I met Glenn in 2006 at which time I was a pediatrics resident doing a rotation in developmental pediatrics.  I spent some time in his feeding clinic and immediately felt inspired by and attracted to his passion for caring, his innovative thinking, his family-centered practice style, and his extraordinary talent as a clinician and teacher.  I knew, right away, that I would like to spend my professional career working with Glenn. We soon became great friends, colleagues, and eventually professional partners.  He taught me virtually everything I know about pediatric nutrition. He opened countless professional doors of opportunity for me. And most of all, he was, and continues to be, a wonderful friend.

Glenn currently has limited means to prepare for the eventual progression of his ALS.  At the moment, he and his wife, Darlene,  are making arrangements for home care, a wheelchair and renovations to accomodate those. A community fundraising website has been set up to help raise funds for this.

If you wish, please consider making a contribution.  Further details here: http://www.plumfund.com/community-crowdfunding/glenn-and-darlene-berall

The post My Colleague, Partner, and Friend has ALS appeared first on Kindercare Pediatrics.

This year, in time for World Breastfeeding Week, the World Health Organization (WHO) published four fantastic graphics aimed at teaching husbands, partners, friends, family, and employers how to support breastfeeding dyads.

The following is a summary of the messaging from the four graphics:

What Moms Can Do to Support Their Own Breastfeeding

1. Before your baby arrives, get the facts on breastfeeding
2. When your baby is born, try to give the first breastfeed within an hour
3. You’ll need help with learning to breastfeed and so will your baby.  Don’t be afraid to ask for it!
4. Make sure you get plenty of healthy food, water, and rest.

What Dads (Partners) Can do to Support Their Partners and Babies with Breastfeeding

1. Help around the house, reduce stress for your partner and make sure she gets enough rest
2. ‘Burp’ the baby after a feed – dad’s chest is great for this!
3. Care for the baby in ways other than feeding (baths, diaper changes, walks)

What Family and Friends Can do to Support Breastfeeding

1. Provide emotional support and practical help (deliver groceries, cook meals, clean the house)
2. Take care of big sisters and brothers
3. Listen and be supportive.  Boost mum’s confidence in breastfeeding

What the Workplace Can do to support Breastfeeding

1. Give enough maternity leave for mums to get breastfeeding established
2. Make it easier for mums to return to work by providing time and a place to breastfeed, express, and store milk
3. Support your colleagues while they’re breastfeeding – it’s not always easy to balance work and being a new mom!

The links to these graphics can be found here.

Kudos to the WHO for putting together such practical and valuable set of recommendations.  Hopefully we can all take these measures, from whichever perspective we’re coming.  Some effort in that regard will, no doubt, help more mothers to best achieve their breastfeeding goals.

For more information about the WHO’s role in supporting breastfeeding and infant nutrition visit the Breastfeeding section of their website

The post How to Support Breastfeeding – Fantastic Recommendations From the WHO appeared first on Kindercare Pediatrics.

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Dr. Mirisse begins seeing clients July 15th, 2013.  To further enquire sbout her services and availability, see our contact information here.  See Dr. Mirisse’s recently published flyer here.

The post We Are Pleased and Excited to Welcome Dr. Mirisse Foroughe, Clinical Psychologist, to the Kindercare Team appeared first on Kindercare Pediatrics.

This past Saturday, my wife, two kids and I woke up to a beautiful warm sunny morning and decided to spend the day at Canada’s Wonderland (CW). Before hitting the road, we hastily packed lunch and snacks: Peanut butter on whole-wheat bagel, sliced apples, whole-grain crackers, carrot sticks, and sliced cheese. We also promised the kids that they could pick a treat at the end of the day.  And off we went.

Upon our arrival, we were greeted by a teenager in uniform with the words ‘Access Control’ written clearly across his chest.  He was checking everyone’s bags … for guns? Knives? I wondered. In fact, his job was to confiscate any and all food brought into the facility by patrons.  As I looked around, I noticed about a dozen of these ‘Access Control’ agents meticulously rummaging through each and every patron’s bags, strollers and wagons, confiscating anything edible. Each item was thrown on one of many tables sagging under the weight of  small mountains of contraband.

