Nutrition

Dr. Chheda – A little bragging about myself – I have been named one of the top docs in Atlanta yet again! This is a nomination that comes from fellow doctors that recognize doctors in the area. So my fellow physicians in Atlanta have recognized me as one of the top pediatricians in the Atlanta area. Yay! So if you’re looking for a pediatrician who will take the time to listen to you, to hear you out, to give you advice, who incorporates integrative, holistic care into their treatment plan, who tries to prevent disease rather than treat it – if that’s the kind of pediatrics that you’re looking for, check me out. HarmonyPeds.com – I’m Doctor Shafali Chheda. Transcriptions from AI and may not be 100% accurate

Dr. Chheda – Yay, your child’s first tooth came in! Now what? Well, in the beginning it’s okay to just take a washcloth with a little bit of water and just kind of wipe the tooth. You want to make sure that there’s no food, especially milk, sitting on the teeth all night long. This will help prevent cavities.

As soon as more teeth start coming in, you do want to introduce a soft brush, a toothbrush. You can use a finger toothbrush, you can use a washcloth, you can also use your own finger and put some fluoride on the teeth at nighttime.

The goal is not brushing for two minutes. The goal is to make sure the fluoride is on the tooth. So you can take your finger and just smear a little bit of fluoride, and you want just a little smear. You know, less than the size of a rice grain – that’s how much fluoride you should be using for all the teeth in the mouth until your child is about 2 years old.

After the age of 2, then you want to start using a pea-size amount, so the size of a small green pea, twice a day. Brush the teeth, and that should be enough to help prevent cavities.

“Hey, you got time for lunch today?” “Yeah sure, what time?” “About 1:15-ish.” “Well I have a doctor’s appointment for my daughter at 1.” “Oh, sounds perfect – you said one, so push it to 1:30?” “It’s gonna be pretty hard. Our doctor actually spends a full hour with us.”

“An hour WITH your doctor or waiting FOR your doctor?” “No, an hour WITH the doctor. Really.” “What? Are you guys related or something?” “No, we go to a DPC practice.”

“What’s DPC?” “Direct primary care – kind of like concierge medicine where we are the doctor’s priority. It’s not about how many patients you see a day, but how long you spend with each patient, caring for that patient.”

“Wow, that’s interesting. I’ll have to get her information.” “Absolutely! Give us a call: 770-475-9924.”

Dr. Chheda – What is folic acid? There’s been a lot of talk recently about folic acid and how it might help kids who have autism. So folic acid is vitamin B9. It is one of the B vitamins. Typically we eat foods that contain a lot of B vitamins, or you might even take a B supplement. And then the body has to convert folic acid into methylfolate. Once it’s converted, then it can penetrate the brain, and it is important for neural development.

Moms, when you were pregnant, you were told to take folic acid either in your prenatal vitamin or as an extra supplement to help with brain development. That is what vitamin B9 does. That’s what folic acid does. But your body has to convert it into the proper form.

Now if you’re missing the enzyme to convert it, then it’s not gonna do anything. So sometimes it’s better just to take the form that is already converted, and that’s called methylfolate. Once you take methylfolate, or once your child takes methylfolate, then it can actually penetrate the brain and help with neural development. That is how it is helping some kids on the spectrum. They may not have the enzyme to convert it. They may not be eating enough vitamin B9 containing foods because of their restricted diet. So you give them a methylfolate supplement, and that should be sufficient to help with neural development. And once neurons develop properly, then their full development can proceed and progress.

And this is true for everybody, not just kids on the spectrum. Everybody should be taking some methylfolate if you don’t have the enzyme to convert folic acid into methylfolate. If you have the enzyme, just eat a lot of folic acid containing foods like broccoli and kidney beans.

Dr. Chheda – What do you do when you as the caregiver fall sick or get injured? I sprained my ankle this morning, and the whole morning routine of the house went into chaos because I’m the one that does most of the caregiving. And so what do you do at that point? Everybody’s upset, the routine’s upset, you’re upset, things aren’t going the way you want it to go. There is no good time to be sick.

So what do you do when that happens and you are the caregiver who’s gonna take care of everybody? First, give yourself some grace. The human body will fall ill at some point. You will injure yourself. It’s okay. Yes, it seems like it’s never a good time to be sick. Appreciate those days when you’re feeling great and healthy, but give yourself some grace when you are sick.

Ask for help. It is perfectly fine to ask for help, and it’s perfectly fine for things to fall out of routine until you can get a new routine back. There is no easy answer. The human body heals on its own schedule. You can’t speed it up. If something hurts, if there’s something swollen, it is going to take at least 48 to 72 hours before the body can control it and the swelling gets better. If you run a fever, it may take five days because that’s just the way the body works.

