the-prolonged-breast-milk-jaundice-journey-two-months-photo

The Prolonged Breast Milk Jaundice Journey (Two Months)

by with No Comment Motherhood

经常在社交媒体的群组里看到父母们为了刚出世就全身泛黄的小宝宝在发文求救，寻求最快退黄疸方式。身为父母的我们，每当听到小宝宝扎针抽血时的哭喊声，一定会心如刀割，心急如焚。所以才会到处寻找各种偏方，希望宝宝少受一点扎针之苦。

7年前的第一胎，曾经历长达两个月的母乳性黄疸。所以这一胎，我已提前为肚子里的两个宝宝即将会经历黄疸治疗做好一切的心理准备。

我的双胞胎宝宝终于在5月15日来到了我们的身边。

相信有follow我的 IG 的小伙伴们一定知道，我在过去的两个月里到低经历了什么。我们在COVID-19疫情最严峻的时期频密的往返 KK (Klinik Keshitan)，带宝宝们各种验血验尿，两次进院照灯，最终被refer到了巴生中央医院 (HTAR) 的儿科专科。

新生儿黄疸 (Neonatal Jaundice, NNJ)，正常吗？

新生儿的红血球(Hemoglobin)比成人多，它们的寿命也不长。当新生儿出生后，开始哭泣呼吸，肺循环须提供充分的氧气，这时体内过多的红血球因而被破坏。红血球被分解后，产生未结合胆红素(Unconjugated Bilirubin)。所以这意味着，这时新生儿体内会产生很多的胆红素。一般，胆红素不会引起黄疸，因为肝脏会代谢它并将其排出到肠道中。可是，因为新生儿肝功能尚未成熟，未结合胆红素无法有效经由肝脏代谢排出体外，因此沉积在皮肤表面而导致皮肤甚至巩膜(sclera)变成黄色。所以，黄疸是新生儿时期正常的生理现象。

新生儿黄疸分为生理性及病理性。

生理性黄疸 (Physiological Jaundice)

一般来说，足月宝宝的生理性黄疸通常是在出生后2~3天才出现的，第4天至5天达高峰期，一星期后就会慢慢消退，消退的时间一般不会超过2周。早产儿因为代谢能力差，黄疸消退的时间可能拖比较久，可延长至3周之久。 生理性黄疸通常不需要特殊治疗，除非黄疸出现过早或升高的速度太快、胆红素指数偏高。一般，父母只需在家观察，继续母乳喂养，1-2周后黄疸就会慢慢消退，不会对宝宝造成任何伤害。这就是为什么有些宝宝在满月前黄疸指数就已恢复安全水平，无需天天跑KK验血。

病理性黄疸 (Pathological Jaundice)

如果孩子出生后24小时内出现黄疸，或者黄疸发展迅速、甚至有贫血、体温异常、呕吐、大小便颜色异常（大便颜色是浅灰白，浅黄色，浅绿色；小便颜色是Teh-O色）、不爱喝奶、嗜睡，消退后又复发或者持续时间长，这种多属病理性黄疸，应立即就诊。 因为我曾有GBS positive 的病史，虽然在剖腹产手术前已施打了抗生素，为了安全起见，在出生后，当天晚上弟弟就安排入NICU观察，姐姐则安排在SCN (Special Care Nursery) 观察。第二天一早，弟弟已被transfer回SCN。吃了早餐，我就到SCN探望两个宝宝。  和医生沟通后，宝宝们都很健康，为了排除细菌感染或败血症(sepsis)，需要等待验血报告，另外我特意交代医生一定要观察宝宝们是否有黄疸。 不出我所料，午饭后，我回到SCN 时，宝宝们已经在进行照光治疗(Phototherapy)，所以暂时不能出院。

Audrey
Avery

接着，验血报告显示没有细菌感染，但是宝宝们有黄疸，需要继续照光治疗。在医院呆了4天3夜，医生让我们出院回家，并交代说一定要到住家附近的KK预约回诊，并接受黄疸检查。

Heel Prick Test

在回KK复诊期间，宝宝会被安排做Heel Prick Test。KK 的医生一直会重复的问宝宝的大便和小便的颜色和次数？喝母乳or配方奶？多久喝奶一次？一次喝多少？父母们在家必须把这些给记录好。同时也会检查宝宝的体重， 确保宝宝的体重没有下降

(here)。 

延长性黄疸 (Prolonged Jaundice) 

足月宝宝出生后14天或早产儿出生后21天，黃疸仍旧持续，皮肤和眼白部分比较黄。延长性黄疸通常无害，大多数是因为母乳性黄疸 (Breast Milk Jaundice)，但有些也可能起源于其他病理问题(溶血性黄疸或感染性黄疸)。 两次的入院照光治疗是day 7 和 day 14。需要入院的胆红素水平是257 umol/L以上，而宝宝们的指数也超过了这个level。宝宝们的胆红素水平在照灯治疗后都有显著的下降。可是过后的几天回到KK验血，胆红素水平又往上飙。就这样我们风雨无阻的往返KK验血。 因为持续性黄疸，宝宝们的日龄也已超过了21天，这时KK的医生安排宝宝们采集血液样本和尿液样本来排除其他延迟性黄疸的可能原因，例如泌尿道感染 (UTI)，败血症(Sepsis) ，甲状腺功能低下 ，肝功能衰竭。 引起黄疸的另一个比较严重的原因是肝脏问题：胆道闭锁 (Biliary Atresia) 胆道闭锁 (Biliary Atresia) 是肝脏通向肠道的胆管受到损伤，阻滞了胆汁流出肝脏。若及早发现，可在在60天以内做手术以恢复胆汁引流，以減少死亡或换肝的机率。 这就是为什么 KK 的护士会死缠烂打，穷追不舍，天天打电话来问宝宝的黄疸指数是多少，确定宝宝的黄疸指数下到安全水平才会罢手！

因为延长性黄疸， 所以宝宝们也被refer到了巴生中央医院的儿科专科。来到中央医院也免不了抽血验尿。抽血比在KK 用的Heel Prick Test更加准确。两个宝宝小小的手被无数的针孔扎过，站在门外听到宝宝哭，我只能和老公互相安慰。在排除了以上提到的潜在风险后，两个宝宝体重增加正常，纯母乳喂养，排便次数多，排便量大，尿液清澈，总体情况良好。医生最后告诉我，应该是母乳性黄疸。

母乳性黄疸 (Breast Milk Jaundice) 

一般喝母乳的新生儿，黄疸会持续比较久，这是因为母乳中含有一种女性荷尔蒙，会抑制新生儿肝脏酵素的活性，使其无法代谢处理胆红素，导致持续性的黄疸。 另一方面可能因为新生儿一开始喝母乳，奶量还不是很多，当摄取奶量不足时，可能出现轻微脱水，便便排出延迟，增加肠、肝循环，血液中未结合胆红素增加而出现黄疸。 在这个时候，很多妈妈听到 “母乳性黄疸” 会想要马上停止母乳喂养。

NO! NO! NO!!

事实上，解决母乳性黄疸的方法就是母乳本身！黄疸会随着时间慢慢消退，母乳性黄疸的宝宝应继续母乳喂养。

偏方有用吗？

如今网络媒体资讯发达，在各个群组里，我还是会时不时看到一些完全没有科学根据的 “退黄偏方”。上一胎，因为是新手妈妈，人在国外坐月子，当时宝宝黄，心急如焚的家人到处问人，而以下这几种方式是最多人建议的：

  • 喂宝宝喝羊奶？
  • 喂宝宝喝青葡萄汁？
  • 用黑狗啤酒给宝宝洗澡？
  • 用特制药材包给宝宝洗澡？
  • 坐月子期间不要吃黄色的食物？不要给宝宝穿黄色的衣服？

当然，“退黄偏方” 不只这几种方法而已，只要你在社交媒体的群组里发一个求救贴，底下一定会有很多“我试过了xxx” ”这个对我宝宝有效，黄很快退了” “给宝宝喝XX” 等等的留言。 如果你把前面的文字已读明白了也了解了什么是新生儿黄疸，今天不管你在网上看到，还是听谁谁谁推介超级有效退黄偏方，你都不会随便尝试，因为你知道只有母乳才能解决母乳性黄疸，只是退黄的时间会比较久。

坐月饮食需要戒姜戒中药吗？

在宝宝出生前，我已经和来帮我做月子的老妈说好月子餐要清淡一些，可用姜烹煮，但无需大量使用姜。另外因为需要哺乳+亲喂，暂时也不吃/喝有酒精的食物。在整个做月子期间，不管我是有吃还是没吃姜，酒， 中药，红枣水，宝宝们的胆红素水平还是持续上升，完全不受我的饮食影响。

到目前为止，没有证据表明生姜和黄疸之间存在直接关联；熟食中的酒精本身也不会引起黄疸。红枣水含有丰富的铁和维生素，做月子期间/哺乳都需要大量的摄取水分，所以多补充水分并没有害处。

总而言之，我在整个月子期间吃的均衡适量多样化，红枣水，炒米茶，中药汤，我都有断断续续的喝。姜是适量的用在调味上，也没怎么吃。置于用来炖补的酒，在第一个月里我是完全没有碰，只用了米酒酵素来烹饪。

如果你想在坐月子期间暂时戒姜戒中药，好让宝宝的黄疸退的快一点(有些宝宝是生理性黄疸，两个星期黄疸就渐渐退了)，你也是可以在之后才补上这些食材。

宝宝黄疸指数居高不下，要怎么办？入院照灯须知

不管是生理or 病理性黄疸，只要慢慢增加哺乳次数以及奶量，黄疸自然能改善。总之，多喝奶(每1-2小时)，多排便，多小便，黄疸就会退的很快。如果胆红素超过照光标准(257 or 308 umol/L)，医生就会建议入院进行照光治疗。照光治疗可以安全和有效的迅速降低黄疸，因为蓝光治疗能改变胆红素分子的形状和结构，使它们能随尿液和粪便排出体外。 在治疗期间，宝宝会脱光衣服，只穿上尿布和戴上眼罩，这种光不是紫外线，防护屏会过滤掉可能发出的紫外线，所以爸爸妈妈不需要担心宝宝晒伤。 假如黄疸指数真的非常高，可能需要进行换血(Exchange Transfusion)。因为黄疸指数太高，不及时治疗，胆红素有可能会进入脑细胞，干扰脑细胞的正常活动和功能，伤害到神经系统，造成永久性神经系统损害，脑性麻痹 (Cerebral Palsy) ，听力丧失，智力落后等，更严重的还可能危及生命。

“居家照光治疗服务”可行吗？

在宝宝们第二次入院前，由于疫情逐渐严重，想要减少出入医院的次数，我有尝试询问医生，我们能否租借仪器回家为黄疸宝宝照灯。医生的回答是 “NO”。他认为照光治疗必须在儿科医生和专业护士的观察和指导下进行，不是租借仪器回家照个一两天就当没事了，而且宝宝隔天还是必须回诊与抽血，追踪治疗。因此，他建议如果黄疸指数居高不下，入院治疗才是最快最安全的方式。

宝宝们入院照灯 

因为疫情关系，宝宝们入院照灯，妈妈是不能入院陪同宝宝过夜。一天只有两次探望时间。所以，两个宝宝入院后，我只好在家把母乳挤出来，然后等到探望时间或一大早送过去医院给护士们。 在这里要提醒大家，如果想要宝宝入政府医院进行照灯治疗，一定要带上平时到KK 产检的Pink Book。因为入院时，医生会问很多问题，关于你整个怀孕过程，宝宝在哪家医院出生，宝宝的各种体征，宝宝的喂奶状况等等。 出入医院那么多次，马来语不好的我，都用英语和政府医院的医护人员沟通，不管我问什么问题，他们都很耐心的回答我。

新生儿黄疸可以预防吗？

不能。新生儿黄疸是正常的生理现象，我们无法在怀孕过程预测哪些胎儿出生比较有可能出现黄疸。不管你在怀孕期间，还是坐月子期间，吃什么用过什么都不会把新生儿黄疸的几率降低。想要黄疸退的快，妈妈们在生产后一定要尽早哺乳，初乳有催便效果，胆红素即可迅速排出体外。

总结

新生儿黄疸有哪个新手爸妈不担心的呢？听信坊间流传的没有科学根据的偏方，盲目使用偏方很可能会给宝宝的肝脏带来更多的负担，延迟让宝宝接受应有的治疗，对宝宝的黄疸并不会有帮助。不管你是在政府还是私人诊所follow up， 是生理性黄疸还是病理性黄疸，一定要听从医生护士的建议，准时回诊。 女儿Audrey 在第41天的验血报告里，胆红素已降到56 umol/L；儿子Avery的胆红素在第51天已降到179umol/L。

新手爸妈们，你们是否和新生儿黄疸对抗过呢？请留言分享！

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Things I Learned About My Body and Mindful Eating During Pregnancy

by with No Comment Fertility & Women's HealthMotherhood

While we often view pregnancy as a “glowing” time, for many women the first trimester brings nausea, food aversions, and fatigue. Mom-to-be may also feel anxious during pregnancy, especially if they’ve previously experienced fertility struggles or miscarriage.

Now that you know I’m in the 2nd trimester of my pregnancy with Baby #2 & #3, I thought it would be fun to talk about what I’ve learned about my body and mindful eating during the first trimester.

MY MORNING SICKNESS VS MINDFUL EATING 

People typically think of morning sickness as throwing up in the morning. The truth is that it can happen any time or, for some unfortunate people, like me, ALL DAY. Sometimes you just have constant bouts of nausea without throwing up, I had that and it’s the worst feeling. It stays in the back of my throat and I feel like puking, but I just can’t.

In addition, during the first trimester, foods I didn’t usually crave were suddenly finding their way into my grocery cart, and foods I normally love and want to eat all the time were push to the back of the fridge. My cravings also changed more quickly than I could keep track off. One minute I was cooking lunch for my son, next I can’t even think about eating that right now.

