple, Parents can get absolutely overwhelmed by their cup choices.

Another deep breath, see if this post can help make sense of that.


A few extra topics

Drinking Juice 

Water is almost always preferable to juice.  If your child simply won’t drink plain water, see about flavoring it with a slice of fruit, such as an orange. If that doesn’t work, then it is fine to add a little splash of apple or white grape juice to add a little flavor.  Adding some pedialyte powder is another option. Kids tend to like the flavors and as a bonus the added electrolytes are helpful if it is hot out.

There are times when juice does become a tool. If your child is sick and you are really focused on getting them hydrated, at that point you can offer whatever you need to get them drinking, but that added pedialyte might be especially helpful.

 Another time when juice comes into play is if they are constipated. I am a big fan of diluted prune juice to get things moving along.

Picky Eaters

Picky eating after 12 months is super common and totally normal. At this age, kids are starting to develop independence and become more aware of their preferences, which can lead to them rejecting certain foods. Evolutionary-wise, this pickiness actually helped kids avoid harmful foods—our ancestors didn’t have food labels, so being cautious with new or bitter foods kept them safe. But it can be frustrating for parents! One way to encourage trying new foods is to keep offering them without pressure. Kids often need to see a food multiple times before they’ll try it, so don’t give up if they turn something down at first. Also, try pairing new foods with things they already like to make the experience more familiar. We often feel like the “healthy food” needs to be served healthfully (i.e. cheese over here, broccoli steamed over there). But if the cheese is eaten anyway, just melt it on the broccoli! That will incorporate the flavors and adjust the palate.

Mama Jen shared that frozen veggies are her favorite tip.

 The nutrient content of frozen veggies is actually generally at or better than fresh, because the nutrients are preserved at their peak, and they last longer, and can be prepared in just a few minutes with a microwave. All of our kids LOVE peas and broccoli, without any added seasoning. But if we want to boost the calorie content, we can add cheese or butter and they gobble that up just the same.

It's also important to remember that kids at this age might just seem picky at dinner because they’ve eaten a lot earlier in the day. Many toddlers are big breakfast and lunch eaters, and by dinner, they’re simply not that hungry. If they’re growing and hitting their developmental milestones, it’s totally fine if they have a small or even skipped dinner. The idea that dinner needs to be the biggest meal is a Western thing and not how people eat in many parts of the world. So, if your kid is thriving, don’t stress too much about how big their dinner plate is.

Remember attention? Notice it when they try something new! Feel their muscles when they eat some good ‘growing food’.

There are some more picky eating tips here.

Safe Eating

Safety is key since they're still learning how to eat properly. Make sure you're sitting with them during meals and model good habits—chewing slowly, taking small bites, and not talking with your mouth full. Toddlers love copying what they see, so if you're practicing good habits, they'll pick them up. They will pick up your bad habits even faster.

It's also important to prevent them from running around with food, since it can be a choking hazard. Encourage them to sit calmly during meals and remind them not to shove too much food in their mouths at once.

Salt and Spices

Babies are generally content to eat fairly bland food, They don’t know any differently! The minute they are exposed to the wonders of salt, that acceptance phase is behind you. I am fine with most spices, but if you can avoid adding salt, your child will be better off. If you are cooking for the family, consider holding the salt for everyone and just adding it at the table (in secret)

Most other seasonings are actually a bonus and can expand their palate.

Sweets

Added sugar is actually an inflammatory food that can lead to health issues later on in life if you eat too much of it, but it is VERY hard to avoid it completely.

When kids are old enough to grasp the concept, I divide foods into ‘growing food’ or “Not growing food.” If kids have had enough of the growing food, then you can make a choice as a family how you want to handle the occasional dessert. I would counsel you that if you elevate it to a rare or forbidden treat, that will add to its allure. I would also suggest that sugar ‘treats’ are not to be used for rewards (good luck with that). I prefer a reward to be a special activity.

Vitamins/Supplements?

If kids are eating a good variety of food (eat the rainbow), then it is probable that they are getting all of the vitamins they need from their diet.

Vitamin D is the exception. It is tough to get adequate amounts from food alone.

For that reason we think that kids should continue taking Vitamin D supplements.

If your family is vegetarian, then a B12 supplement is needed

If your little one has severe allergies and can’t eat all of the standard food groups,  it is worth meeting with nutritionist  ensure they are getting a balanced diet

Microplastics

Microplastics is one of these emerging areas of medical research that are still poorly understood and absolutely terrifying. The idea is that flexible plastics (think plastic bags, plastic tupperware, disposable water bottles) leach microplastic particles into our foods and bodies, where they might increase the risk of hormonal disruptions and unknown impacts. Microplastics are literally everywhere, and they’re almost impossible to avoid. It’s worth noting that we have lived with microplastics for generations and have managed to get by. But as our awareness grows about them and their possible health impacts, there are a couple of ways that one could easily decrease their microplastic burden: cold over hot, firm over flexible, and water over grease.

  • Cold over hot: Microplastics shed more when hot. Try not to microwave plastics. This includes tupperware and frozen bags of food. 

  • Firm over flexible: Thin and flexible plastics are worse than firm, re-usable containers. Pouches and rusks may be significant carriers due to their processing and delivery (pouches are often plastic bags).Try to avoid thin disposable water bottles.

  • Water over grease: Research has suggested that oils assist in leaching microplastics from plastic containers. Dry things and less greasy things are better for plastic than oily leftovers. 

Pet Safety: Which foods are toxic?

Now that your little one is eating, no one is more excited than the family pet. They are no doubt circling the area like little sharks, waiting to see what food is dropped.

Sawyer’s mama Becca warns that letting your pup lick up the spilled prunes may have unfortunate consequences.

It is important to be aware that some human foods can be toxic to animals.

Be especially careful of anything that contains Xylitol (also known as birch sugar).


In case you missed these links

Eating together as a family can have significant benefits

Introducing your child to allergens

Iron

Vitamin D

Picky Eating

Attention

Poop and Solid foods

Teething

Sippy cups

The milk Transition

Dental Health


Other Resources

https://nursejudynvp.blogspot.com/2020/07/2020-2025-dietary-guidelineshighlights.html 

Food Worksheet

Super Baby Food

Note: Parents do not  need to make homework out of feeding your child. You don’t need to monitor every pea that they eat. But for the parents who really want a worksheet, the above are useful resources.

Food Safety Websites

Breast milk storage guidelines

Worthy books to scope out

  • Super Baby Food by Ruth Yaron

  • Baby Led Weaning by Gill Rapley and Tracey Murket

  • River Cottage Baby and Toddler Cookbook. 

    • This has recipes that are super yummy, and it gives suggestions on how to vary for babies, toddlers, older kids, and adults, in a way that we all eat the same food but it doesn't taste plain or boring, so the whole family is happy. (from Mama Paula)

Useful Apps

  • Solid Starts

  • Safe Beginnings


A giant shout out to the incomparable designer Nancy Elle, who acted as a sounding board as well as offering her expert eye on our formatting.

Thank you to the models

Elliot, Coby, Sawyer, Bowie and Waffles