So take a deep breath. It’s gonna be okay. And then get well and incorporate lots of wellness into your routine so that you can heal faster the next time it happens.

A common question we get in pediatrics is, when can my baby start solids?

Absolutely! As a breastfeeding mom, I was so eager – I mean, that was a long time ago now, but 10, 11 years ago – I was so eager to find out, “Hey, when can I feed this baby something so I can take a break and eat?”

Sure! And so you can actually start at 4 months of age. If your baby is breastfeeding, gaining good weight and you have plenty of it, you can wait until six months. But typically the recommendation is to start right at four months.

And most people will start with pureed foods, but there also is something called baby-led weaning. Yes, which is more of a new phase. It is a little bit newer, and I think it’s one of those things that if it works for your baby, it works, and if it doesn’t, kind of maybe then that’s okay. It is okay!

You can do the purees and kind of start slow. Typically it’s one or two meals a day, and then by nine months they’re then getting three meals a day.

And when you start with your purees, of course you always want to start with like your rice cereals or your oatmeal or something like that. But once they have tolerated that well, I know myself I was giving my children – I was not like – everything! They were eating everything! Like we had the little baby blender, and I would, you know, just add a little breast milk to it, puree down chicken, rice. That’s right! Salmon like… Don’t limit them! They want to eat what you eat!

That’s right! And then also with a lot of people in the past used to hold off on the common allergens. We actually recommend now that you do give them a little bit of peanut butter earlier, a little bit of scrambled egg, something like that, once they’ve started and have tolerated solid foods. And that way, hopefully it reduces the risk of them getting allergies down the line. Absolutely!

Dr. Chheda – 🧬 You may have heard a lot about leucovorin recently, especially if you have a child with autism. What is leucovorin? Leucovorin is folinic acid. It is vitamin B9. So let’s back up a little bit. Vitamin B9 is folate. Folate is found naturally in foods like broccoli and kidney beans. Folic acid is the synthetic form that is found in supplemented foods like breads – it’s supplemented with folic acid.

Now both folate and folic acid you ingest, and then the body converts it into methylfolate. Methylfolate is the active form that goes into the brain to help with the nervous system developing appropriately.

Leucovorin is folinic acid. It is a medical supplement that also goes into the brain to help with nervous system development. Now whether you take folinic acid, leucovorin, or whether you take methylfolate, which is a supplement that you can buy over the counter, both of them can go into the brain and help with nervous system development.

Now does your child with autism need any one of these? Not everybody does. There are tests that you can do to see: does your child need folinic acid? Do they have the receptors? Are they receptor deficient? Or do they have the enzyme, the methylfolate, the MTHFR enzyme that actually helps with the conversion? If they have the receptor, if they have the enzyme, you don’t necessarily have to give them any extra supplementation. But if they don’t, the supplementation may definitely help. Discuss this with your pediatrician. Here at Harmony Pediatrics, we offer an individualized approach and we can do the testing.

Dr. Chheda – 🍽️ Food is fuel for the body, but mealtimes are a source of connection to language of love. Every bite is an invitation – feed, breathe, trust, and repeat.

So, did you know that upper respiratory tract infections most of the time do not need to be treated with antibiotics?

Actually I did know that, ’cause you know, my kids, if they’re gonna grab something, it’s gonna be that yucky, gunky stuff in the chest, that you know, kind of stuff. But yeah, I think that’s a big misconception though. A lot of people think that the way to treat an upper respiratory infection is with an antibiotic. So how do we actually treat it?

So yeah, so typically you can have cough, cold, runny nose, congestion for up to 10 to 14 days. You can have fever for up to five days, and all of that can be viral, which is about 99.9% of what we see, sometimes even in the winter months. Absolutely.

And just a lot of supportive measures – kind of saline and suctioning the nose, sleeping on a couple of pillows if you’re older, using a humidifier in your room. And then for those older than a year of age, a teaspoon of honey once a day can do wonders. Yes!

Dr. Chheda – How do you get your toddler to eat more vegetables? There’s lots of different ways. I’ll just tell you what I did.

I would blend up whatever vegetables we had, cooked them, blended them, added some spices to them, and then made a vegetable soup. And I gave it to them in a bowl with a straw, so all they had to do was suck them. That was fun!

And every week I would make vegetable soup, and I would put in different vegetables. Whatever we had would go into the vegetable soup. And they’ll be like, “Well, this tastes a little different this week, mom.” “Yes it does, but that’s okay you can eat it.”

You can put some goldfish on top of them, you know, make it a little fun. But at least they’re getting their vegetables.

What things have you done with your toddler to help them eat their vegetables? Put them in a pressure cooker.