Monday, November 23, 2015

Autism & High Prevalence of GI Problems

Dear Melissa,
My 5 year old grandson has Autism, and he has a lot of trouble with constipation. Is this common in the children you treat?

YES! One of the problems with Autism that is not often discussed are chronic issues with the gastrointestinal (GI) system. Constipation, abdominal pain, difficulty toilet training, and severely picky eating are some of the troubles that I see most commonly. When you add in the facts that many children with Autism have low or poor verbal skills AND the fact that many of them have decreased sensitivities to pain, my patients are often in real GI distress before their caregivers realize that there is a problem.

I researched this topic heavily this week so that we could find some real numbers and answers to the topic of Autism and constipation. So lets get started!
Autism & High Prevalence of GI Problems
A large meta-analysis study published from Emory University in 2014 looked at previous research on the topic of Autism and gastrointestinal disorders. This study found that individuals with Autism Spectrum Disorder had a greater than 3-fold prevalence of diarrhea and constipation, greater than 2-fold prevalence of abdominal pain, and greater than 5-fold prevalence of “general gastrointestinal concerns” compared to the control population.

When you add food sensitivities into the mix, Virginia Chaidez and fellow researchers at the UC Davis MIND Institute found that individuals with Autism are six-to-eight times more likely to have GI issues than children who are developing typically. In contrast, they found that children with other developmental delays had only a five times more likely to exhibit various GI concerns.

There are 2 different theories as to why children on the Autism Spectrum tend to have higher rates of constipation and other forms of GI distress:
1. Behavioral: Individuals with Autism are often prone to sub-optimal diets to say the least. Between defensiveness toward taste, smell, and texture, as well as ritualistic behaviors surrounding foods, many people on the Autism Spectrum have extremely limited diets that are generally high in simple carbohydrates, and low in fruits and vegetables. This combined with often having defensiveness surrounding toileting, can be a recipe for chronic constipation.
2. Biological: Preliminary research has also provided some support for such biological factors as altered flora of intestinal microbes, altered patterns of intestinal contractions, food allergies, and gastroesophageal reflux disease. 

Why do we care?
Besides generally wanting to know when our kiddos are not feeling well, why do we care so much that people with Autism have such a high incidence of GI problems? Well…children with Autism often present with “problem behaviors”. Quite frankly, children are often referred to me as an occupational therapist for these negative behaviors long before they are sent to a neuropsychologist for a diagnosis of Autism. But think about it, when your stomach hurts, you generally have poor attention, are irritable, and don’t want to work. Sound familiar? 

Many of my “cranky kids” have negative behaviors that are greatly exasperated by medical causes such as GI distress. Individuals with more severe forms of Autism might also be more likely to engage in self-injury or aggression at times of GI distress as well. AND…When you have low verbal skills, how else do you let those around you that you are in pain?! 

Chaidez's UC-Davis GI Study also found that parents who reported that their child with Autism had abdominal pain, gaseousness/bloating, constipation, and diarrhea also reported significantly more incidences of irritability, social withdrawal, repetitive behavior, and hyperactivity than did those without GI symptoms. As a pediatric occupational therapist dealing with kiddos who have negative behaviors, I always like to rule out medical causes for these negative behaviors such as difficulties with sleep, allergies, or GI distress in combination with my behavioral interventions.

How do you treat it?
If you have concerns that your child has chronic constipation, you should discuss this with your pediatrician, especially if your child is on the Autism Spectrum. While diet modifications alone would be optimal, they are not often effective enough for children with more severe chronic constipation, nor are they practical for children with severe food defensiveness. The recommendations for primary care physicians and pediatricians regarding children with ASD and constipation involve a very complicated algorithm involving medication, diet assessment, behavior therapy, abdominal exam, x-rays, etc, etc., etc. 

Bottom line...chronic constipation in children with ASD is complicated and needs professional help. Don’t hesitate to talk to your child’s pediatrician, and request a pediatric gastrointestinal specialist if you don’t see relief.