Of course we were no exception. Our access control agent proudly discovered our pre-prepared picnic.  He then gave me a look. The last time someone gave me THAT look was 15 years ago when a Canada Customs officer caught me bringing cured meats and raw-milk cheese into Canada from Europe. He promptly confiscated our food and reassured us that there are plenty of eating options in the amusement park.

Scratching my head, I wondered, why the ‘no outside food’ policy?  As I walked through the facility, The answer became quite clear – there is way too much money to lose when allowing patrons to bring their own food.  A pizza costs $25.00. A fountain drink: $4.00. A bottle of water: $3.00.  ‘Criminal’ I thought to myself.

As lunch-time neared, and as I started scouting out our food options, I felt an ever-building sense of frustration and anger.  Not only was our picnic confiscated and my wallet robbed,  but the food options were grotesque!

Some places offered the usual suspects: Hot dogs with fries, Chicken-fingers with fries, Burgers and fries. Or, we could get creative and consider…

The good ol’ foot-long hot dog:

450+ calories
26 grams of fat (almost half of  daily requirement)
9.5 grams of saturated fat
1.5 grams of salt (100% of daily requirement)
1.5 grams of fibre (daily requirement = 26 grams/d)

Or we could go for the comfort option: Pizza

As I checked the menu, I wondered … why were the only vegetables in the vicinity 1 mushroom slice and 2 specks of green pepper on the Pizza-shop’s sign? Pepperoni or Plain were the only options.  No veggies. No whole wheat option either :(

We could each get a personal 9-inch pizza – plain or pepperoni – for $9.00 a pop.

I also wondered why a personal-sized pizza needs to be twice the size of the plate?  I guess moderation doesn’t sell so well.

1,000 Calories for the personal pepperoni (Half the daily caloric requirements for an active teen)
35 grams of fat – Also half the daily requirements (15 grams saturated)
2 grams of salt – Above the daily requirements
1 measly gram of fibre – recall that 26 grams/d is the recommendation.

Our other option was to share the Family Pizza for $25.00 (Pepperoni or Plain) –
1 of six servings has:
460 calories
12 grams of fat (3.5 saturated)
1.2 grams of salt
1 gram of fibre

‘Too many refined carbs’, I thought.

Then, I found a gentleman selling the infamous smoked turkey legs made popular by the Disney theme parks in Florida and California.

1,100 Calories
53 grams of fat – that’s all your fat for the day!
A whopping 5.3 grams of salt! Double the upper tolerable limit for sodium!!

We passed on the turkey leg and opted for sharing one personal sized pizza.

As for drinks, lots of options: Bottles of pop, pop from the fountain, fruit drinks, and ice tea – All variations of way too much sugar in water.

All of the bottles and fountain drinks were OVERSIZED. The smallest option was a generous  22 ounces, 6 ounces more than the maximum soon to be allowed in New York!  Incidentally, how is $3.99 good value for 32 ounces of Coke?  Last I checked, that’s a rip-off.  And Coke has just about the poorest ‘health value’ of anything, edible or otherwise, that can be placed in a human GI tract.

So our only healthy option was water…

Water water everywhere, only $3.00 per person to drink!

After dropping $12.00 for the family to drink some water, I walked around the back of a building looking for a quiet spot to check my email.  Just then I notice…

CW must have forgotten about water-fountain signage when they crunched out their budget.  Or maybe there’s no money to make selling tap water in Toronto.  Trying to save face, I tried to convince myself that bottled water was probably healthier than tap water.  WRONG!

Over-filled with way too much white flour, fatty cheese and cardiac-arrest quantities of salt/nitrites, my daughter and I filled our now-empty water bottles with Toronto tap water from the fountain and decided to go on a hunt for vegetables. As we embarked on our search, I walked past a mother breastfeeding her baby under the shade of a tree.  ‘That little bugger,’ I said to myself. ‘He’s the only one eating healthily in this entire amusement park!’

