pediasure vs. chocolate ice cream

if your toddler needs to gain weight, should you give her pediasure? or premium chocolate ice cream? as it turns out, the ice cream will do the same job the pediasure does (once you add in a vitamin supplement), and it's nutritionally superior and more healthful. plus, it's far less expensive! here's how i came to that conclusion:

as part of our goal of getting eva to gain some weight, i've been told to give her pediasure. pediasure is a child formula made by ross pediatrics, the company that makes similac infant formula. i know from extensive research in the past that infant formula is made out of the cheapest possible sources of the macronutrients (carbohydrates, fats, protein). the idea of giving that junk to my nursling makes me ill (as does the idea of supporting a formula company in any way if i don't have to). before making any decisions, however, i wanted to verify that i wasn't doing her any nutritional harm by withholding the pediasure. (gag.)

my theory was that i could make her some chocolate ice cream that was sweetened with maple syrup, and that would provide all those necessary macronutrients. to cover the micronutrients (vitamins and minerals), i'd continue giving her the schiff's children's chewable vitamins she loves so much. i've never seen her refuse either ice cream or vitamins, so this seemed like a hassle-free way to get these calories and the like into her little body (i have no confidence that she'd actually drink the pediasure, since she rejects milk after one sip and rarely drinks kefir yogurt or smoothies).

i went to nutritiondata.com to look up the nutrition facts on the ingredients of my ice cream (cream, whole milk, maple syrup, egg yolks, and cocoa) and totaled it all up. for fun, i compared this to the nutrition facts of haagen-dazs chocolate ice cream and found them to be similar (unsurprising, given they have the same five ingredients other than my substitution of maple syrup for sugar). next i compared this to pediasure. it was difficult to figure out what the serving size of pediasure should be. since it's a "medical food", it doesn't have the usual suggested serving size, and i assume one is to ask one's physician how much to offer. (1000 mL apparently would replace all food for the day.) i think 8 oz would be a reasonable assumption, but i doubt i'd ever get eva to drink that much, so i estimated 5 fl oz (well, 4.84, actually, because the calculations worked out that way). for the ice cream, i used 1/3 c since that's only a little more than what i've been giving her (or, 2.67 fl oz). that's nearly twice as much pediasure as ice cream by volume, but is similar in calories, etc, so i think it's a comparable serving. below are the results. (i apologize for the blank space preceding the table, i blame blogger :)

	Pediasure	Eva's Ice Cream	Haagen-Dazs
	Chocolate flavor	made by mama	Chocolate Ice Cream
	(4.84 fl oz)	(2.67 fl oz)	(2.67 fl oz)
Total Calories	148	210	180
Calories from Fat	64	108	108
Total Fat (g)	7	12	12
Saturated Fat (g)	1	7	7
Cholesterol (mg)	3	110	77
Sodium (mg)	54	26	40
Carbohydrates (g)	16	14	15
Dietary Fiber (g)	0	1	0
Sugars (g)	16	12	14
Protein (g)	4	3	3

(the astute observer will notice that a few of the numbers on eva's ice cream are off due to error propagation since the original data were rounded off, but it's close enough.) as i said above, the two kinds of ice cream come out basically the same. and in the grand sense, really, all three come out sufficiently similar: there's more saturated fat (and thus more fat calories) as well as more cholesterol in the ice cream than the pediasure. the carbohydrates and protein come out about the same (except notice that there are more sugars in the pediasure than the ice cream! and i plan to reduce the maple syrup next time, but i didn't want to undersweeten it the first time lest she reject it.) so, with regard to macronutrients, i'm satisfied.

eva's chewable vitamin contains as much or more than the (admittedly small) serving of pediasure when it comes to: vitamins A, B6, B12, C, D, E, and K, folic acid, thiamine, riboflavin, niacin, calcium, iron, magnesium, and zinc. and the maple syrup adds sufficient manganese. the pediasure also has (which is missing from the ice cream): choline, biotin, pantothenic acid, inositol, phosphorus, iodide, copper, chromium, molybdenum, and selenium, none of which i'm particularly concerned about, because i'm sure eva will be covered by the other whole foods she does eat. (i could be wrong, but i prefer to look at nutrition in terms of whole foods rather than at the nutrient level.) so, micronutrients, check!