Do you have a question you would like me to address? 
Please don't hesitate to share:

If this week's blog didn't answer your questions thoroughly enough, feel free to delve into the matter further with the links below.
Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report, Pediatrics (Jan 2010) 
Children with Autism Spectrum Disorder May Have Increased Rates of Gastrointestinal Symptoms, Jill Jin, News@JAMA, Journal of the American Medical Association (April 2014)
Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis, McElhanon et al, Pediatrics (April 2014)
Children who have autism farm more likely to have tummy troublesVirginia Chaidez, et al., UC Davis Health System (November 2013), summarized in the UC Davis News (2013)

Monday, November 16, 2015

Inexpensive Sensory Toy Ideas

Dear Melissa,
Do you have any sensory toy ideas for things that are a bit more affordable?

OF COURSE! Some of the best sensory toys are some of the cheapest. Many are even found in the dollar section of your local Wal-Mart or Target store. Others can be found on Amazon. And yes, these are TOYS, not “therapy equipment” so they are fun for everyone, whether you have sensory processing disorder or not. (And really, don’t we all have a some degree of SPD at times??? I know I do!) Most of my picks below are in the $5 and under range and NOTHING is over $10. I will admit, I tried to limit myself to 10 items. However, I found so many great items that I had to finally stop myself at 12. This proves that you don’t need to break the bank to find some fantastic sensory toys!
Inexpensive Sensory Toy Ideas
1. Koosh balls: The classic. Enough said. 
2. Chew necklaces: OK, so this one is a bit more “therapy” than toy. But I know I personally am lost if I am not wearing a sturdy necklace to fidget with throughout the day. I specifically chose the chew necklaces below because they looked more “fun” rather than “therapeutic”. The idea is that the kiddo just gets a cool necklace in his stocking, and doesn’t realize that it is purposefully meant to be sturdy enough for fidgeting and chewing. Pick a shark tooth, kitty cat, dog tags, Legos…whatever floats your child’s boat! Simply search for “chew necklaces” on Amazon and find what your child will LOVE!
3. Slinky: This has quickly become a favorite in my sensory box at work. And I found mine in the dollar section at Target!
4. Silly putty or Theraputty (Amazon): Take this squishy goodness and add beads or pennies to create “hidden treasures”!

5. Water Wiggles: I love how kiddos gravitate toward these squishy things!
6. Water timers: The great thing about these little gems is that they can be used to help with timing brushing, etc, as well as being visually stim-a-rific!
7. Light up toys: This is another favorite in my sensory box. They also often come in a variety of cartoon characters and are often found in the dollar section at Target and Toys-R-Us.
8. Wind up toys: Yes, these wind up toys tend to be fragile, but they also work on fine motor skills as well. Win, Win!
9. Pin Art boards: These can be prickly or soft, depending on how you touch them. Double fun!
10. Etch-a-sketch: OK, I know this is a bit “old school” but my son just got one of these, and it has turned into hours of fun! It is the ultimate fidget toy between the twisty knobs and then shaking for erasing. Bonus? Our ½ sized Etch-a-sketch fits nicely in my purse so it works perfectly for restaurants and road trips.
11. Pop tubes: I will admit it. I don’t get the appeal of these guys. But my sensory kiddos just gravitate toward them! And, at a couple bucks a piece, I don’t really have to understand it!
12. Glitter wand tubes: These water and glitter filled tubes are definitely stim-a-rific. In our family they also double for pretend play as we regularly switch from fairy godmothers to Harry Potter characters. The fun is endless!
Disclaimer: The pictures above are simply examples. In this post I'm not reviewing the quality of actual brands. Feel free to read reviews and choose similar or alternate items. All product images in this post are those shared by

For ideas for larger toys, checkout my Post on Christmas Gift Ideas for Children with Autism

Do you have a question you would like me to address? 
Please don't hesitate to share:

Monday, November 9, 2015

Christmas Gift Ideas for Children with Autism

Dear Melissa,
Christmas is approaching. Do you have any FUN sensory toy ideas for my 4 year old grandson with Autism?

I love the Holiday Season! Eleven months of the year, I try to make my recommendations to parents as cheap as possible. I love to try to “make due”, get creative, and make equipment with what people might already have on hand. But…when Christmas or a Birthday is approaching, I love to share ideas about sensory therapy toys that may be a little pricy to purchase “just because”, but may be worth splurging on if wrapped up with a shiny bow.  

The items I have recommended are NOT “therapy equipment”. They are TOYS! Yes, each and every one serves a specific therapeutic purpose. However, each of the items was selected because they are simply FUN! Whether your child has sensory processing difficulties or not, many children would love receiving the items below under the tree!