Your body will let you know what it wants.

Pregnancy is a really amazing time to practice mindful eating because your body is going to tell you exactly what it needs. Before getting pregnant, I was in a good routine with my eating where I was still being mindful, but I didn’t have to pay quite as much attention because I generally needed food around the same time most days, and I had learned what types of foods usually felt best for me at certain times.

But things change in pregnancy. In my first trimester, I pretty much couldn’t eat or smell anything.

BUT, why am I hungry all the time?

Getting “hangry” was always something I was susceptible to, but having hangry also come paired with a face smack of nausea.

Not only did I need to eat more often (with small portion size), but it was much more urgent.

I was totally turned off cooked vegetables, difficult to eat foods high in fat like meat, water or soup fill me up and made me nausea. So, I actually lived off bran cereal with milk, crackers, lemon water, fruit smoothie, pao , etc. I was nauseous but hungry all day long, so bland foods like cereal and milk were my BFF. I was probably dehydrated so smoothie and lemon water were my go-tos. I off fatty foods for a while since these are typically harder on body to digest and I constantly burping.

Pregnancy hunger can sometimes feel chaotic and out-of-control. But it doesn’t have to be this way. The truth is mindful eating can be helpful.

Our body is fully capable of doing what it needs to do to keep us and our baby healthy, and most of all, our body can be trusted.

Mindful eating is the practice of learning to pay attention to (and honouring) your body’s natural cues in regards to food. This means nourishing your body when it’s hungry, noticing and stopping when you’re full, and honouring your cravings.

Up until now, when I am feeling hungry, I eat something. When I am getting full, I slow down, take few minutes, and decide if it’s time to stop eating.

No matter what changes your body is going through, you can learn how to dial in to exactly what your body needs and feel confident to give your body just that.

MY BODY WILL GAIN WEIGHT AT ITS OWN PERFECT PACE 

Pregnancy has been a really good lesson in surrendering to my body. Week by week, some weeks subtle and others not, my body has literally changed before my eyes. One day I would worry I was gaining weight too fast, and the next, I would worry I’m not gaining enough and that something was wrong with babies. I’ve spoken with so many of my friends and I came to realize that this is just one of the brutal realities of being a woman, not just in pregnancy when body changes come fast and furious, but pretty much all throughout the life cycle. But as I near the end of my second trimester, I’ve learned to make peace with the chaos. My body will gain weight at its own perfect pace. It may not be the precise 0.5-1 kg each and every week.

I know that for me, some weeks I gain nothing, and others I’ll jump 1 or 2 kg on the scale. But if you’re listening to your body, just know that your body is doing what’s best for you and baby and your weight will find its happy place in the end.

MY BODY DOESN’T JUST CHANGE OVERNIGHT WHEN I SKIP THE EXERCISE ROUTINE 

Before getting pregnant, I work out every day for at least 30 min to an hour. But I was just anxious at the beginning of my pregnancy that I took about 3 months off the exercise routine. Not 3 days or 3 weeks, it is 3 months. Obviously, it was all worth it. But taking that much time off kind of freaked me out. 

Would I lose all of the strength I had worked so hard to build and have to start from scratch again?

Would I gain 20kg?

Would I just fall out of the habit for good and never go back?

After first trimester, I started doing light yoga stretching and leg exercise. I keep telling myself, I have two babies growing inside me, don’t feel guilty because I took 3 months off the exercise routine. It doesn’t have to be all or nothing. Just listen to my body when I’m ready to get back on my yoga mat.

IT’S OKAY TO FEEL EMOTIONAL 

When I found out I was pregnant, I was more terrified than excited. The fear of bleeding, cramping, not hearing heartbeat, it all messes with my head in a way that no one can really understand unless they’ve been there.

Every doctor’s visits are also scary. Every time I have an appointment, I have to take deep breaths to try to stay calm and positive. I find myself constantly thinking about the babies’ movement and heartbeats. To handle fear in the moment, I am taking one day at a time and feel grateful for every day of my pregnancy, allow myself to enjoy things like a positive ultrasound or big kicks.

Now moms and moms-to-be, can you tell me, what are some of the pregnancy lessons you’ve learned along the way that have helped you through your journey? Leave me a comment below and help a fellow mom-to-be out!

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My Infertility, IVF, Miscarriage Journey & Big Announcement

by with No Comment Fertility & Women's HealthMotherhood

今天的文章将会用中文来表达，因为这样比较能诠释我内心的情感。

THE GOOD NEWS 

你喜欢先听坏消息还是好消息呢？我想你在2021年的第一天可能已经在我的社交媒体上看到了我和你们分享的好消息，我也陆续收到很多followers 的祝福，而且还有很多人私信说很期待这篇文章的出炉。是的，你可以从缩图和标题中看出来了，我想告诉大家的好消息就是 – 我怀孕了！

二胎的备孕过程真的是一条艰辛又漫长的路，我无数次幻想着我该如何写这篇文章，和身边所有人分享这份好消息。此外，这篇文章的另一个目的除了是要记录我这5年的备孕心酸过程，我也想和大家谈谈我的不孕症和流产的经历。

看别人分享怀孕，生孩子，坐月子的文章看多了，但是网络上确实很少看到文章分享和谈论不孕和流产的话题。事实上，4-6对夫妇里就会有一对夫妻面对不孕症问题，10-20%的女性曾经有过流产经历，所以我希望此文章能给正在备孕的姐妹们一些希望和正能量 ，you are not alone! 

MY FIRST PREGNANCY 

一直长居加拿大的我在2011 年硕士毕业后，得到了一份很好的 job offer，于是就打包好行李独自一人来到了新的工作和居住环境，一个人生活。一直以来我和现任老公都是远距离恋爱，我过我的自由生活，他过他的忙碌打工日子。直到2012年的 Chinese New Year，他买了机票就这样飞了一天一夜来到了这个冰天雪地的国家，这是他第一次踏入北美洲，也是他第一次看见雪。短短的两个星期的假期，我被求婚了！

2012年12月，我回国，和他举办了一场浪漫的 Beach Wedding。

之后就开始了我们的远距离婚姻。婚后一直觉得自己还很年轻，想要在工作上进修更多，我就尽情玩乐，享受自由自在的日子。而他决定不再做打工仔，想出来创业。他把工作辞了，隔天就直飞加拿大陪伴我两个月半。

就这样，我们的第一个宝宝是在完全无预警没有做任何的planning的情况下就悄悄的来到了我们的身边。

整个孕期，生产过程，哺乳期也可以写成一篇文章！

Anyway, 2014年5月，我当妈妈啦！

MY INFERTILITY TREATMENT

一直以来，我和老公都是处在远距离婚姻，我们一年见面2次，半年一次，我们只能各自拿最多3个星期的有薪假期。一般正常夫妻，即使什么问题也没有，在自然不避孕的状态下，每个月自然怀孕的几率也大约仅为 15-25% (here, here)。所以，一年只有两次机会的我们想怀第二胎的几率是非常小的。因为第一胎是在没有任何计划的情况下怀上的，而产后的我，身体状况，体力，经期，饮食，生活作息，比任何一个人都还要正常。所以 “不孕不育” “试管婴儿” 这些字眼从来都没在我的脑海闪过。

同时，我决定哺乳儿子至少3年，把最好的和花更多时间在陪伴儿子身上，所以就算没有怀上，我们也没放在心上。

不过，当时身边许多家人朋友都陆续结婚怀孕生子。经常都被念叨：

“什么时候要生多一个女儿呀？”

“你儿子那么可爱，可以再生多一个？”

“你还不赶快趁年轻的时候，快点生，有人帮你照顾？”

“赶快戒奶，喂母乳很难怀孕的？”

“一次过生完，你就可以收工了！”

因为哺乳了将近两年多，而我似乎开始有些介意这些 “好心人” 的叮咛，有没有可能是因为哺乳的关系导致不孕？自己本身曾有贫血症状，每年都会做一次比较详细的 full body check-up。结果不出乎意料，我的 TSH level 显示异常的底，Thyroid peroxidase antibody (TPOAb) 偏高，幸好的是T3和T4, 都属于正常。见了内分泌科，抽了一瓶又一瓶的血，做了 thyroid ultrasound，最后医生说，有可能是 Hashimoto’s disease? 等孩子戒奶了，这些指数可能会慢慢回归正常。但是，我的家庭医生为了安全起见，我每一个月都要抽血monitor我的TSH level。另外，她也建议我去咨询 fertility doctor。

就这样，我半只脚踏入了 infertility treatment 的圈子。我开始上网阅读每一间 fertility centre 的文章，技术，关于IUI，IVF，ICSI 的疗程。原来这圈子的水很深，当你研究的越多，懂得越多，你就知道能够 “自然受孕”，还一年生一个的人，是有多么的幸运呀。

子宫腔内人工受精（intrauterine insemination, IUI）是指将男性精液经过人工筛选之后，选出健康的精子直接注入女性子宫颈或宫腔内，以协助受孕。此一技术使用细小的管道插入子宫颈内，在排卵时注入精子，以便让精子更容易与卵子结合而受精，增加受孕成功率。过程不需手术和麻醉。

体外人工受精（In vitro fertilization，IVF）则是指分别将精子与卵子带到体外，在试管内进行受精和发育成为胚胎后再移植回母体子宫内。通常使用小盘状的培养皿，在适宜的环境下受精。当把卵子和精子均放入到同一培养皿中之后，让精子自由游动与卵子结合，并发育成为小型的胚胎，胚胎在培养箱中一段时间后，则移回母体子宫内着床怀孕。

卵细胞浆内单精子显微注射（Intra Cytoplasmic Sperm Injection, ICSI）是一种人工辅助受精技术，将精子直接注入卵子中以形成受精卵，也是人工辅助受孕的一项科技，特别是有助于男方精子缺陷或精子不够活跃所造成的不孕症，或者曾经使用过IVF技术辅助受孕却不成功的案例。因为透过IVF技术治疗时发现，虽然将精子与卵子放在同一培养皿中，仍存在精子无法穿破卵子外壳而实现受精的情况，可能是精子本身不够有力或质量偏低，精子前冲力道不足，也可能来自女方卵子外壳过厚，导致精子无法穿破。因此使用ICSI能辅助精子穿透卵子外壳。首先在显微镜下选出最健康优质的单精子，并使用非常细小的玻璃管刺穿卵子外壳，将单精子注射进入卵子中。这一辅助受精技术可大幅度提升受精率，也使试管婴儿受孕方式的成功率获得提升。

除了low TSH level 的问题之外，我也做了HSG X-Ray，检查结果显示我右边的输卵管 “好像” 堵塞了，因为无法在X-Ray里看到造影剂流入到右边的输卵管。最后，医生给的建议是既然你之前能够自然受孕，经期正常，身体状态良好，左边的输卵管运作正常，那么就尝试吃排卵药。

子宫输卵管造影（hysterosalpingography，HSG）是针对输卵管和子宫的一种特殊X光检查。医生会将细导管穿过子宫颈插入子宫，然后注射特殊的对人体无害的不透射线造影剂染料，通过这种造影剂医生可以看出整个输卵管的通畅程度、堵塞的部位和宫腔的形态。

想要怀孕是两夫妻的事。当然，我老公也误打误撞的和我一起踏入了这个圈子，他也去做了精子检查。报告显示精子浓度正常 (concentration)，只是精子异常 (morphology) 和活动力不足 (mortility), 属于中度弱精症。因此，Dr. A (Fertility Doctor) 建议我们可以尝试吃排卵药，打排卵针或尝试人工受精。我们接受了医生的建议，我一共吃了4个cycle 的 FEMARA® (letrozole) 5mg。

大部分患有弱畸形精子症的原因不明确，需要多个方向 (生活作息，药物，饮食) 综合治疗。老公的生活作息一项良好，不烟不酒，不熬夜，不挑食，只是偶尔中午没吃 (工作太忙)。经过一番饮食调理，2018年夏天，我们选择了IUI疗程。在疗程进行前，我也去了当地来自中国的中医师做针灸。

IUI对年龄在35岁以下的女性平均成功率为每周期的10至20%。 35岁至40岁的女性为10%成功率，40岁以上的女性则有 2％至 5％的几率。但是，成功率主要取决于精子质量和受孕女性的子宫健康状况，许多研究证实接受大约三到四个周期IUI疗程有更高的成功率。

护士帮忙施打排卵针

很可惜，第一次的IUI疗程没有成功。

由于 Dr. A 只负责 IUI treatment。于是，家庭医生又refer 我到另外一家fertility centre 做咨询。疗程讲解，抽血，ultrasound，可以做的都做了。这次的fertility doctor – Dr. S 在验血检测里多加了一样就是 AMH (anti-mullerian hormone) (here)。

抗苗勒管激素 AMH浓度是评估女性的卵巢储备和受孕能力的重要指标，这项检测对计划怀孕或继续治疗不孕的女性非常重要。AMH是女性卵巢卵泡产生的荷尔蒙，分泌於卵泡初成形之时；若卵巢卵泡数目越多，血清中的AMH值越高；反之，若卵巢卵泡越少，AMH值就越低，因此透过AMH值可评估卵巢的卵泡库存量。

AMH值低于5属于低水平，数值超过15为高水平，数值落在两者之间则属于中等 (here)。

我的AMH 指数是 13.2 pmol/L，医生说如果要进行 IVF疗程，她希望AMH可以在14 以上。同样的，由于老公本人不在加拿大，要 sign up IVF 疗程，必须两人同行，还要报名上一些辅导课程。医生还是给了同样的建议，先尝试排卵药，于是我又吃了4 个cycle的 Clomid。

