Milk and Your Toddler

Many parents ask me questions about transitioning their child from mom's milk/formula to cow's milk. Here are some tips that you should remember as you and your child make the switch:

Milk should be stored in a refrigerator that is cooler than 40 deg F. Once milk temperature reaches 45 deg or higher, bacterial growth can occur. Milk temperature can go up fairly rapidly, especially in warm weather. Generally speaking, milk should be used within 1 hour of taking it out of the refrigerator and should never be re-refrigerated.

Milk should be served at meal or snack times, but remember that toddlers should not walk around with a cup or constantly sip throughout the day. Those who constantly snack or sip their drinks give acid-producing bacteria a longer time to create damage/cavities.

In order for milk to be classified as "USDA organic," farms must meet the following criteria: cows are exclusively given feed grown without the use of pesticides or commercial fertilizers; cows are given periodic access to pasture and direct sunlight; cows are not treated with supplemental hormones and cows have not been given certain medications to treat illness. If you choose to give your toddler organic milk, make sure that it is treated with the conventional pasteurization process. Raw, unpasteurized milk may contain a wide variety of harmful bacteria including Salmonella, E. coli, Listeria, Campylobacter, and Brucella. These can cause illness and possibly death. Raw milk-related illnesses can be especially severe in infants and young children.

A toddler generally needs about 3 cups (24 oz) of total dairy, including milk and yogurt, daily. In general, toddler's tend to be picky and it can sometimes be hard to get them to accept a well-balanced variety of foods. Drinking too much milk may fill them up and make it more difficult to get them to eat other foods. Drinking excessive amounts of milk (more than 40 0z daily) can also lead to Iron deficiency anemia in some children, because milk can interfere with iron absorption in the intestines and can cause irritation in the GI tract leading to microscopic blood loss.

Dr. Sumita Ram
Pediatrician
Meriter Middleton Pediatrics
meriterkids.com

Backpack Tips

I remember seeing a child with a complaint of shoulder pain in the office during the last school year. Did she have a history of trauma? No. Was she in athletics? Perhaps it was overuse. No. Did she ever injure her shoulder in the past? No, but she did complain of numbness and tingling in her arm as well. Was she sleeping on a lumpy or worn out mattress? No. It turns out that the problem was her backpack. She routinely carried about 40 pounds of books on her right shoulder every day and eventually she developed shoulder pain and nerve irritation.

Kids haul around a lot of stuff in those backpacks and they are a known source of shoulder and back pain in children. So much so, that there are medical studies devoted to the subject. As the school year begins, it's a good time to make sure your child's backpack meets criteria for carrying her homework, books and personal items in as safe and comfortable manner as possible.

Here are some things to look for in a backpack:

• The straps should be wide to distribute weight evenly. They should be easy to adjust.


• The pack should always be worn on both shoulders in order to allow easy balance. Some packs have a waist belt that can help to distribute weight better. Padding in the backpack reduces pressure points on the back.


• The pack itself should be fairly light-weight so that it doesn't contribute much weight to the load. Some packs have wheels that allow them to be rolled like luggage. This is helpful, but keep in mind that in the winter they can't roll through the snow.

You may also talk to your child and help her to organize her things efficiently in all of the compartments of the backpack. Heavier items should be centered on the back if possible. Encourage your child to make stops at her locker throughout the day rather than carry all of her supplies for the day at once. If despite these measures the pack seems to be too heavy (more that 20% of your child's weight) talk to the school and other parents to encourage changes. Hopefully, with these measures you won't need to worry that your child will come home complaining of a back ache.

Dr. George Idarraga
Pediatrician
Meriter McKee
meriterkids.com