Christmas Gift Ideas for Children with Autism
I have taken a Twelve days of Christmas approach in recommending the 12 items below. 

1. A Mini Trampoline ($50)  
A mini trampoline is my #1 go-to for sensory input.  They can slide under a bed perfectly, so they don’t take up much space and are WAY less dangerous than a standard trampoline. (I do not recommend standard trampolines. Even with nets and other safety precautions, they just are not safe for the little sensory seeker!)
2. Tent ($30)  
Throw in a few old pillows, bean bags, or blankets and you have the perfect “positive time out” space. Tents can be fantastic for calming. They are great for pretend play, and combine with a bucket of fidget toys and your child with have the ultimate calming retreat. 
3. Hippity hop ($25) 
I love these things!  Kids can gain some strong vestibular and proprioceptive input from bouncing on hippity hop balls. In addition, it provides strong exercise which helps with attention to task as well as provides a good cardio workout. 
4. Scooter board ($20)  
Find a hallway, grab some empty 2 liter bottles and go kiddo bowling with a scooter board! Whether sitting on the board or laying on their tummies on the board, kids again can gain a great cardio workout as well as gain sensory input from one relatively inexpensive item. 
5. Body sock ($40)  
Kids love the compression from a body sock's stretchy fabric! It can be used passively while snuggling up and watching a movie, or can be used more actively around the house while pretending to be monsters. 
6. Vibrating animal massager ($10)  
I will be honest, my son asks for one of these every time we see one. Kids tend to either gravitate toward or avoid vibration greatly. If your youngster is one who loves to put his hand on the clothes dryer or chew on a vibrating toothbrush, then a vibrating animal massager is a must have gift! 
7. Gel water scene ($40)  
Ok, ok. This is one that I had given to me, handmade, by a loving intern. She used hair gel and a zip lock baggie. And my homemade one IS super cool, but as someone who is obsessed with sea creatures…this one is WAY cool! Let your future creature-explorer enjoy this gel water scene with its captivating sensory world. It also works as a wonderfully quiet hand fidget. 
8. Doorway Swings ($230 each) 
The doorway swing pictured comes with the doorway bar, sling swing, and trapeze bar. It is listed as appropriate for ages 3-10 years of age.

9. Crash Pads ($175 each)  
This crash pad is huge at 5 feet x 5 feet and is perfect for jumping, crashing, cuddling, and even napping. Perfect for the little “crasher” in your life who may not be safe with a mini trampoline. 
10. Hammock  ($150)  
OK, so I don’t really think of hammocks in the winter either, but you will be glad you have it come spring. Even better that you can crawl in the hammock with your little one and enjoy a good snuggle together! 

11. Bubble light tube ($110)  
At Children's Therapy TEAM our bubble light tube is probably the most popular items in the clinic! The one I have linked to is a large 3ft floor model, but you can gain similar effects with much cheaper lava lamps. Fantastic for calming your wound up child! 

12. Office Chair ($125)
This may seem like an odd choice, but spinning provides strong vestibular input that so many children crave, and it also provides a comfy place for you to get work done too. Win, Win! The prices are really all over the place for an office chair, the one pictured is just an example, but you definitely want one with arms. Feel free to hunt around for the one that looks best to you. 

As a disclaimer, I provided a rough price, website link, and picture for each item above. These are simply examples and generally not actual brands of items that I have tried. Feel free to read the reviews and choose similar or alternate items. In this post, all the product links I have provided are from All product images in this post are those shared by

Monday, November 2, 2015

Flu Shot vs Nasal Spray Mist

Dear Melissa, 
I know you advocate the importance of getting the flu shot, but should I give my 2 year old son the Flu mist nasal spray or the traditional flu shot?


Flu Shot vs Nasal Spray Mist

Thanks for the question! This is something many parents will have to consider soon. The decision between a flu shot and the nasal spray is something that varies from person to person and should be discussed with your family physician. Personally, my kiddos are terrified of shots (like most kids). Therefore, I make sure to track down the sometimes elusive vaccination nasal spray to make the process much less stressful. Whichever you choose, there are pros and cons to consider.