半只脚在这个飞也看不到尽头的不孕圈，感觉很孤单，很无奈，很无助，很沮丧。在此时，我已经把自己和不孕症画上了等号。从一开始天真的以为 “自然受孕” 是那么的简单，到今天经历了那么多的打针吃药，检查的轮回，大姨妈还是每个月都准时到访。那种失落感无人问津。

当一个极度想要怀孕却总是每个月看到白板的人，这个时候只要一打开自己的社交媒体账号，朋友圈里的所有朋友都好像同一时间怀孕；只要一走在shopping mall一定会看到经过你身边的每一个人都是大肚婆；在工作上每个星期都会接到关于prenatal and postnatal care 的referral cases；就连身边已年过40岁的两个朋友本来就不打算怀孕生小孩的也怀孕了！这个时候，我的世界只有我一个人，天天都在问自己到底那里出错了！

MY IVF JOURNEY

可能因为自己是理科生，看过无数关于卵子+精子受精的影片，所以一直以为吃一吃排卵药，把卵子养大，打个排卵针，再来把精子处理一下，那么一定会中的！

但是，我和老公从来没有中大奖的命，就连安慰奖也没份儿。

2019年2月，我拿了2个月半的假期回国。在决定回国前，老公已经到几间 fertility centre 去听课也 survey 了费用。回来后，我带着一份份厚厚的体检报告来到了 fertility centre 见 Dr. H。医生给我的诊断结果是 “unexplained infertility”。因为一边的输卵管堵塞了，如果真的要自然怀孕，有可能需要靠点运气和漫长的等待。又抽了一瓶又一瓶的血，所有的指数，子宫内膜厚度，卵子的成长大小都很理想，医生建议不如这个cycle再试试看吃排卵药，打排卵针和直接进入IUI 疗程。

中医VS西医

中医和西医在 infertility treatment上的差别挺大的，中医讲求的是将体质调好，辅助血液循环，提高卵泡的质量以及改善子宫内膜的环境。西医的强项是诊断不孕的原因，能在各种仪器的辅助之下，提供不同的方式协助女性怀孕 (服用排卵药，打促排卵针，调理荷尔蒙失调问题等)。

做了一些 research 后，我决定在进入IUI 疗程前，再尝试多一次针灸疗法来增加受孕几率。毕竟，当时在加拿大咨询的中医师并不是专注于助孕疗程。

针灸真的有用吗？我有吃中药吗？

首先，我咨询过 Dr. S 和 Dr. H，两个医生都没有明确的说不建议或不鼓励，他们处于中立态度，完全取决于我的budget和我的时间。我也翻阅了一些研究报告，在临床研究上，针灸确实能辅助子宫血液循环。不过，我也曾听过一些国内的 fertility doctor 是不鼓励中医疗法也会督促在进行疗程的女性不要乱吃中药以免影响疗程效果。

但是，我还是想要做最后的尝试，毕竟在国内确实有几间不错的助孕中医诊所。为了配合IUI 疗程，我几乎天天到中医馆针灸和服用中医师给的药粉。只要你和中医师说明自己正在疗程中，中医师都会配合西医的疗法。由于我对国内的交通路线不熟悉，所以不管到什么地方都是由老公亲自接送。老公没有任何怨言也很愿意配合我的时间。医师人很亲切，整个针灸过程都让人很放松。

第二次的IUI疗程，我们还是没有成功。

2019年3月正式踏上试管之路

 

 

 

 

 

 

 

 

IUI失败之后，我们回到诊所咨询 Dr.H 后，决定要选择IVF 疗程。回家的路上，我问老公：“你觉得我需不需要再回到中医馆去针灸呢？老公给我的回答是：“如果你觉得压力很大，每天要这样赶上赶下，就不要回去了，我们就听医生的指示，该休息就休息，该打针就打针”。于是，我没有回去接受针灸调理。

促排+取卵

打了10天的针。我对针筒并不会感到害怕，所以全程都是自己打针，儿子在一旁鼓励和观看，老公则躲的远远的。

药物：吃的，塞的，打针的。
取卵前
取卵后

 

 

 

 

 

 

 

 

 

取卵手术需要全身麻醉，晚餐后就要 fasting 了。当天一早梳洗完毕，就出发到诊所去了。Dr.H 在取卵过程中也顺便帮我子宫里小小的息肉 (polyp) 也一起割走了。

通常取卵手术后，会容易有卵巢过度刺激综合症（OHSS），具体表现为腹胀，腹水，严重的会全身水肿。因此在术后，护士会建议患者多喝运动饮料 (如100Plus)，多吃高蛋白的食物等，避免辛辣，油炸和甜食。我的 OHSS 的症状不是很明显。休息了几天，等待诊所的电话。

卵巢过度刺激综合症 OHSS (Ovarian Hyperstimulation Syndrome) 是IVF 的主要并发症之一，因为排卵药物促使过多卵泡发育，但这并发症是可以治疗的。

一共取了21颗卵，有19颗mature eggs同时也做了ICSI。一共有9颗成功受精，能成功让胚胎师决定留下来的只有4颗胚胎。

Day3: 2颗 8 cells grade 2

Day 5: 1颗2BB，1颗3BB

我们决定下一个cycle 就做 FET (Frozen Embryo Transfer)。我选择植入2颗Day 3 的胚胎。植入后的四天，我就直接飞回加拿大工作了。一个星期后的验孕结果是：

隔天我马上到家里附近的 walk-in clinic 见医生，要求做HCG test, 为了确保HCG 有翻倍，放工后，我都到验血中心报道，我一共抽了3次血：

Test 1: 2366 IU/L

Test 2: 3261 IU/L

Test 3: 6596 IU/L

从看见验孕棒 positive 的那一刻起头脑就涌现出许许多多的画面和计划，心里是又兴奋又紧张，感觉像是在做梦一样。

验了3次HCG test，一星期后又用了另一支验孕棒验多一次，确保这一次是真的成功，不是在做梦。指数那么高，会不会是双胞胎呢？内心其实很不踏实，因为真的太久没有看过 positive result了。

MY MISCARRIAGE STORY 

到了大约8-9 weeks 时，我带着忐忑不安和期待的心情去做 dating ultrasound。在房间里sonographer 照了很久很久，我不敢发出任何声音但又很想知道到底有没有双胞胎。结果 sonographer 让我去上厕所，要做阴超。上厕所时，我心里一直在祈祷。在做阴超的时候sonographer 还是一样的安静，照了很久很久，整个房间的气氛很奇怪很凝重，我开始有点不安。结束后，她让我换上衣物，然后对我说：“对不起，我们没有听到宝宝的心跳，胚胎的大小刚好停留在8 week 3 days (正是我做ultrasound 的前一天)，你需要尽快咨询你的家庭医生”。

当下，我的脑袋是一片空白的，一时之间不知道如何反应过来，“没有心跳” 是什么意思？验孕棒不是 positive了吗？HCG 很高呀？在回家的路上，我一面开着车，一面留着眼泪，一直不断的回想，前一天我做了什么，吃了什么，是因为什么原因导致宝宝没有心跳？回到家我整个人瘫坐在床边，一面哭，一面上网查询 “when can we hear baby’s heartbeat?”

接下来的一个星期，只能用 “煎熬” “痛苦” 来形容。我需要一面装着若无其事的样子上班，一面要坚信一个星期后能听到宝宝的心跳声。每一次上厕所都一定检查有没有出血症状，有没有肚子痛。日子过的非常模糊，就这样昏昏噩噩的过了一个星期。

第二次的ultrasound 结果还是显示宝宝没有心跳。Sonographer 完全没有让我看影像，之后radiologist 进来和我解释检查结果。接着到诊所会见家庭医生，医生向我解释了流产迹象和几种不同的流产程序。我强忍着泪水离开诊所，一个人呆坐在车里，眼泪一直流。因为我完全没有任何流产的迹象，医生说我可以等宝宝自然排出体外 (可能需要1-2星期) 或可以尝试用药，暂时先不需要入院做人工流产。这时我的整个世界是崩溃和黑暗的。

老公知道消息后，马上定了机票飞过来加拿大。而我也和老板说了自己的情况，请了两个星期的小产假。因为只有两个星期的病假，我只能选择用药，但在用药的前一天，已经有一些些出血现象。两个星期的小产假，我除了哭，一直都在回忆着这两个月的所有画面，我做了什么，吃了什么。我的心情就好像坐过山车一样，上上下下，突然被狠狠的抛出车外，这一摔，很痛很伤。

2nd TRANSFER & 2 WEEKS WAITING PERIOD 

我曾经天真的以为只要验孕棒出现两条线，就代表你成功了！经历过这次的流产事故，我深深体会到女人能够从孕育一个新生命开始到把一个健康的宝宝带到这个世界上来，是多么的不容易。许多研究发现，流产其实并不罕见；每100名怀孕的女性，就有15人有过流产的经验 (here)。

根据统计，流产发生几率大约在12%～15%之间，其中又以妊娠13周前发生的早期流产最常见 (here)。

休息几个月后，我要求再做多一次 HSG X-Ray。这次 HSG X-Ray 显示，我两边的输卵管是通的。这让我又燃起了 “自然受孕” 的期望。

2019年12月，我决定把事业的中心放在 Simple Balance Nutrition，于是我把工作辞了，回到马来西亚，想给自己一个假期，同时多陪伴家人。结果遇上COVID-19 疫情大爆发，全世界都在抗疫，锁国封城。我们也只能乖乖呆在家。没错，我和很多人想的一样，这是不是上天给我的安排呢？多了和老公相处的机会，那么受孕几率也会大大增加。结果还是一样，每一个月都是失望收场。

2020 年突如其来的疫情，打乱了许多计划，但却给了我很多工作上的新挑战和机会。我本身的性格很执着而且还是个完美主义者，只要我想做的事我一定会做到101%！但是对怀孕这件事，不是我一个人可以控制的。流产后，我用了15个月的时间平抚情绪，调整自己的心态和身心，听到看到别人怀孕，脸上总是挂着一副羡慕的表情，尤其是我特别热爱自己的工作，想在 childhood nutrition，prenatal/postnatal nutrition，儿童挑食，育儿方面多做些深入的研究。

终于，2020年9月，在疫情似乎控制下来时，同时工作上的几项大project 也告一段落，儿子也回校上课了，我和老公讨论后，决定再次鼓起勇气回到 fertility centre 见 Dr. H。

备孕饮食+生活作息

在饮食调理上，我对 fertility diet 做了很多的研究，读了很多论文，该吃的备孕 supplement 照样吃。在平时的饮食上，身为饮食治疗师，一切讲究均衡，多样化，适量为主。有在follow 我 IG 的朋友们，一定知道我热爱瑜伽，我天天都一定会抽至少半小时的时间运动。

自制滴鸡精

在移植前，我也吃了至少3个月的 homemade 滴鸡精直到开奖。

这次采用的FET 疗程是以 natural cycle 进行，所以在移植前是完全不需要吃/塞任何药物。移植当天，由于疫情关系，老公完全不能进入手术室，我一个人换好衣服，躺在手术台上等待时，我看见在电脑萤幕里的两颗健康的胚胎，心里一直在默念祈祷，希望今天我可以把你们两个宝贝一起带回家。

这次我们一共移植了最后仅有的两颗 Day 5 的胚胎。移植后，开始服用Duphastan，一天两次。

为什么移植两颗胚胎呢？

其实这是我的决定。努力了那么多年，年纪也越来越大，每一个月最煎熬的就是等待验孕开奖的那两个星期，一次又一次的失望，压力大到无法形容。

上次移植了两颗胚胎没有成功，research 了很多流产和 IVF 不成功的原因，医生无法给出任何解释，有可能是精卵质量不好，染色体异常，高龄，又或者是自己没有足够的休息而导致流产的。

这一次，因为不想明年再交 freezing fee，也不想再为了生育这个问题搞得我们夫妻压力重重。干脆直接移植最后两颗胚胎。如果不成功，可能我们会从新开始新的 IVF 疗程，或认命。既然上天给了我一位那么可爱，乖巧，暖心的男孩儿，我不应该要求那么多。所以直接拼了！Dr. H 很随和，她不会给任何太过主观的意见（除非是她真的觉得不适合，她会直接和我说），她也知道我的专业，我在做任何决定前，一定是已经 research 好了，才来告诉她。当时，我和她说想要移植最后两颗胚胎的时候，她给了我很正能量的鼓励同时叮咛我有可能是双胞胎，也告知了怀双胞胎的风险！

再来说说移植后的事情，之前老是听别人说移植胚胎到子宫后不敢立马上厕所，连洗澡都不可以，怕胚胎流出来，其实这个真的不用担心。我移植完后直接就在手术台上问护士我能不能在这里躺一下，躺了大概15-20分钟，我害怕下一个要移植的妈妈要进来了，就慢动作的去上厕所排尿换衣回家。回家后在家前3天基本都是躺着多，但是吃饭会起床到楼下餐桌吃饭，不时的在客厅走走坐坐，我个人观点是没有必要一直躺着，不时起床走一下，可以促进子宫血液循环，帮助宝宝着床，3天后我就开始做一些文书处理工作，写写文章。

第二次移植和第一次移植的心态和心境有所不同。可能第一次移植时，时间太赶，压力太大，没有足够的休息，而且我还长途跋涉的飞回加拿大。这一次，一切放慢脚步，看书，写文章，看连续剧，写计划书，吃饭，睡觉，和儿子读绘本等。

就这样等到了第十天。我十分明白这两个星期对期待受孕的夫妻而言，是最难熬的过程。

在开奖的前一天，我心血来潮，因为家里多了一支普通的验孕棒，我就想说，那不然来验一下吧。其实心里很清楚，如果是白板，也不要伤心太久。老公天天都对我说：“不管结果是什么，我们只要秉持着一颗平常心就好”。我们已经尽力了，一定要放松心情。这天早上，老公和儿子已起床吃早餐，准备要去上学上班，儿子上来看一看我是不是睡醒了，顺便和我道别。而我，告诉儿子：“来，我们来做一个 scientist 的实验好不好，你帮妈咪把这个stick放入这个有尿尿的杯子里，看看会不会变颜色”。