Well, our search for vegetables wasn’t entirely fruitless.

We found home-made freshly sliced potatoes deep-fried in oil and then smothered in salt.  Potatoes are vegetables, right?

We also discovered that potatoes can be cut into narrow slices and also deep-fried in oil followed by an endless shower of salt.  Great for those folks already salt-toxic from the turkey leg. And, who knew that you can dip these vegetables in another vegetable … ketchup!

In all fairness, there are some vegetables for sale at CW.  It’s just that I would not have been able to find them had I not asked a nearby employee where my family and I can find something healthy to eat…
Though I originally thought that this was the hut where we could exchange dirty towels for clean ones, it turns out this is where the vegetable options were located – a not-quite-so-visible Subway Stand.  I still can’t figure out why Subway would choose to go so under-noticed.

Towards the end of the day, as we walked towards the main entrance, we passed by the children’s play park which, by the way…

is named after SUGAR!

And as we passed by, my kids dutifully reminded us about the treats we promised them.  So off to the treat shop we went…

Unhealthy options were plentiful, but when it came right down to it, most of us faced the choice between…

100% pure sugar lolipops…

100% pure sugar lolipops…

And 100% pure sugar  which you are expected to pour into an over-sized straw-like countainer that you can then pour directly into your mouth!

An utterly disgusting end to a horrendously unhealthy but otherwise enjoyable day at the amusement park.

When we got home, I hopped on the CW website and confirmed that they do, indeed, have a ‘no outside food’ policy. From their website: ‘No outside food, beverages or coolers are allowed to be brought into CW. However, baby food and formula are permitted as is plastic bottled water.’  Grrrr, I could have saved $12.00.

Digging a little deeper, I found this National Post article from which I learned that this food policy was implemented when new corporate owners took over in 2007.  Their rationale: ‘guests purchasing meals at the park’s food service outlets often found that tables and chairs were being commandeered by patrons bringing their own food into the park.’ Yeah, sure.  It had nothing to do with squeezing out better profits by giving patrons no choice but to buy crappy high-margin foods for astronomically high prices.

Just as troubling, from the same article, CW’s spokesperson reassuringly promised that “We will have vendors on the streets selling carrot sticks and vegetable packs and we are introducing a brand-new restaurant in the next couple of weeks called Marketplace that will have every single health food imaginable.” I guess that didn’t work out so well for them.

So why this rant?

In my view, this is a case of three strikes you’re out.  To confiscate outside food but prominently offer healthy food choices – even at inflated prices – would be justifiable.  Alternatively, offering crap at outrageous prices could be justified if, as an alternative, families were allowed to bring food from home.  But to combine ‘no outside food’ with ‘outrageously unhealthy options’, at ‘criminally high prices’ is a triple-foul that, in my opinion, crosses a threshold of acceptability. CW can always say that they’re not in the health food business.  Fair enough.  But I suspect they don’t consider themselves to be in the ‘Slowly Killing Children‘ business either.  I have many patients who spend every one of their summer vacation days at CW.  I watch their weights charge up unabated despite my best efforts to curb their obesity, the miserable effect that easy access to crappy food has on way too many children.

If you feel so inclined, please consider contacting Canada’s Wonderland and asking them to consider one or all of the following requests:

1) Please allow outside food to be brought back into their facility

2) Please make healthier food choices more readily available to patrons

3) Please charge more reasonable prices for the foods on offer

With any luck, we’ll help to make Canada’s Wonderland not only a fun place to visit, but a healthy one too.

The post My Family’s Visit to Canada’s (Food) Blunderland appeared first on Kindercare Pediatrics.

Thanks to @picardonhealth for tweeting it. You can see another great visual lecture by Dr. Evans here. Also, visit his web site where he curates more fantastic medical materials of really high quality.

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