Considerations according to R. Morgan Griffen 
(WebMD writer reviewed by Jennifer Robinson, MD)
Pros and Cons of the Flu Shot 
The shot involves an injection into the upper arm with a vaccination containing a dead virus. (1)
PROs: Can be given to a wide range of individuals, beginning at age 6 months and in my experience is easier to obtain than the Nasal Spray Mist.
CONs: Many people don’t like shots. The most common side effect is soreness at the injection site. Much less common reactions include a mild fever and achiness. (1)

Pros and Cons of the Nasal Mist 
This vaccine is sprayed into the nose. It is made from a live virus that has been weakened and can NOT cause the flu.(1)
PROs: Does not involve an injection. In addition, the CDC reports that the FluMist might actually provide better protection than the traditional shots for children ages 2-8.
CONs: Possible side effects include: slightly stronger flu-like symptoms than the shot, such as runny nose, headache, sore throat or cough. In children, side effects can also include wheezing, vomiting, fever, and muscle aches. The mist can only be given to individuals between the ages of 2 and 49 years who are generally healthy and not pregnant.(1) In addition, young children need to be able to breathe in through their nose on command in order to take the dose. In my experience, it is good to “practice” this with young children before entering the doctor’s office.

Other thoughts to consider:
As I noted before, it has been my practical experience that the flu shot is easier to obtain. Many chain pharmacies, as well as local pharmacies, offer flu shots. In addition, many employers provide flu shots. It literally can take less than 5 minutes of your time to save yourself the risk of a week in bed. On the other hand, last year I had to call several different clinics to find one who had the Mist in stock. Then I had to make an appointment and wait in the waiting room in order to obtain the Mist for my daughter and myself. But again, much better to deal with this at my convenience than a week sick in bed for either me or my daughter.

U.S. Center for Disease Control Recommendations:
Children receiving the flu vaccination for the first time will need TWO doses. Children, ages 6 months through 8 years, who need two doses of the vaccine should receive the first dose as soon as possible to allow time to get the second dose before the start of flu season. The two doses should be given at least four weeks apart. (Again, my personal recommendation is to talk to your physician.)
The CDC recommends “All persons aged 6 months and older are recommended for annual vaccination (against the flu) with rare exception." Those exceptions include individuals who:
1) Have had Guillain-Barré Syndrome OR
2) Are allergic to any components of the vaccine (such as egg)(3)

Those in particular who should receive the flu vaccination include the following:
1) Children aged 6 months to 18 years
2) Adults 50 years and older
3) People with chronic illness
4)Women who are pregnant during flu season
5) Health-care workers
6) Caregivers/family members for individuals younger than 5 years or older than 50 years
7) Caregivers for infants younger than 6 months of age (due to the inability for young infants to be vaccinated themselves).(2)

We mamas don’t have time for the flu! We don't want our children to be miserable in bed for a week, nor do we want to spend the following week sick ourselves because our child gave us the flu. So, don't just vaccinate your child, but vaccinate yourself, your spouse, and anyone else you can coerce into getting the vaccination as well. Yes, I can give you all of the scary statistics on how dangerous and even deadly the flu can be, but you can find these in last year’s blog, Flu Shot is a Sure Shot.

Want more information? Check out the resources below:
1. Flu Shot or Nasal Spray? R. Morgan Griffen, WebMD, July 16, 2015
2. Vaccination: Who Should Do It, Who Should Take Precautions, Center for Disease Control and Prevention
3. What you should know for the 2015-2016 Influenza Season, Center for Disease Control and Prevention

Monday, October 26, 2015

Healthy Classroom Snacks

Dear Melissa,
Do you have any ideas for “healthier” snacks for me to send to my daughter’s preschool?

I have to say, I VERY MUCH DISLIKE it when my daughter comes home from Pre-K, and says that she had two different cookie snacks at school that day.  And this, at a school that tells parents not to bring in sugary snacks for birthday treats!  With Halloween coming up, I do NOT want to overload our kiddos with candy.  As an OT who often sees these kiddos in the afternoon, and as a mama who then needs to settle her own kiddos down for an evening of homework and bath time, please let’s stop the sugar overload!

Now I know there is MUCH debate as to what is the healthiest diet for kids as well as adults.  However, I think that we would all agree that the list below is healthier than a standard sugar cookie.  AND, I am not a crafty, Pinterest queen.  The following snacks were chosen because they are a good balance between cute/fun, as well as easy for busy moms to pick up and prepare for your child’s party the next day. 