因为有太多太多次的失败和失望。我这次真的很怕看到“白板”。一面刷牙洗脸一面等成绩，很快的，试纸显示两条线，我立马再看一下说明书，确实是有很清楚的第二条线，我告诉儿子说：“mommy 的肚子很像有baby了，不过这个是 secret，不可以告诉任何一个人哦！”

第二天，也是一样趁老公在楼下吃早餐，我又叫了儿子上来再做一次 scientist 的实验，这次用的是 ClearBlue 的 pregnancy test。看到positive的那一刻我简直难以按耐内心的兴奋，但是心里还是很害怕，拿着验孕棒下楼告诉老公后，他的第一个反应是：“怎么办，现在是怎样，等下快点打电话给诊所，看看下一步要做什么，你不要再做家务了，饭也不用煮了，你快去楼上躺着”。

发了简讯给诊所的 nurse，他们要我马上回诊所验血。下午护士打电话告诉我成绩，这次的HCG 成绩是 623.4 IU/L。指数没有上一次移植的高，我问了问护士姐姐，她说，只要是超过600 IU/L，医生就很高兴了。于是，她要我继续吃药 – Duphastan 同时开始吃 Aspirin。

MY RAINBOW BABIES 

在 week 7 day 1 时，我和老公带着很忐忑的心情回到诊所见Dr. H。我们一路上都没怎么说话，紧张的情绪完全都写在我们的脸上了。在躺上要照 ultrasound 的那张床上时，脑袋是一片空白的，我只乞求胚胎可以成功着床，可以听到宝宝的心跳。因为周数太小，所以我们照的是阴超。眼前的电视荧幕出现了子宫内有小小的一粒黑点，然后 Dr.H 就说：“爸爸要不要进来看一下”。老公走过来，在我身后，看着黑白银幕里的宝宝 (其实我知道他看不懂)，接着我很紧张的问 Dr. H有心跳吗？她播放心跳的声音给我们听，她说：“有心跳呀，而且很好。Eh….我是不是放两颗呀？好像有两个胚胎哦，两个都有心跳，周数也差不多”。当下她移过去看到第二个胚胎的时候，我眼眶泛泪，内心激动不已，很想跳起来抱着她 (反而不是自己的老公)，但是因为 social distancing 的问题，加上她是全副武装的穿着PPE，我也只好掩饰内心的激动和兴奋。

My rainbow babies

MY THOUGHT

为了结束这个冗长的文章，我想只有亲生经历过这一切的姐妹们才能真正的体会到，我们到底经历了些什么。相比之下，我的个人经历和故事并没有其他姐妹们来的坎坷。在 infertility 这个圈子，我属于 secondary infertility (续发性不孕症) 。

通常不孕症又可分为原发性不孕症 (primary infertility)和继发性不孕症(secondary infertility)。所谓原发性不孕症就是指从来没有怀孕过的病人，称为原发性不孕症；而继发性不孕症就是指过去曾经怀孕过，但是结果是流产，子宫外孕、死胎、死产，或是正常生产之后，而再也没有怀孕的病人，都称为继发性不孕症。

踏入这个圈子后，我才发现好多姐妹们都比我坚强，勇敢和更加努力，有些经历了7-8次的IVF 疗程，2-3次的流产事故，花了大笔的积蓄只为了生下一个健康的宝宝。

我十分可以理解不易受孕的女性往往为生育问题而整日忧心忡忡，心情随着每月的月经来潮而跌入低谷，看到别人或亲友怀孕，享受当妈妈的甜蜜滋味，有些还说是意外怀孕的，自己就会莫名奇妙的变得很沮丧，甚至开始埋怨自己的肚皮不争气。长期累计的压力很容易造成忧郁症，忧虑过多，反而降低受孕几率。如果身边的人对你心理和情绪上造成了极大的压力和反感，那么请暂时远离他们吧！

如果你看到这里，我也谢谢你的耐心，希望你对 “生殖医学” “不孕不育” ”试管宝宝” “人工受孕” 这些字眼不要有太多的避讳。如果你是家婆，岳母，七大姑八大姨，或是同事，闺蜜，千万千万不要追问身边已婚女性 “什么时候要生？” ，“什么时候要生二胎/三胎/收工？”，也不要给一堆不正确的助孕资讯，推销一些不需要又昂贵的保健品。如果一对夫妻在无避孕的情况下已经尝试12个月或更长的时间，我强烈建议你们尽早咨询妇科或助孕科进行生育评估检验，一定要相信科学，相信你的医生。

最后，姐妹们，如果你有任何关于不孕症饮食，试管婴儿，流产，怀孕，孕期保健品等问题，请留言。 在接下来的一段时间内，我将做更多的这些帖子和更新，因此请务必继续关注我的文章。

Have you or someone you known struggled with miscarriage or infertility? Let’s keep the comments respectful and support one another here!

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Does My Child Need to Take Probiotics?

by with No Comment Child & Family NutritionDigestive HealthInfant NutritionSupplementationToddler Nutrition

You’ve heard that probiotics are important for good digestion and immune function. Does that mean you should supplement your kids? What strain will help provide the best support for your child’s digestive system and relieve their constipation? I dive into the latest research about probiotics and health and provide tips for choosing the right supplements for your children. 

WHAT ARE PROBIOTICS?

Probiotics are a combination of live beneficial bacteria (and/or yeasts) that naturally live in our body. We have two kinds of bacteria constantly in and on our body — good bacteria and bad bacteria. Probiotics exist naturally in some foods and are also available as dietary supplements in powder, capsule, and tablet forms. The World Health Organization and the Food and Agriculture Organization of the United Nations call probiotics the “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.”

So we hear that probiotics are good for us. But a lot of the information that you will find about probiotics is not all that useful and does not help us decide whether the probiotics found in food are good enough, or if we need supplements. And if we need supplements which strain of probiotic should we get? How much of a dosage do we need to see a benefit? How long to take it for? And what type of benefit can I expect?

THE PROBIOTIC STRAINS ARE KEY 

There are many different species of probiotics, and many different strains within species. That means when we say “probiotics”, we are actually referring to many different types, not just one.

GENUS: A genus is a biological classification of living organisms. The term comes from the Latin genus meaning group. A genus contains one or more species. Examples of common probiotic genera include Bifidobacterium and Lactobacillus.

SPECIES: ‘Species’ refers to a type of microorganism existing within a genus or family. For example, acidophilus is the name of a species within the Lactobacillus genus.

STRAIN: A probiotic ‘strain’ is a genetic variant or subtype of a species. Different probiotic supplements contain different strains, which may be classified under the same species and genus. However, one acidophilus is not equal to another acidophilus. It’s the strain level that matters when you choose a probiotic in order to help with a specific health condition. If you neglect to pay attention to the specific strains in the kids probiotic, you may not be able to gain the health benefits you desire, and as such, be wasting your money.

In general, you’ll find many supplements will have a variety of Lactobacillus and Bifidobacterium species some limited to just one or two strains, others with several.

Bifidobacterium longum BB536;

Bifidobacterium breve M-16V;

Bifidobacterium infantis M63;

Lactobacillus acidophilus LAC 361;

Galacto-oligo saccharides (GOS)

THE NUMBERS OF THE PROBIOTIC STRAINS MATTER

Probiotics are measured in colony forming units (CFU), which indicate the number of viable cells. Amounts may be written on product labels as, for example, 1 x 109 for 1 billion CFU or 1 x 1010 for 10 billion CFU. Many probiotic supplements contain 1 to 10 billion CFU per dose, but some products contain up to 50 billion CFU or more. However, higher CFU counts do not necessarily improve the product’s health effects.

Manufactures should have storage conditions listed on the label. Stability testing is conducted under the same temperature as the recommended storage condition on the label.  Because probiotics must be consumed alive to have health benefits and they can die during their shelf life, users should look for products labeled with the number of CFU at the end of the product’s shelf life (the expired date), not at the time of manufacture.

When choosing your child’s probiotic, considering the amount of each strain is important. Most research suggests the minimum quantity of bacteria needed to generate therapeutic effects is 1 x 109 for 1 billion CFU. So you need to think billions when selecting a supplement.

Some of the gummies and chewable probiotics targeted to kids or packaged probiotic foods like bars you’ll find in the supermarket, simply don’t have a high enough dosage to gain any health benefits.

For infants, the dosage should be 5-10 billion CFU per day. For children over the age of 2, the desired dosage should be 10-25 billion CFU per day.

CONSIDERING YOUR CHILD’S AGE IS IMPORTANT

An infant’s gut microbiome is very vulnerable and lacks diversity compared to adults. It’s estimated young babies have approximately 10 different species whereas an adult has over 1000 species. A baby’s microbiome born vaginally is predominantly made up of Bifidobacterium species verses an adult’s microbiome which is dominated by Lactobacillus species.

After the age of 2, the child’s gut microbiome composition resembles that of an adult and is much more stable.

As a result, you’ll want a probiotic supplement that contains a higher dosage of beneficial bacteria in children over the age of 2. And, you won’t necessarily need to be limited to just kids specific products and brands.

If you’re breastfeeding, you may also want to assess your own gut health as bacteria will be transferred from the intestines to your baby’s through your breastmilk.

WHEN YOUR CHILD NEED A PROBIOTIC SUPPLEMENT?

 Antibiotic-Associated Diarrhea

Antibiotics can reduce the amount of friendly bacteria in the gut, both good and bad bacteria, which lowers the body’s defenses against other types of invaders, including bacteria, yeasts, fungi, and parasites. Taking probiotics containing Lactobaciallus rhamnosus GG and Saccharomyces boulardii may help to replace the bacteria lost as a result of antibiotic use and reduce the risk of antibiotic-associated diarrhea, which occurs in 40% of children on antibiotics (here, here).

Most probiotics should be taken after taking the antibiotics, so that they won’t be affected by the antibiotic.

Acute gastroenteritis (not related to antibiotic use)

Sometimes your child will just have diarrhea for a variety of reasons (most likely due to a viral or bacterial infection). Research has shown that there can be a reduction of stool frequency and duration of diarrhea experienced (by about 1 day) in children when probiotics containing Lactobacillus rhamnosus GG and Saccharomyces boulardii are taken (here).

Constipation

There is very limited evidence at this point, but some studies do show an increase in stool frequency with the use of probiotics. However, there is not good consensus on the dose or the type of probiotic (here).

Atopic Dermatitis / Eczema

Several studies and reviews have looked at the role of probiotics in preventing and treating atopic dermatitis. While some of the research has provided mixed reviews, many studies have found that infant at risk for developing eczema have benefited from taking probiotics with the  Lactobacillus rhamnosus GG strain (here). Other beneficial strains include Bifidobacterium lactis UABLA-12 and Lactobacillus acidophilus DDS-1 (here)

And, the protective effect of probiotics may be strongest when given to pregnant mothers.  Three studies using Lactobacillus rhamnosus GG given to pregnant women for 2-4 weeks before labour and continued treatment post-birth found significantly lower rates of eczema/atopic dermatitis during the first 2 years of life (here, here, here) so we probably want to make sure that moms are getting a good supply of these beneficial bacteria before baby is even born.

A New Zealand study was the first randomised controlled trial to show that Lactobacillus rhamnosus HN001 can be beneficial for childhood eczema. The key is to start supplementation with rhamnosus HN001 early from 35 weeks of pregnancy until two years of age (here).

The health benefits of rhamnosus HN001 include reduced risk of childhood eczema by 44% until the child’s 6th birthday and beyond. The protection continued even after supplementation was stopped by the child’s 2nd birthday. This confirms that not all probiotics are the same. Rhamnosus HN001 is also thought to reduce symptoms of postpartum depression in women.

Functional Gastrointestinal Disorders

A recent systematic review focused on probiotics and functional gastrointestinal disorders in children birth – 18 years yielded no studies on infants and young children (birth – 2 years old). While their search included studies on probiotics that reported on gastrointestinal outcomes such as abdominal pain, stool frequency, stool consistency and bloating/flatulence, these studies did not include infants and young children. Therefore, as evidence is not available for infants and young children, no probiotics can be recommended to improve functional gastrointestinal disorders for those 2 years and under at this time (here).

Infantile Colic

Colic is difficult to understand, and even more difficult to treat.  As a parent who has lived through colic, I know and understand the desperation in trying to find a solution. Research shows that a specific bacterial strain called Lactobacillus reuteri 17938 has been associated with decreased crying spells in exclusively breastfed infants during the first three months of life (here, here, here, here. here, here).

Immune Health 

As parents, we’re always looking for ways to reduce the number of colds and flus that find their way into our lives! Maintaining a healthy population of gut bacteria, along with a healthy diet and lifestyle may be key to staying healthy during cold and flu season. A recent meta-analysis of probiotic use (specifically Lactobacillus and Bifidobacterium strains) in children and adults revealed significantly fewer numbers of days of illness per person, shorter illness episodes by almost a day, and fewer numbers of days absent from day care/school/work (here).

WHAT TO LOOK FOR IN PROBIOTIC SUPPLEMENTS 

If you’ve decided to buy a probiotic supplement for your kids, prepare yourself for a dizzying array of options. The particular brand you purchase doesn’t matter as much as a few key criteria, which I’ve outlined for you below:

  • “Live, active cultures.” Make sure the supplement you choose contains this actual phrase right on the bottle, so you can be sure you’re getting an effective product. Some brands of probiotic supplements even come refrigerated to help protect these living cells.
  • High bacteria count. The concentration of bacteria in probiotic supplements is measured in CFUs (that’s “colony forming units.”) Look for a probiotic supplement that has, at a minimum, 1 billion CFUs (on the “expiration” or “use by” date on the product label).
  • Multiple strains. Balance matters! Different strains of probiotics can have different health effects. A supplement with eight or ten different strains of bacteria may help to diversify the bacteria that make up your kids’ microbiome.
  • Enteric coating. This refers to a hard coating on the outside of the pill that lets it survive the journey through the harsh, acidic stomach. An enteric coating means that bacteria are released in the intestines, where they can thrive.