Grab and Go Snacks:  Lets face it, sometimes you totally forget that it is your child’s turn to bring snacks until that morning.  The following are fun & healthy treats that can be picked up on the way to school.
  • Veggie sticks & Hummus
  • Apple slices and nut butter
  • “Frozen Forest” Broccoli and Cauliflower “trees” with Ranch dressing “snow”.  (Hey, its all in how you sell it!)
  • Cheese sticks/string cheese
  • Wheat crackers and cheese slices
  • Popcorn
IMG_7215(1)Un-fail-able Make Ahead Snacks: These are NOT the type of cutesy snacks that require a frosting bag and glue gun.  Each of these are so easy that my 4 and 7 year old kiddos even help me with them.  Added bonus? They can be modified for Halloween parties or standard classroom snacks.

String cheese faces Simply use a Sharpie marker to draw silly faces on the package of string cheese.  You can make them look like ghosts or just a silly face.
Cutie orange faces – Again, simply use a Sharpie to draw silly faces on a cutie orange.  You can make them look like jack-o-lanterns or just a silly face.  Apparently the one my daughter drew was “Elsa”. (A very loose interpretation!) 

Trail mix – have your little one help you mix up individual baggies containing pretzels, dry cereal, chewy dried fruit such as Craisins (dried cranberries) or raisins, crunchy dried fruit such as banana chips and freeze dried strawberries, and nuts (if there are no allergies).  You can even throw in a few mini marshmallows if your child craves a bit of extra sweetness.IMG_7210(1) 

Fruit cup faces – See a theme here?  Once again, take a Sharpie and draw either a jack-o-lantern or silly face on top of the fruit cups.

Kid Chefs!  My daughter’s pre-K strongly encourages classroom “cooking”. They love it when we bring in the ingredients, and the kids get to be the chefs. As an OT, I love how getting kids to “cook” encourages them to try new foods, as well as encourages fine motor skills.
  • Banana Wheels: The kids can slice bananas with a butter knife, and spread nut butter on the top of each wheel.
  • Ants on a log: Kids can spread nut butter into celery sticks and add the “ant” raisins.
  • Cheese sandwiches: Easy assembly – bread, sliced cheese, done!
  • Nut butter sandwiches: Again, the children can practice their fine motor skills by spreading nut butter to slices of bread and folding.
  • Fruit Kabobs: The kids can wash and pick the grapes, slice bananas, cube (already peeled) melons, etc, then string the fruit onto BBQ skewers. Again, multiple fine motor tasks in one yummy treat!
What snacks do you like to send to your child’s school?  Please share your faves here!

Monday, October 19, 2015

Perspectives on Sippy Cups

Dear Melissa,
My son just turned 6 months old. When should I start thinking about introducing a sippy cup?

Ahhh, the great sippy cup debate.  What, you didn’t realize that sippy cups are controversial?  Well actually, they are!  And what makes this even more tricky is that each slightly conflicting view has very real and valid arguments. So, to help tease out the pros and cons of sippy cup use, I sought the advice of fellow speech-language pathologists here at Children’s Therapy TEAM, Dr. Karen Green, DDS from Pediatric Dental Associates in Fayetteville, Arkansas, and online with the American Academy of Pediatrics.   

Pediatric Dentist Perspective (Dr. Karen Green, DDS) 
The American Academy of Pediatric Dentistry recommends transitioning away from the bottle/breast when the infant is 1 year old. The reason behind this is that the child can develop severe early childhood caries (formerly known as baby bottle tooth decay).  A child who nurses on demand or is allowed to carry a cup of milk/formula around to suck on throughout the day is much more likely to develop these cavities. Milk (breast, cow, or soy) contains sugars. These are fermentable carbohydrates that are digested by oral bacteria into acids that can lead to enamel breakdown and eventually cavities. In addition, if the child uses the sippy cup like a pacifier, it can lead to tipping of the teeth (teeth shifting forward or backward).

Sippy cups are great for learning to transition to a cup, but their use should be limited to the learning period. Once the child has the ability to use an open cup, the sippy cup should be discontinued. A cup with a lid and a straw is a good option to keep sugary liquids off of the top front teeth, but note that these liquids will still remain on the back teeth. I don’t see any reason straws should be discouraged, unless the child develops a bad habit of chewing on the straws.

In addition, juice should be limited to no more than 4-6 ounces per day. Only allow milk or juice in the cup/sippy cup at mealtimes.  Between meals, only water should be given, and NEVER put your child to bed with milk or juice. I would also advice against giving sodas/sweet tea to children in general as this is added and unnecessary sugar that can be avoided, and it should definitely never be put in a sippy cup or bottle. 

Pediatric Physician Perspective (American Academy of Pediatrics) 
The American Academy of Pediatrics recommends breastfeeding as the sole source of nutrition for your baby in the first 6 months. Once solid foods are introduced, it is recommended to continue breastfeeding until at least 12 months. Breastfeeding  can continue after 12 months if both the mother and the baby desire. For those infants that are bottle-fed, the recommendation is that bottles should be phased out between 12-24 months of age. When weaning from either breastfeeding or bottle, the AAP recommends using a sippy cup to transition. This transition to an open cup should occur as quickly as possible, preferably before 2 years of age. The AAP also cautions against “grazing” on milk, juice, sodas, or any beverages other than water, as it can lead to tooth decay.  

Pediatric Speech-Language Pathologist Perspective (Connie Clark & Amy Love-Smith) 
We agree that infants should be weaned from the bottle/breast at around 1 year of age, but not necessarily to a sippy cup. Quite frankly, sippy cups are simply a tool to keep kitchen floors clean from spilled milk rather than a necessary developmental milestone. We feel that around 12 months of age, a child would preferably be transitioned from the bottle/breast to a cup with a straw or an open cup. A cup with a straw promotes more mature lip closure and tongue retraction, whereas a sippy cup continues to promote the immature sucking pattern associated with a bottle. We also agree that cups should primarily contain water between meals with milk being reserved for meal-times. Drinking milk and juice between meals leads children to fill their caloric intake with liquids; therefore, they are not hungry for actual food at mealtimes. This can cause food battles and “picky eating” that would not normally be an issue for many children.  

Pediatric Occupational Therapist Perspective (Melissa Foster) 
I have a slightly different slant on the whole sippy cup issue. Personally, I like to introduce sippy cups a bit earlier, at around 6 months of age. In my practice (primarily with children with Sensory Processing Disorder), I find that many children become dependent on drinking from only a bottle or nursing from the breast, and are resistant to the change of drinking from a cup. The closer the child gets to 12 months, the more stubborn he can be! SO, whether it is from a sippy cup, open cup, straw cup, or simply taking sips from a straw held from Mom’s glass of ice water, I prefer for infants to begin being exposed to different vessels early. Now, I realize that this is earlier than others recommend. This is why I think it is perfectly fine to put formula or expressed breast milk in these various containers for purely experimentation sake so that the infant can learn that nutrition can come from many different sources. 

Furthermore, in keeping with the sentiment of dentists, physicians, and speech-language pathologists, I agree that milk, juice, etc. should be reserved for scheduled meal/snack times. (And soda should NEVER be used in a sippy cup or bottle!)  Water should be the only allowed drink between meals to prevent “grazing”. This creates the hunger drive necessary for the child to be a more adventurous and successful eater during mealtimes and will reduce the likelihood of the child becoming a “picky eater”.

As I warned, the recommendations differ slightly as to when to wean, and what the recommended next step is.  In studying the literature carefully, it seems that the only consensus is to stick with milk and water, and eliminate or significantly reduce any other beverages. As with all things in life, I really think this is a time to know your child, know your family, and know what your concerns are for your particular child. In my opinion, the bottom line is do what you can to try to minimize cavities and to use the sippy cup only as a short-term transition tool geared towards teaching the child how to drink from a 'standard' cup. 

Resources: (accessed August-October 2015)   
Pediatric Dental Associates, Fayetteville, AR 
What to Expect: Introducing a Sippy Cup
From baby bottle to cup: Choose training cups carefully and use them temporarily, American Dental Association 
Get It Done in Year One, American Academy of Pediatric Dentistry  
Weaning Your Baby, American Academy of Pediatrics 
AAP Reaffirms Breastfeeding Guidelines, American Academy of Pediatrics 
Discontinuing the Bottle, American Academy of Pediatrics
What Kids Should Drink. Melissa Foster, Children's Therapy TEAM Blog

Monday, October 12, 2015

What kids should drink.