FOODS CONTAINING PROBIOTICS

Many parents forget to consider probiotic strains that can be included in the child’s diet to enhance gut bacteria diversity. If you’re choosing a probiotic supplement to provide general support for your child’s immune health or digestive function, please focusing on foods first.

Common foods containing probiotics include yogurt, Kefir, kimchi, sourdough bread, sauerkraut, kombucha, miso, tempeh, fermented vegetables.

YOGURT VS PROBIOTIC 

The most common strains found in yogurt are L. bulgaricus and S. thermophilus. Yogurts labeled as having “live active cultures” must have at least 100 million live active bacteria per gram.

The key to introducing probiotic foods to your child is to start low and go slow to reduce any unpleasant side effects such as bloating and flatulence. Start with half a teaspoon every second day and slowly build up from there. To increase bacteria diversity and encourage a healthy gut environment, include a selection of different probiotic foods into your child’s diet and don’t forget about prebiotics.

BOTTOM LINE

There’s a lot of anecdotal evidence supporting probiotic use in children. But the health benefits may be strain-specific. A strain that helps one condition may be useless against another. For that reason (and due to lack of research), there’s no clear answer as to whether you should give your child probiotics, especially for long periods of time.

Giving probiotics to children isn’t without risk. Children with compromised immune systems may experience infection. Others may have gas and bloating. Probiotics can cause serious side effects in very sick infants. Check with your pediatrician before giving probiotic supplements to your child.

Did you know that I offer personalized one-on-one nutrition counselling for children and families? If this is something you’s like to learn more about, check out my service.

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Does My Child Need to Take Multivitamins?

by with No Comment Child & Family NutritionSupplementationToddler Nutrition

If you have a toddler who has a meltdown at the thought of eating more than two bites of something green, you know that getting children to eat a well-balanced diet isn’t easy. Whether to start giving your child vitamins is a question many parents have, as well as at what age they should start? Which brand to choose? What should be in multivitamins? However, for most healthy children, vitamins are unnecessary.

According to the American Academy of Pediatrics, children receiving a normal, well-rounded diet do not need vitamin supplements at all. Still, it can be difficult to know how many vitamins your child is getting each week. A toddler’s plate after dinner is finished may look like a crime scene. Did they actually consume any of that broccoli, or did it just get pushed around?

REASONS TO GIVE YOUR CHILD A MULTIVITAMIN 

When parents aren’t sure their children are getting the proper nutrients to achieve good health, their first route will immediately jump to a multivitamin. In my Peaceful Mealtimes online course, I teach parents how to analyze their child’s diet, they often find their “picky eater” is actually getting more variety than they initially thought. But under certain circumstances, some children don’t eat a normal, well-balanced diet, and may need to supplement with vitamins or minerals, such as those who:

  • are extreme picky eater and struggle to eat a variety diet
  • have food allergy
  • follow a vegetarian or vegan diet
  • have abnormal growth pattern
  • have a medical or digestive condition that affects the absorption of or increases the need for nutrients, such as celiac disease, cystic fibrosis, inflammatory bowel disease (IBD) or cancer

If your picky eater has a poor appetite or has been omitting whole food groups for a long period of time, you will likely need to temporarily support them with a multivitamin as picky eater may experience with low intake of zinc and iron.

Children who follow vegetarian or vegan diets may need to take specific supplement (ex:  vitamin B12 – found in animal foods). Another example, if a child who doesn’t consume seafood, I may recommend supplementation with Omega-3 fatty acids (DHA & EPA). For a child who is allergic dairy or does not consume dairy products, I’d recommend vitamin D and calcium.

If your child is experiencing declining or stagnant growth on their growth curve, it could mean that they’re not absorbing nutrients (medical or digestive problems) or their appetite is low due to a mineral deficiency (ex: iron deficiency anemia).

Children who have inflammatory bowel disease or celiac disease might have difficulty absorbing several minerals and vitamins like vitamin D, calcium, iron and zinc. It is because the diseases cause damage to the areas of the gut which absorb micro-nutrients. Additionally, kids with cystic fibrosis have trouble absorbing fat and may not absorb fat-soluble vitamins – A, D, E, and K. Children who take certain medications that interfere with intake may need a supplement.

Giving a multivitamin with various vitamins and minerals that aren’t actually targeted at what your child needs based on what is lacking in their intake is like shooting in the dark. You’re unlikely to actually see good results! Instead, work with dietitian to analyze your child’s diet, and help you find targeted supplements that might help.

THE RISK OF TAKING TOO MUCH SUPPLEMENT 

MegaDose 

A lot of marketing companies are constantly trying to convince us that children are just generally “picky” and need a multivitamin to fill the nutrition gap. And often these marketing campaigns are targeted at children themselves and their apparent need for a wide range of low dose multivitamins. This type of marketing can be very misleading, especially if you have a fairly healthy child that is eating a generally varied diet as is. As a result, parents may be spending money on something that is just not needed, or risking giving their children too many vitamins, resulting in overdose on certain vitamins, especially Vitamins A, D, E and K. Be very careful when you see a multivitamin that contains 100% of a vitamin/mineral dose per day or more (even when ingredients, etc. look great! See example here).

Not a magic pill 

Some parents also treat multivitamins as an insurance policy, a way to ease a parent’s worry. But, it can also mask the underlying problem of an extremely unhealthy eating habit, no supplement can replace feeding kids a well-balanced diet.

Avoid artificial colours and sugar 

So many popular multivitamins out there are just full of sugar, dyes and fillers. You want your children’s multivitamin to taste good enough that they’ll take it, but you’ll also want to avoid products that are high in sugar and/or include artificial sweeteners like high fructose corn syrup or Aspartame. Also, the sugars in gummy vitamins can contribute to dental cavities.

Never refer to vitamins as ‘candy’

Finally, the fact that many look and taste exactly like candy. Always read the label on the back for how many vitamins your child should be taking (usually one a day) and keep them out of sight of your children, as kids often think of them as candy and try to eat more than one per day.

WHAT AGE SHOULD MY CHILD START TAKING VITAMINS? 

I know we all want to do the best for our children but if your child eats a healthy, well-balanced diet, they don’t need vitamin supplements. However, infants do have different nutrient needs than older children and may require supplements. For example, some breastfed babies need a vitamin D supplement.

It’s important to ask your pediatrician if your child may require any supplementation, and always check with your child’s doctor first before administering any vitamins or supplements.

WHAT SHOULD I LOOK FOR? 

The National Pharmaceutical Regulatory Agency (NPRA) under the Ministry of Health Malaysia (MOH) is the only agency to regulate the registration, licensing, surveillance and quality control as well as Good Manufacturing Practice of supplements in Malaysia.

Every health supplement registered with MOH has two key features. The first key feature is the registration number (known as the MAL registration number) that starts with the letters MAL followed by eight digits ending with the letter N (ex: MAL 12345678 N). The letter “N” at the end of the MAL registration number indicates the type of product, which in this case stands for “supplements”.

The second key feature of registered health supplements is the presence of a “MOH Hologram” sticker on the packaging. This hologram sticker is considered a safety feature for all MOH registered health products as it is highly sophisticated and cannot be replicated.

When selecting a child’s multivitamin, you’ll be looking two options: with and without iron. The choice is yours based on your child’s diet and the perspective of their pediatrician. Most vitamins are water-soluble, which means that your child will simply eliminate whatever they don’t need in their urine. But vitamins A, D, E, and K are stored in the body’s fat. This means that there is a risk of toxicity (levels higher than the recommended). So, when buying a multivitamin, be sure to look at the label. You want to avoid multivitamins that contain more than 100% of the daily value of vitamin (especially of the fat-soluble ones).

Try your best to avoid any artificial colours and dyes that come in a multivitamin or supplement. Be aware that again, there are a lot of multivitamins that are very much like candy and full of sugar.

Third-Party Testing

Supplements that are third-party tested are sent to a lab where they are tested to ensure they contain what they say they contain and are not contaminated with specific high-risk, common contaminants. However, it’s important to note:

  1. Third party testing does not test to see if a product is effective or safe for everyone, and it does not ensure the supplement will not interact with other supplements or medications.
  2. Not all third-party testing is created equal. It is not uncommon for supplement companies to pay labs for certificates after conducting minimal to no testing.
  3. The third party certifications we can trust are: ConsumerLab, NSF, and USP. However, these certifications are difficult to obtain and/or expensive for manufacturers, so many companies choose not to get their products tested by one of these three organizations.
  4. Sometimes products tested by these three companies are more expensive to try to offset the cost they pay for certification.
  5. Just because a supplement is not tested by one of these three companies, it does not mean it’s a bad product. We recommend doing some research on the reputability of the manufacturer, and calling up the manufacturer and their testing lab to determine their protocols and decide if you feel comfortable consuming the supplement.

Form

Multivitamins come in a variety of forms:

  • Chewables
  • Gummies
  • Liquid
  • Powdered

The one you choose will be up to you depending on what your child accepts more easily and what the vitamin content of each one is.

For example, most kids enjoy chewable gummies, however they usually contain a bit more sugar than other versions. That being said, this may be the only way you can consistently get your child to take the vitamins, and so in that case, it may be worth it to purchase these. However, gummies don’t usually have high levels of iron in them. You also want to be conscious of the fact that gummies are a choking hazard for kids under 4, so if offering them, chop it up into smaller pieces to make it safer for younger children.

Chewable tablet vitamins tend to have higher iron doses,  so pay attention to this if this is a main nutrient of concern for your child. The liquid and powdered supplements can come in many flavours and parents often find that mixing them into a smoothie or yogurt is the best way to get it in. The trick here is, making sure your child takes the smoothie or yogurt + vitamin mixture daily!

Of course, taking into consideration cost of a product, accessibility, as well as all the other factors described above is going to be important and individual to every family. Weight out your pros and cons and remember to consult a doctor or dietitian for specific advice.

BOTTOM LINE

Research tells us that for healthy toddlers, a nutritious diet is the best way to be getting all the vitamins and minerals they need. Whole foods offer more/better absorbed nutrients than multivitamins can offer. So generally speaking, if your child is healthy (growing along their growth curve, no medical/nutritional diagnosis), eats a decent variety of foods, is active and sees a doctor regularly, they should not need a multivitamin.

Finally, if you have a picky eater, or are unsure of how to feed your toddler or what to feed your toddler to raise a healthy, happy eater, you can check out my Peaceful Mealtimes course for help. You will learn how to slowly begin introducing more fresh, whole foods to your toddler so that eventually, they may not need to rely on a multivitamin anymore.

For more tips and tricks when it comes to feeding your family, head over to Peaceful Mealtimes online course to learn more. 

sensory-fun-food-play-photo

What You Should Know About Sensory Food Play

by with No Comment Baby Led WeaningChild & Family NutritionInfant NutritionToddler Nutrition

Sensory food play is an extremely hands-on activity, which lets children engage with their senses through the exploration of different foods and textures through play. When sensory play is focused on food, it becomes even more stimulating   a b   se food is the ultimate sensory experience.

I know FOOD PLAY is usually not considered a good thing by parents as it is messy, but it is important for them to explore the foods through play.

Sensory food play is not just about playing foods      

WHY?

In a study published in Public Health Nutrition, researchers from Finland describe “sensory-based food education” programs that are common in preschools there. The programs include activities like preparing salads, growing vegetables in a garden or on a windowsill, taking field trips to pick berries, and participating in “sensory sessions” where children touch, listen, taste, and smell different kinds of foods—then share observations with each other.

They found that preschoolers who participated in this food education chose more fruits and vegetables from a buffet compared to those who didn’t receive it. Researchers say this sensory-based education helps children explore food with all five senses and instills a joy of eating. They also note that the findings held true even if there was a high level of pickiness in the group—which shows that “positive peer modeling” can also encourage children to try new foods.

  • Explore: When we let children explore and play with food, it gives them an opportunity to get to know their food and become comfortable with how it will eventually feel in their mouths.
  • Stress-free: Some children are anxious about unfamiliar foods, and Sensory Food Play provides them with some much-needed relaxation when faced with the overwhelming sensory experience of a new food. Smashing, squishing, poking, rolling, pouring, and dumping the food can provide stress relief as well as teach them how that food might feel in their mouth (and they just might try it!).
  • Build Trust: The use of Sensory Food Play can assist the child with touching, smelling and playing with the texture in an environment with little expectation. As the child develops trust and understanding of this texture it helps build positive pathways in the brain to say it is safe to engage with this food.

SENSORY FOOD PLAY RULES:

You can set a time and place for playing with food. You can also set the rules and boundaries for this exploration process. If you are worried about the mess or expense,  make a rule about that.

  • Mess: You can help your children manage their mess with consistent directions and rules. Before you get started, make sure that you have decided where your children are going to be playing. If it is going to be on the floor, put down a splash mat, old shower curtain or blanket. You could also play in the car porch to avoid lots of mess (handy for a rinse over afterwards!). I love to put the infant (6 months+, support with cushion) in highchair and put the messy/food play activity on highchair table. Just remember, the goal is for your children to develop positive feelings and connections with their food, so let them have a little fun with it.
  • Clean up: Have a clean up bin ready, such as baby wipes, apron, sponge, paper towels, cleaning spray.
  • Expense: Most of my sensory food play items I buy in bulk (e.g., rice, pasta, beans, cereal, oatmeal, yogurt, food coloring, toothpicks, etc.), which saves money in the long run. I often buy canned food items (peas, pears, fruit cups, etc.) or use leftovers. Also, I use items I receive for free at fast food restaurants (ketchup packets, straws, and other dipping containers).