Credit: Envato Images

Dear Melissa,
I hear a lot of debate amongst my mama friends about kids drinking milk, 100% juice or water. They all seem to have opinions as to what is best. What are your thoughts?
Only Water and Milk. Some of each every day. Wow! That was easy! Now, off to read a book on the patio! Oh, wait, my editor probably would not appreciate a blog that is only 9 words long. So, let's visit the literature. First according to the Nemours Children's Health Foundation (, the current beverage recommendations for milk for children are as follows:
  • Kids ages 2 to 3 should drink 2 cups (480 milliliters) every day.
  • Kids 4 through 8 should have 2½ cups (600 milliliters) per day.
  • Kids 9 and older should have 3 cups (720 milliliters) per day.
In addition the American Academy of Pediatrics states that boys and girls aged 9-18 years old should be drinking the equivalent of 4 ½ glasses per milk (or servings of milk products) per day, but that little more than half of teens report drinking milk daily. And this, at such a crucial time when calcium is imperative for building strength for growing bones.

When kids drink too much juice, juice drinks, sports drinks, and soda, these beverages can crowd out the milk they need. Sugary drinks also can pile on the calories which contribute to weight gain. 

As for water, the Academy of Nutrition and Dietetics reports that the daily amount of water that a child or teen needs will depend on factors such as age, weight and gender. Other factors such as air temperature, humidity, a person's activity level and his or her overall health affect daily water requirements, too.  So, what are some rough estimates on how much water your kiddo needs? 
  • Kids ages 4-8 years need approximately 6-7 cups per day
  • Kids ages 9-13 years need 7-8 cups per day
  • Kids ages 14-18 years need 8-11 total cups of water per day.
This may seem like a lot, but keep in mind the numbers listed above are for total water, which includes tap water, water from other beverages, and water from solid foods such as fruits and vegetables. 

The Academy of Nutrition and Dietetics also stresses the importance of children (and adults!) keeping hydrated during physical activity. Pay close attention to your child to make sure that he drinks plenty of water before, during, and after physical activity, especially during hot weather. The goal is to drink ½ to 2 cups of water every 15-20 minutes while exercising. Furthermore, the American Academy of Pediatrics states that water (not sports drinks) should be the primary method of hydration for children. 

So, if both milk and water are good, then when should you give your child which? Does it matter? Actually it does matter!  In my work with many “picky eaters” as well as attending many advanced courses on this subject;
milk or other caloric beverages between meals often sabotages a child’s hunger drive for good, healthy foods and leads to negative eating habits. Milk should be given in the appropriate amounts listed, but only at scheduled meal and snack times, and not constantly in the sippy cup between meals. Only water should be allowed between meals.  Save the milk (and the occasional juice) for meal times. In addition, Dr. Karen Green, DDS, also stresses the importance of only drinking water between meals to help reduce the incidence of cavities.

Other important beverage facts from the American Academy of Pediatrics:
  • Soft drink consumption is associated with negative behaviors in 5 year old children.
  • Sports drinks and sodas contain extra calories that children don’t need and could contribute to obesity and tooth decay. 
  • Fruit juice offers NO nutritional value over whole fruits and children 1-6 years old should be limited to 4-6 ounces of juice per day.
  •  Fruit juice (even 100% juice!) should not be given to children under 6 months of age unless directed by the pediatrician. 
  • Children (and adults) who drink water containing fluoride are less likely to get cavities. (American Dental Association). 
  • Avoid drinking caffeinated beverages (sodas, iced tea) for hydration. Caffeine is a diuretic, meaning the child might have to urinate more, causing him to lose more fluid and become dehydrated even more quickly.
This was a research heavy blog! If you want the full scoop, please check out these resources/articles below. 
Healthy Drinks for Kids, American Academy of Pediatrics (accessed August 2015)
Snacks, Sweetened Beverages, Added Sugars and Schools, (Feb 23, 2015)
Where We Stand on Fruit Juice, American Academy of Pediatrics (accessed August 2015)
Flouride Supplements, American Dental Association (accessed August 2015)
Calcium: The Teen Bone Builder, American Academy of Pediatrics (accessed August 2015)
How to Hydrate your Active Child, WebMD (accessed August 2015)
Water: How much do kids need?, Academy of Nutrition and Dietetics (accessed August 2015)
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