Sensory food play is so important and beneficial for babies and younger children.  Not only is it lots of fun, but there is a lot of learning going on when they are playing that you might not realise. I am going to should you some benefits when a child engages in sensory food play.

SENSORY FOOD PLAY SKILLS:

  • Sensory system (learning and developing new tastes, textures and smells)
  • Gross motor skills (body balancing)
  • Fine motor skills (scooping, pincer grasp, writing, dipping)
  • Mealtime skills (pouring, tasting)
  • Language skills (maths, food vocabulary , following directions)
  • Play skills (imaginary play, solitary play)
  • Social skills (turn taking, manners) with other children
  • Problem solving skills (How to..)
  • Brain development (enhancing memory, ability to complete more complex learning tasks)
  • Learning cause and effect (what happen after squishing blueberries)
  • Growing independence through play
  • Creativity and FUN
  • Exploring shapes and colours

Here are some fantastic ideas and activities for sensory food play:

Digging in Beans – Get ready to dig, lift, dump, and pour. Fill a pan with dried beans, noodles, or rice and get little trucks or cars out. My son was crazy about this one.

Yogurt Paint – Paint  with yogurt. Get your little one touch new veggies while making beautiful art.

Shape Matching – Simple, quick and easy.

Learning Letters – use yogurt to make a letter, and trace the letter with berries or pomegranates.

Stacking – make a tower or building.

Rainbow Toast – Painting on food you can eat!

Counting Game – an easy educational game you can create for your little one.

Food Ribbons – use a peeler to turn a fruit or vegetable into ribbons.

I recommend Sensory Food Play at least once a week at home for picky eaters or problem eaters. Playing with food away from table (without pressure to eat or eat it now) offers your child the opportunity to look at, touch, smell and hopefully tasting the foods.

Sensory food play is vital for a child’s development and learning process! After you discover the key benefits of sensory food play for children in my article today, you may want to initiate sensory food play at home.

DON’T KNOW HOW

If you have no idea, you can check out this SENSORY FUN FOOD PLAY GUIDE. This guide takes you step by step through how to set up food play at home and get your children engaged in more than 100 sensory food play activities. Don’t be afraid to be silly and creative!

Happy Playing!

CHECK OUT NOW

children-books-about-nutrition-photo

Children Books about Nutrition

by with No Comment Child & Family NutritionToddler Nutrition

We all want our children to learn about nutrition in a fun, creative, and entertaining way. Combine story time with educating children about nutrition, and you have a recipe for success.

It is important to remember that just reading to your children is success itself. Don’t let technicalities or worrying about “doing it the right way”, get in the way of doing it at all. Children love to listen to stories and learn. They love a good character and a fun adventure.

WHAT TO LOOK FOR IN A BOOK:

  • Humor
  • An interesting story
  • Interesting illustrations
  • How to overcome challenges
  • The opportunity for ongoing conversation (ex: what would you do?)
  • A message about nutrition

QUICK TIPS TO MAKE STORY TIME A SUCCESS:

  • Repetition is key!  You may get tired of the same books every night, but repetition helps children learn.
  • Be dramatic!  Change your voice to reflect emotion and emphasize different points of the story.
  • Let your children repeat back to you. Mimicking is a powerful tool for learning.
  • Point to the pictures as you identify and say what they are (point to an apple, when you say the word, Apple). This is great for stories that are mostly pictures, like Eating the Alphabet. Don’t just say “banana”, point to it as well!
  • Don’t rush through it! I know it’s tempting to skip pages and rush through bedtime stories, but get to bed 10-15 minutes earlier than normal and enjoy the time together.  Remember, they are only little once, and they won’t be as attentive to story time when they are teens!
  • Discuss the story after you read it. Talk about what they learned, and what changes they can make to their diet to reflect the lessons they learned.

I’ve put together a reading list for kids including 52 children’s books (26 English and 26 Chinese books) about nutrition to help you entertain and educate at the same time.

These children books include information about healthy eating, where food comes from, how to prepare it, how foods digest in our body, and more.

ENGLISH CHILDREN BOOKS

Bread and Jam for Frances by Russell Hoban

  • Bread and Jam for Frances by Russell Hoban

Frances is a fussy eater. In fact, the only thing she likes is bread and jam. She won’t touch her squishy soft-boiled egg. She trades away her chicken-salad sandwich at lunch. She turns up her nose at boring veal cutlets. Unless Mother can come up with a plan, Frances just might go on eating bread and jam forever! It is great for kids ages 0-5 years old.

  • Cami Kangaroo Has Too Many Sweets! by Stacy C. Bauer

Cami Kangaroo loves sweets. In fact, she can’t stop thinking about them. She loves them sooo much, that even after Mommy catches her eating from a bucket of ice cream, she still finds ways to sneak them. Will Cami ever be able to follow the rules about junk food? It is great for kids ages 0-5 years old.

  • Cloudy with a Chance of Meatballs by Judi Barrett

The tiny town of Chewandswallow was very much like any other tiny town except for its weather which came three times a day, at breakfast, lunch and dinner. But it never rained rain and it never snowed snow and it never blew just wind. It rained things like soup and juice. It snowed things like mashed potatoes. And sometimes the wind blew in storms of hamburgers. Life for the townspeople was delicious until the weather took a turn for the worse. The food got larger and larger and so did the portions. Chewandswallow was plagued by damaging floods and storms of huge food. The town was a mess and the people feared for their lives. Something had to be done, and in a hurry. It is great for kids ages 0-5 years old.

  • Creepy Carrots! by Aaron Reynolds

Jasper Rabbit loves carrots—especially Crackenhopper Field carrots. He eats them on the way to school. He eats them going to Little League. He eats them walking home. Until the day the carrots start following him…or are they? It is great for kids ages 0-5 years old.

  • Daisy Eat Your Peas by Kes Gray 吃掉你的豌豆

Daisy doesn’t like peas. And there is nothing that will get her to eat them. Mum says she can have an extra pudding, a chocolate factory or a space rocket with double retro laser blammers – but it just won’t work! Can quick-thinking Daisy save her tea time and come up with a cunning plan to turn the tables on Mum? This wickedly funny story will appeal to cheeky children everywhere (especially fussy eaters!). It is great for kids ages 0-5 years old.

  • D.W. The Picky Eater by Marc Brown

D.W. is very picky about what she eats. She doesn’t seem to like anything. Her dining out days with her family are cut short when she refuses to eat her salad and flings it to the floor. Will her table manners improve in time for her Grandma Thora’s special dinner out? It is great for kids ages 0-5 years old.

  • Eating the Alphabet by Lois Ehlert

This is a more of a picture book, but kids enjoy reading and seeing all the foods that are associated with each letter. A glossary at the end provides interesting facts about each food. It is great for kids ages 2-3 years old.

  • Good Enough to Eat by Lizzy Rockwell

A practical, hands-on tool for families who want to eat a healthy diet, this book explains nutrition from carrots to cookies. This book is good for ages 4-8 years.

我觉得这简直是一本给小朋友看的营养学教材，用绘本和讲故事的方式，简单介绍了我们吃的食物都有什么营养，包括碳水化合物，蛋白质，脂肪，水，维生素和矿物质的概念，每种营养素的功能，哪些食物含有哪些营养素，每个孩子每天需要多少营养素，我们的身体如何消化食物，以及卡路里的知识，营养很重要，如果宝宝从小就对此有所了解，对他们以后的人生和健康也非常有帮助。

  • Green Eggs and Ham by Dr. Seuss

Have you ever tried green eggs and ham? Sam-I-Am suggests all kinds of ways to try green eggs and ham. This classic Dr. Seuss book is a staple for beginner and emergent readers. This book is good for ages 4-8 years.

  • Gregory, the Terrible Eater by Mitchell Sharmat

Gregory isn’t like most goats. Instead of indulging in delicacies like old shoes, boxes, and bottle caps, he prefers to eat fruits, vegetables, eggs, and fish. Mother Goat and Father Goat are disgusted, and after several attempts to get Gregory to eat like a proper goat, they finally take him to see Dr. Ram. But when Gregory finally develops a taste for flat tires and broken violins, he’s not just eating like a goat—he’s eating like a pig! Will Gregory be able to find a healthy balance before he eats everything in the house? It is great for kids ages 0-5 years old.

这本书堪称对付挑食小朋友的经典之作，第一版出版于1980年，很多当年看过这本书的挑食小朋友现在已经变成了挑食小朋友的爸妈。Gregory是个小山羊，他喜欢吃水果、蔬菜、鸡蛋和鱼，但是山羊们眼中的健康食物与垃圾食物跟我们刚好相反，在它的爸爸妈妈看来，这些都是不健康的食物，它们希望Gregory多吃些旧鞋、罐头、瓶盖、衣服、报纸等它们眼中的“美味佳肴”。后来爸爸妈妈带Gregory去看医生，终于勾起了它对破轮胎和坏了的小提琴的食欲，Gregory胃口大开吃了很多，最后它肚子疼了……这本书也让我们开始反省，我们希望宝宝吃的东西就一定是健康的吗？宝宝吃的很多很饱就是好的吗？无论如何，医生给Gregory爸爸妈妈的建议中有一条是正确的：如果宝宝挑食，应该每次只给他吃一种它不喜欢的食物，而且把这个食物放在他喜欢的食物中，像Gregory的爸爸妈妈，就是把鞋带掺在意面里给他吃。

  • How Did that Get in My Lunchbox? by Chris Butterworth 餐盒里食物的故事

One of the best parts of a young child’s day is opening a lunchbox and diving in. But how did that delicious food get there? From planting wheat to mixing dough, climbing trees to machine-squeezing fruit, picking cocoa pods to stirring a vat of melted bliss, here is a clear, engaging look at the steps involved in producing some common foods. Health tips and a peek at basic food groups complete the menu. This book is good for ages 4-8 years.

上了学的小朋友们每天最开心的就是午餐时刻，打开lunchbox，看看妈妈又给准备了什么好吃的。这本书通过食物介绍了营养的有关概念，比如蛋白质、碳水化合物等，但是也有不同的地方，就是利用小朋友的好奇心，说明了午餐盒中的食物都是怎么制作出来的，比如面包、苹果汁等，它们虽然是在超市里买的，但是可不是在超市里长出来的，这个制作过程可以让宝宝对食物多了一层了解，也许会更亲近。

  • How to Feed Your Parents by Ryan Miller 

Who’s the picky eater? Not Matilda! A little girl with adventurous tastes turns the tables on her food-fussy parents and teaches them that dinner can be more than chicken nuggets. Matilda Macaroni loves to try new foods, whether it’s her grandma’s jambalaya or sushi at a sleepover. But, in this fun, twisted picture book, it’s finicky mom and dad–not the child–who eat only pizza with pepperoni (delivered), burgers from a bag, or noodles from a box. Eager to experience new flavors, Matilda secretly sets out to learn how to cook, satisfy her hunger for something more . . . and expand her parents’ palates, too. There’s also a Macaroni family recipe for quiche that young cooks can try!

  • If You Give a Cat a Cupcake by Laura Numeroff

If you give a cat a cupcake, he’ll ask for some sprinkles to go with it. When you give him the sprinkles, he might spill some on the floor. Cleaning up will make him hot, so you’ll give him a bathing suit . . .It is great for kids ages 0-5 years old.

  • If You Give a Dog a Donut by Laura Numeroff

If you give a dog a donut, he’ll ask for some apple juice to go with it. When you give him the juice, he’ll drink it all up. Then, before you can say “Woof” . . . Dog is off on a backyard adventure! It is great for kids ages 0-5 years old.

  • If You Give a Moose a Cookie by Laura Numeroff

If you give him a cookie, he’ll ask for a glass of milk. He’ll want to look in a mirror to make sure he doesn’t have a milk mustache, and then he’ll ask for a pair of scissors to give himself a trim….It is great for kids ages 0-5 years old.

  • If Your Give Mouse a Muffin by Laura Numeroff

If a big hungry moose comes to visit, you might give him a muffin to make him feel at home. If you give him a muffin, he’ll want some jam to go with it. When he’s eaten all your muffins, he’ll want to go to the store to get some more muffin mix. It is great for kids ages 0-5 years old.

  • If You Give a Pig a Pancake by Laura Numeroff

If you give a pig a pancake, she’ll want some syrup to go with it. You’ll give her some of your favorite maple syrup, and she’ll probably get all sticky, so she’ll want to take a bath. She’ll ask you for some bubbles. When you give her the bubbles… It is great for kids ages 0-5 years old.

  • I will Never Not Ever Eat a Tomato by Lauren Child 我绝对绝对不吃番茄

Lola is a fussy eater. A very fussy eater. She won’t eat her carrots (until her brother Charlie reveals that they’re orange twiglets from Jupiter). She won’t eat her mashed potatoes (until Charlie explains that they’re cloud fluff from the pointiest peak of Mount Fuji). There are many things Lola won’t eat, including — and especially —tomatoes. Or will she? Two endearing siblings star in a witty story about the triumph of imagination over proclivity. It is great for kids ages 0-5 years old.

Charlie和Lola 是一对兄妹，Lola是个非常挑食的小姑娘，有一天她的哥哥Charlie负责看她吃饭，面对Lola对各种蔬菜的抗拒，Charlie充分发挥自己的想象力，给胡萝卜（木星上的橙色树枝）、豌豆（绿色的雨）、土豆泥（富士山上的云）等蔬菜都编了个有趣的来历，于是Lola就愉快地吃下去了。

  • Llama Llama Yum Yum Yum! by Anna Dewdney

Get cooking with Llama Llama in this scratch-and-sniff board book! Llama Llama and his Mama are in the kitchen whipping up some delicious treats! Join in the fun by reading along with this super-sweet story and scratching and sniffing the fun scents on each spread, like pickles and ice cream sundaes! It is great for kids ages 0-5 years old.

  • Lulu’s Lunch by Camilla Reid 

An action-packed activity book perfect for all toddlers. Join Lulu on her exciting edible day as she discovers sticky honey, a banana to peel, a picnic box to unpack and a brilliant finale – a plate full of spaghetti! It is great for kids ages 0-3 years old.

 

  • Pancakes, Pancakes! by Eric Carle

Jack is so hungry that what he really wants is a large pancake for breakfast. Join Jack as he starts from scratch to help make his very own breakfast pancake! It is great for kids ages 4-8 years old.

  • Picky Nicky by Cathy East Dubowski

Picky eater Nicky declares that she would rather eat bees and parrots than peas and carrots until her inventive family devises a clever plan to overcome her finicky habits. It is great for kids ages 3-5 years old.

  • The Berenstain Bears & Too Much Junk Food by Stan and Jan Berenstain

Papa, Brother, and Sister are eating way too much junk food, and it’s up to Mama and Dr. Grizzly to help them understand the importance of nutritious foods and exercise. This story book is a perfect way to teach children about the importance of eating healthy and staying active! It is great for kids ages 0-5 years old.

贝贝熊经典系列是美国小学指定阅读书目，其中很多内容都与日常生活密切相关。这本书讲的是贝贝熊爸爸、哥哥和姐姐吃了很多的垃圾食品，于是贝贝熊妈妈和医生不得不出手干涉的故事。书后有50个贴纸，可以用来给小朋友作为好好吃饭的奖励。

  • The Very Hungry Caterpillar by Eric Carle

A children’s classic about a caterpillar who eats his way through the pages of the book. It is great for kids ages 0-5 years old.

  • Where Do Bananas Come From? by Arielle Lebovitz 

A Book of Fruits is the fruit edition in a series of children’s nutrition books for kids ages 4 and up. This colorful and playful guidebook introduces 108 fruits with full-color photography and charming illustrations. Learn fun facts from farm to table, fruit seasonality, nutrition information, an introduction to cooking with tasty recipes, and how to pick, store, and eat fruits too.

Kids will explore new fruits through experience-based learning with 100 descriptive words to guide their five senses on endless food adventures. It is great for kids ages 4-12 years old.

  • Where Does Broccoli Come From? by Arielle Lebovitz 

A Book of Vegetables is the vegetable edition in a series of children’s nutrition books for kids ages 4 and up. This colorful and playful guidebook introduces 102 veggies with full-color photography and charming illustrations. Learn fun facts from farm to table, vegetable seasonality, nutrition information, an introduction to cooking with tasty recipes, and how to pick, store, and eat veggies too.

Kids will explore new vegetables through experience-based learning with 100 descriptive words to guide their five senses on endless food adventures. It is great for kids ages 4-12 years old.

CHINESE CHILDREN BOOKS

  • 爱吃青菜的鳄鱼 by 汤姆牛

种蔬菜的农夫在河边捡到了一只小鳄鱼，于是每天喂他吃各种蔬菜，吃得小鳄鱼又大又强壮。有一天小镇来了一个医生，检查出全镇的人肚子里都有咕噜咕噜的怪声， 了解到是因为大家都不吃蔬菜，导致便秘的问题，因此肚子里有很多细菌，以致于发出咕噜咕噜的声音；但是又发现小鳄鱼的肚子里很干净、很健康，只有他 一个人没有咕噜咕噜的怪声。

这本书故事简单，内容贴近幼儿的心，用亲切的方式，让小朋友看到青菜长大的过程，了解吃青菜的好处，而且觉得吃青菜是一件很快乐的事！

  • 爱吃水果的牛 by 汤姆牛

在 一座长满各种水果的森林里，住着一只爱吃水果的牛，主人每天喂它各种好吃的水果，日子久了，这只牛就变得既健康又强壮。有一天，主人和邻居们，都因平日营养摄取不均衡，加上天气多变化而感冒了，大家都倒在床上动弹不得，幸亏有 “爱吃水果的牛” 每天提供大家各种好喝又营养的 “香蕉牛奶” “苹果牛奶”，大家才恢复昔日的健康，又变得生龙活虎的了！

这个轻松而富有想象力的故事，虽然主题明确，但故事处理得一点也不说教，简单明了的故事让孩子对吃水果的好处一目了然，不需父母在旁叨叨絮絮费尽口舌，小朋友自然而然会被这只可爱的牛吸引，进而对水果产生好奇与兴趣。

  • 爱挑食的小狐狸 by 陈书韵

狐狸阿布特别挑食，这个不吃、那个不吃，弄得营养不均衡，最后连玩游戏的力气也没了！简单的故事点出偏食的坏处，以及营养均衡的重要。

  • 我的蔬菜宝宝 by 陈丽雅

适合0~2岁幼儿阅读。宝宝的首本蔬菜认知类自然生态绘本，通过近距离的观察，探索植物生长的奥秘。

  • 汉堡男孩 Burger Boy by 艾伦•杜兰 (Alan Durant)

维尼讨厌蔬菜。他不喜欢红萝卜。也不喜欢各种各样的蔬菜。维尼喜欢汉堡。汉堡是维尼的最爱。其实维尼的食物名单只有汉堡而已。“总有一天，你会变成一个大汉堡！” 妈妈警告他。有一天，维尼竟然真的变成汉堡了。狗狗、牛、小男孩都追着他，想一口吃了他，维尼怎么办？妈妈能把他救回来吗？

  • 胖国王 by 张蓬洁 

这本书通过轻松幽默的故事，提醒孩子注意营养均衡，常常运动、保持身心健康，让孩子学到一些简单的饮食观念。父母也可以通过故事，引导孩子认知：胖国王最大的问题不是胖，而是不健康。所以不是要孩子成为一个瘦子，而是要孩子变成一个健康的人。

  • 瘦王后 by 张蓬洁

瘦皇后本来没有那么瘦的，但是因为担心胖国王太胖了，所以天天紧紧张张，又忙着藏胖国王的零食、忙着陪国王做运动，忙到不想吃东西、睡不着觉，有一天居然昏倒了……书中以轻松活泼的方式，提醒现代人注重营养均衡、适量运动，内容相当具有现代意义。

  • 挑食的小老鼠 by 何文楠

小老鼠青青刚开始的时候，非常偏食，只吃肉，不吃蔬菜。后来发生了什么事让青青一下子改变了挑食的坏习惯了呢？

  • 山姆吃饭了Sam, Go to Eat by (加)奥德里奇•加西亚

山姆是一个不爱吃饭的孩子。吃饭的时候，他只吃饼干，藏着自己的小脑袋或者挥舞自己沾满颜料的小脏手拒吃饭……咦，发生了什么事让山姆专心吃饭了呢？

 

  • 挑食的弗雷达 by 朱莉娅•贾曼

弗雷达的小女孩儿太爱挑食了，无论爸爸妈妈做什么菜肴，她都不喜欢吃；奶奶给她带来了美味的海鲜，她也不喜欢吃；从法国度假回来的舅舅带来了法国美食，可她依旧不爱吃。有一天，她突然变小了，不好，猫要把她当老鼠吃掉了。

弗雷达是如何从一个挑食的小女孩转变成一个胃口好，吃什么都香的孩子呢？其中的关键转变就是自己对坏习惯的意识，放弃与父母的对抗，从而学会对自己负责。家长们想尽一切办法，即辛苦又不讨好，可当孩子意识到问题的严重性以后，就会主动地去改正自己的行为，从而养成健康饮食的习惯。

  • 挑食的弗莱娅 by (英)凯瑟琳•夸恩比

弗莱娅的胃口原本要多好有多好，可突然有一天，她向大家宣布：“你们做的饭一点儿也不好吃。” 第二天她连香肠也不喜欢了。没多久，她就变得很瘦。妈妈无奈之下只好给外婆打电话讨救兵。“把弗莱娅送到我这儿来吧，我们会调教好她的，这个挑剔的小东西。” 于是， 弗莱娅动身去外婆外公家享受无上美味去了——在那儿，她还将学到一点令她终身难忘的东西。

对于挑食，有时需要淡化处理。如果孩子只是偶尔有那么一两样东西不吃，没什么大不了，完全可以不去管它，刻意的纠正有时反倒会强化“不吃”的心理。要是挑食过了火，影响了健康，我们可以从外婆的秘诀中取经。总之，不管用什么方法，大人首先要保持轻松的心态，以不伤害孩子的心理健康为大前提。

  • 不一样的小公主：公主小姐不想吃饭 by (法)克里斯汀•诺曼•维拉蒙

小公主不想好好吃饭的故事，她不喜欢这个不喜欢那个，于是爸爸妈妈决定让她扮演爸爸妈妈的角色去劝自己的小仓鼠吃饭。在自己要成为榜样的过程中，会发生什么事？公主小姐不想吃饭，谁来帮帮她？

  • 我可不吃那个！I won’t Eat That ! by (美)克里斯托弗•赛拉斯•尼尔

猫宣告它不吃又干又乏味的猫粮了，那它该吃什么呢？它走进自然界，去向乌龟、狐狸甚至是鲸鱼求助，可是它们吃的东西猫都不感兴趣。猫很沮丧，它还能找到自己爱吃的东西吗？

  • 如果不吃青菜 by 黄小衡

《淘气包明一》习惯养成系列绘本的其中一本。本书画风夸张、幽默、想象力爆棚，让孩子在笑声中认识到这些坏习惯的“可怕”后果，真正用孩子喜欢的方式寓教于乐。

  • 哪个是哪个？食物比一比 by 高岡昌江

先用清楚的图示、对比，让你一眼看出这些食物外观的不同，再详细介绍它们的种类、来源、演变、营养和料理方法等。超多图示让你一目了然学会如何区分这些食物，更进一步告诉你这些食物为什么这么好吃的秘密！

  • 用什么做的呀？by 大森裕子

适合0~4岁幼儿阅读。饭团是用什么做的呀？汉堡包、拉面、饺子、圣代又是用什么做的呢？我们大家又是用什么做的呢？通过不断的提问启发小朋友们思考事物是如何构成的。本书语言简洁、色彩柔和，小动物的形象生动活泼，小朋友们可以通过图文识别常见的食品及原料，是一本颇具美感又趣味十足的幼儿读物。

  • 食物从哪里来？by (意)阿戈斯蒂诺•特拉伊尼

餐桌上的米饭、面包、水果、点心都是怎么来的呢？跟随小小美食家的步伐，穿过田野，来到城镇，深入海底，逛逛市场，参观工厂，一起来了解食物是怎么来的，它们又是如何加工变成我们餐桌上的美食的吧。这本书以图解的方式和活泼的语言，将食物的来源、加工制作的过程讲解得轻松有趣。

  • 跟饭团一起插秧 by (日)加岳井广

适合3岁以上的儿童阅读。又到了饭团家插秧的日子了，附近村子的伙伴们都来到稻田旁集合，豆皮寿司、酸梅、干木鱼等和米饭相关的食材都来了。大家互相帮忙插秧真是太好了！努力了一上午，可是还有一大片稻田等着呢。真能完成插秧的任务吗？正当大家忍不住怀疑的时候，两位神秘的帮手出现了。他们是谁呢？饭团家能顺利插完秧吗？田园风光和劳动的结合，帮孩子们理解食物与生产劳动的关系。

  • 唤醒童心的美味秘方 by (加)京•麦克莱尔

茱莉亚从小就喜欢法国美食，她甚至爱上了动手制作。为了做出美味佳肴，她和好朋友西姆卡一起学习烹饪，在厨房里快乐地煮啊煮，并希望能永远做小孩儿。

这本书，讲述的不仅仅是美食、烹饪的艺术，还借由孩子的眼睛，提醒我们每一个人，放缓节奏，欣赏沿途的风景，不争不抢，品味每一个当下的时刻；放松心情，保有一颗童心，不急不躁，感受生活中的乐趣和美好。

  • 小豆子豆豆 Little Pea by (美)艾米·科考斯·罗森塔尔 Amy Krouse Rosenthal 

豆豆每天都过得很快乐，他喜欢做的事有很多，但是晚餐时间却是他的噩梦，豆豆如果不把他的晚餐，讨厌的糖果全部吃完，就没有她最爱的蔬菜点心，豆豆会否吃完她最讨厌的糖果？这是一本以逆向思考及幽默的方式讓小朋友學習輕鬆看待自己不喜歡的事物(挑食)

  • 一园青菜成了精 by 周翔

出了大门往正东，一园青菜在农夫走后开始了大战，它们个个成了精。在农夫回来后，一园青菜已然熟透……本书通过幽默风趣及夸张的表现手法，朗朗上口的儿歌语言，演绎了一个菜园里的热闹故事，给予儿童无穷的想象空间。

  • 蚂蚁和西瓜 by 田村茂

一个好热的夏天的下午，蚂蚁们发现了一大块西瓜。“真好吃，赶紧搬回家吧！”可是怎么搬回去呢？一只蚂蚁想到了好主意……简单的线条、漫画式的夸张，把勤劳、乐天、齐心协力的理念呈现得无比幽默，结尾别出心裁。

  • 肚子里有个火车站 by (德)安娜•鲁斯曼

肚子里有一群帮助食物消化的小精灵，如果吃的太多太快，精灵们就会游行示威、罢工抗议，肚子里就会乱作一团。这本书一种极其有趣的方式使我们了解自己的消化系统，从而帮助我们养成健康的饮食习惯。

  • 肚子里的小人 by 吉村亚希子

这本书解决了这一沟通难题。不说教、不示范，而是采用“共情”的方法，利用孩子天生的想象力，使之假想肚子里面有一个跟自己吃一样、喝一样的小人。如果自己习惯不好，那么肚子里的小伙伴可要遭殃了。这样的方式，生动、形象，而且讲过一次，便难以忘记。家长可以继续根据需要，创造出更多关于“肚子里的小人”的故事。

  • 影响孩子一生自我意识养成绘本第二辑（4册）

用充满趣味的语言解读身体的秘密，让孩子在童话故事中了解自己身体的秘密，自主养成好的生活习惯，拥有保护自我的意识，理性认识自我的能力。

  • 揭秘食物（10册）by 周东

让孩子探索食物的秘密爱上美食。

Let me know what you think! Is there a book you love that’s not on this list?

No Knead Oat Bread (Dutch Oven)

No Knead Oat Bread (Dutch Oven)

by with No Comment Recipes

This bread is packed with oatmeal and whole wheat flour. This is truly an easy bread to make, no hand-shaping, no kneading, no mixer. All it really takes is some wait time.

There are two rises required to make this loaf of bread, so plan accordingly. I usually make my dough in the afternoon and then bake my loaf next morning.

No knead oat bread
Get the ingredients ready

First, you will combine your dry ingredients together: whole wheat flour, white flour, oats, salt, sugar and yeast. The wet ingredients for this homemade hearty bread are oil and warm water. Mix the dry and wet ingredients together with a wooden spoon. While the oats will soak up a lot of the moisture, the dough will look slightly wet and you’ll be tempted to keep adding flour. Don’t do that!! Slightly “wet” looking dough is just fine. Cover the dough and allow it to rise for 2 hours during the day.

After 2 hours, the dough will have grown quite a lot.

Stir the dough to roughly form a ball, cover, and refrigerate overnight.

After a night in the fridge, the dough will still be wet.

Remove from the fridge

Now, the dough is ready for its second rise. If the dough is sticky and you can barely form it into a ball before baking, you can dump it onto a floured surface, pour more flour on top, and let the flour help you form it into a ball. Start folding the dough over itself so it is nicely coated with flour. Keep doing this until the dough holds its shape.

Sprinkle a small handful of oats in the center, then carefully place the ball of dough on top of the oats with the seam side down. By seam, I mean the crease that you’ll create as you fold the dough over itself. So the top of the dough should look nice and even.

Place the ball of dough on top of the oats with the seam side down

Add another few pinches of oats on top, and cover with plastic wrap and let rise in a warm place for 1-2 hours (or until about 50% larger than it’s original size).

After 2 hours of rising, 50% larger than it’s original size

Meanwhile, preheat your oven to 400 degrees Fahrenheit. Also, as the oven preheats, stick your dutch-oven in the oven so it gets as hot as possible.

Preheat the dutch-oven in the oven

When the oven is ready, remove the dutch-oven and carefully roll your dough ball into the pot, now the seam on the dough is facing up. This allows steam to escape as it bakes. Cover the pot with lid and bake it for 30 minutes.

Remove the dutch-oven and carefully roll your dough ball into the pot, now the seam on the dough is facing up

After 30 minutes, carefully remove the lid and bake for another 15 minutes, which will brown the bread nicely.

Carefully remove the lid and bake for another 15 minutes

Then carefully remove the loaf from the pan and let it cool for about 30 minutes before slicing it.

let it cool down

I am using dutch oven. What if you don’t have a dutch oven.

This recipe can also be baked in a cast-iron skillet, a random oval, round, or rectangular oven-proof dish that’s somewhere around 9-inches long, or even on a cookie sheet.

Enjoy !

No Knead Oat Bread (Dutch Oven)

This easy no knead bread are loaded with oats, perfect for toast, sandwiches and snacking.
Print Recipe Pin Recipe
Prep Time 10 minutes
Cook Time 12 hours
Total Time 12 hours 10 minutes
Course Breakfast, Snack

Ingredients
  

  • 1 1/2 cup Warm tap water
  • 2 tbsp Sugar or maple syrup or honey
  • 1 tbsp Olive oil
  • 1 tbsp Instant dry yeast
  • 1 cup All-purpose flour
  • 1 1/2 cup Whole wheat flour
  • 1 cup Oats
  • 1/2 tbsp Salt

Instructions
 

  • Put all ingredients into a large bowl. Stir with a wooden spoon until combined. The dough will be sticky, but that’s fine. As long as all the flour has been absorbed, you’re good.
  • Cover the bowl with plastic wrap or a clean kitchen towel and let sit at room temperature for at least 2 hours. It will become bubbly and rise quite a bit, so be sure your bowl is large enough.
  • Once risen, stir the dough to roughly form a ball, cover, and refrigerate overnight (at least 8 hours).
  • When ready to bake, remove the dough from the fridge and use your hands to form it into a ball (I find this is easiest when I wet my hands first).
  • Cut a 10-inch or larger square of parchment paper and sprinkle a small handful of oats in the center, then place the ball of dough on top of the oats. Add another few pinches of oats on top, and cover with plastic wrap and let rise in a warm place for 1-2 hours (or until about 50% larger than it’s original size).
  • When dough is nearly done rising, turn your oven on to 400 degrees Fahrenheit. If you have a large dutch oven or cast iron skillet, put it into the oven to get hot while the oven preheats. If you don’t have either of those, you can use a large oval or round oven-safe dish, or even a cookie sheet, which doesn’t need to be preheated.
  • When dough is nearly done rising, turn your oven on to 400 degrees Fahrenheit. If you have a large dutch oven or cast iron skillet, put it into the oven to get hot while the oven preheats. If you don’t have either of those, you can use a large oval or round oven-safe dish, or even a cookie sheet, which doesn’t need to be preheated.
  • Remove bread from the oven and wait as long as you possibly can before cutting into it (ideally until its just barely warm, or even until it’s fully cold.
  • Store leftover bread in an airtight container at room temperature for 3-4 days, or slice and store in the freezer for several months.

Recipe adapted from Baked Greens.

I’m afraid of baking bread as I’ve never successfully made anything with yeast before, but after this homemade bread recipe, I am super thrilled and I definitely will make this freshly baked bread every week.

If you like this recipe, you might also want to try this delicious Cranberry Walnut Scones.

Cranberry Walnut Scones

Cranberry Walnut Scones

by with No Comment Recipes

I’ve been making this Cranberry Walnut Scones recipe for my family in the past week.

Scones are perfect for dessert, breakfast, snacks, whenever.

Press the dough into a 3/4 inch thick circle.

Cut across the diameter into 8-12 wedges.

You can adapt the recipe to any season by adding a different mix of berries and nuts. This combination is perfect for everyone.

Enjoy!

Cranberry Walnut Scones

This combo is amazing, but you can stir in almost anything into this rich and delicate dough.
Print Recipe Pin Recipe
Prep Time 10 minutes
Cook Time 12 minutes
Total Time 22 minutes
Course Breakfast, Snack
Cuisine American

Ingredients
  

  • 2 cups all-purpose flour or cake flour
  • 1/2 tsp salt
  • 2 tsp baking powder
  • 3 tbsp sugar

Instructions
 

  • Heat the oven to 450°F. Mix the flour, salt, baking powder, and 2 tbsp of the sugar in a large bowl. Add the butter and press it into the flour mixture, breaking it into tiny pieces with your fingers until it looks like coarse meal.
  • Stir in the egg and 1/2 cup cream/milk. The mixture should form a slightly sticky dough. If it's too sticky, add a little flour, but very little; it should still stick a little to your hands. If it's too dry, add more cream/milk 1 tbsp at a time.
  • Sprinkle 2 tbsp flour on a work surface and turn out the dough. Sprinkle the cranberries and walnuts over it and knead only a few times to incorporate the fruit and nuts. If the dough is very sticky, add 1 to 2 tbsp flour, but no more.
  • Press the dough into a 3/4 inch thick circle and cut across the diameter into 8-12 wedges.
  • Brush the top of each scone with a bit of cream/ or milk, sprinkle with a little of the remaining 1 tbsp sugar (optional), and transfer them one by one to an uncreased baking sheet with a spatula, leaving at least 1 inch between them. Bake for 10-12 minutes (1-2 min more if needed), until the scones are golden brown.
  • Transfer to a rack to cool a bit. Serve right away if possible, or at least the same day.
Keyword healthy snacks
Notes
Instead of cranberries and walnuts, try up to 1/2 cup of any of these: [br]1. Raisins [br]2. Chocolate chips [br]3. Grated cheddar or Parmesan cheese (omit the sugar from the recipe)

If you like this recipe, you might also want to try this delicious Golden Cornmeal Bread.

Salt:Sodium for Babies and Toddlers

Salt/Sodium for Babies and Toddlers

by with No Comment Baby Led WeaningChild & Family NutritionInfant NutritionToddler Nutrition

As parents, many of us are mindful of how much sugar we give to our little ones, but what about their salt intake, especially if you’re following mixed feeding approach.

HOW MUCH SALT IS TOO MUCH?

Due to limited data for babies, an AI (Adequate Intake) for sodium has been established.

  • For infants 6 months and younger, the AI for sodium is 110 milligrams per day (here).
  • For babies between 7 and 12 months old, the AI increases to 370 milligrams per day (here).

This means that for babies under 12 months, the recommended sodium intake is less than 400 mg per day, which includes sodium from both breastmilk/formula and solid foods. Considering that breastmilk and formula contain around 200 mg of sodium per 24 oz., babies should only be consuming about 200 mg of sodium through solid food daily.

The reason for this recommended intake level is that we assume that babies’ kidneys are still very immature and may not be able to process large amounts of salt properly. While there isn’t enough research to definitively say that 400 mg is the maximum safe level for babies under 1 year old, it’s best to stick to this limit until more data is available. Exceeding this could potentially increase the risk of health issues, so erring on the side of caution is recommended.

 

SALT VS. SODIUM

Salt and sodium are often used interchangeably, and you may see both terms on food labels. However, table salt is actually composed of 40% sodium and 60% chloride.

1 teaspoon of salt = 2300 mg sodium 

1 gram of sodium = 2.5 grams of salt 

Both sodium and chloride are essential electrolytes (along with potassium) and play vital roles in the body. They help transmit nerve signals, enable muscles contractions,  regulate fluids balance, enhance nutrient absorption, maintain acid-base balance, support potassium absorption, and control stomach bacteria levels.

 

SALT IN FOODS

Salt is found in almost all store-bought, processed, or packaged foods. It acts as a preservative and enhances flavor, so food manufactures often add it deliberately. Common foods that contain salt include:

  • Processed meats like deli meats, bacon, hotdogs, ham, and sausages
  • Frozen foods like fish sticks, chicken nuggets, and frozen meals.
  • Potato chips
  • Crackers
  • Canned soups
  • Gravy
  • Broths (vegetables, chicken, beef)
  • Olives, pickles, pickled vegetables (Kimchi)
  • Soy sauce

Other foods that are high in sodium, even though they may not taste very salty, include:

  • Cheese and other dairy products like yogurt and milk
  • Bread, bagels, English muffins, tortillas, and other bread products
  • Canned tomato and pasta sauce
  • Canned vegetables
  • Canned beans
  • Boxed cereal

*Fresh Milk  contains about 100 mg sodium per cup. This is one reason why milk is not recommended as the main drink for babies under one year old. However, a small amount of milk in cereal or baked goods is fine, so there’s no need to eliminate it completely.

 

WHAT SHOULD YOU DO?

As shown in the picture above, sodium is naturally present in many foods and is often added to processed foods. It’s found in nearly everything we eat. So do you need to completely eliminate salt from your baby’s solid foods?

AT HOME

When cooking meals for your family, you can hold off on adding salt until after you’ve taken out your baby’s portion. For example, when if you’re making a stir-fry, take out a small portion for your baby before adding soy sauce to the rest of the dish.

It’s important not to add salt to anything you prepare from scratch, even if you think it tastes bland. What may seem bland to you could be perfectly flavorful for your baby.  Instead of salt,. try using herbs and spices as to enhance the flavor.

During the first few months of eating, it’s very unlikely that a baby will consume a large amount of sodium, especially if you’re mindful of the foods you provide. Since babies don’t eat that much in the beginning, it’s difficult for them to take in  lot of sodium. Additionally, if your baby is self-feeding, it can take time for them to actually ingest a significant amount of food!

As you baby gets older and starts sharing more family-style meals, you’ll need to be more aware of their sodium intake, as hidden sodium can be found in many foods!

AT RESTAURANT

Restaurant foods tend to be much saltier than what you would make at home, and it’s hard to know exactly how much sodium is in a dish. Even if the nutritional information is available, chefs often add salt as they see fit, regardless of the recipe. Here’s how you can approach dining out with your baby.

Generally, I recommend not stressing too much about it. As long as you aren’t eating at a restaurant daily or multiple times a day, it will balance out. Try ordering dishes that are typically prepared with less salt, and don’t hesitate to ask the waiter’s or chef for suggestions.

If your baby isn’t eating much yet, or if they tend to eat small portions, you should be fine. However, if your baby has a good appetite, consider bringing some low-sodium food for home. Personally, I find that I can usually make do with what’s on the menu, and I want my child to experience a variety of flavors. But if you’re unsure, bringing your own is always a good backup.

The key is to be mindful and balance things over the next few days. For example, if one day your baby eat a a lot of cheese and bread, you can focus on offering low or no sodium foods the next day. If they eat a meal at a restaurant, you might serve fruit and a homemade muffin for their next snack.

Pick your battles and make the best choices you can. If you only eat out once or twice a week, just adjust your baby’s food choices for the rest of the week! Keep it truly balanced while continually striving to plan ahead.

 

BOTTOM LINE

Do your best to serve homemade meals whenever possible. Read labels and be mindful of what you and your baby are eating. This is a healthy habit for the entire family.

What you feed your child today helps shape their taste preferences for the future.