let's look at the cost: according to amazon.com, i can get chocolate pediasure for $1.49 for the serving size above vs $0.70 for the serving size of haagen-dazs chocolate ice cream. the premium haagen-dazs ice cream is cheaper! and i guarantee i can make my own ice cream for about half that (or probably less). i realize i'm comparing a smaller serving (by volume) of ice cream, but it delivers the same or more macronutrients, so basically the difference in serving size comes down to the water content in the pediasure. even when factoring in the $0.08 per day for the vitamin supplement, and you still come out with an almost 50% savings buying premium ice cream and vitamins vs. buying pediasure (and a far greater savings if you make your own).

and just what, pray tell, are you buying when you buy pediasure? (ooh, i saved the best for last!) let's compare the ingredient lists, shall we?

eva's ice cream: cream, whole milk, maple syrup, egg yolk, and cocoa
haagen-dazs: cream, skim milk, sugar, egg, and cocoa
pediasure: water, sugar, corn maltodextrin (thickening agent), milk protein concentrate, high oleic safflower oil, soy oil, cocoa powder, soy protein isolate, medium chain triglycerides (a fatty acid). this is followed by "less than 0.5%" of the various vitamins and minerals as well as artificial flavors, dyes, gums, gels, stabilizers, and emulsifiers.

yum!

so, where the ice cream gets fat from cream, the pediasure gets it from safflower and soy oil. the ice cream gets carbs from milk (lactose) and maple syrup, in pediasure it's from sugar. the ice cream finds it's protien in eggs and milk, the pediasure in milk protein concentrate and soy protein isolate (which i try to limit in eva's diet for several reasons). i don't know about you, but why would i want to pay double for that pile of food-industry byproducts when i could feed her real food, which also happens to be tastier? (or to paraphrase michael pollan, i'd rather eat food made of food.) they make pediasure (like all infant formulas) out of the absolute cheapest ingredients available (never mind the quality of the various macronutrients, not when that would cut into profits) so it costs them just pennies on the dollar to make this processed stuff. then they charge you nearly double the cost of premium ice cream (remember: made from food), which is just as "nutritionally complete" once you add a multivitamin -- why not just eat the ice cream?! (heck, it's even got less sugar...)

(i'd like to say "i don't know how they get away with that crap" but sadly i do know. if you want to know, check out "milk, money, and madness" by baumsag and michaels. here's just one little fact: 1 to 2 million infants around the world still die each year due to formula feeding, according to WHO and UNICEF. i'm glad formula is available for the cases where it is needed, but the predatory marketing practices used by these companies are unconscionable.)

anyway, lest the ross people ever get ahold of this, i'm not saying ice cream is better than pediasure for all toddlers trying to gain weight. (i'm not a nutritionist or a medical professional, and you obviously should consult your child's physician as needed before making any changes.) but what i am saying that i've weighed the facts (which are presented here accurately to the best of my knowledge) and for my child and our situation, the ice cream wins hands (and spoons) down.

or, as eva would say, "more shoc-it ice keem, pease, mama?"

i welcome comments for any reason, but particularly if you find errors or have questions regarding my analysis.

morning adventure

earlier this morning, eva put on larry's stocking hat and went over to her stroller and said "bye-bye. i'm going to work." i said, "with your stroller?" "uh-huh. i take bunny to work." oh, that's a progressive job you have, then, if you can take your "baby" to work with you. "uh-huh." larry asked, where are you going to work? "i go on a big airplane." oh really? where are you going on the airplane? "to germany." well, that makes sense. how would she know anyone goes anywhere to work, other than via airplane? as far as she knows, work equals laptop. she'll go up to one of larry's spare laptops (there are currently four laptops in our living room, long story) and "type" and say proudly, "i'm working, mama!" (not unlike her uncle john's work on his "dinnertation" when he was a kid and grampy was finishing grad school.) so, off she went with her stocking cap and baby stroller to go to work in germany. "i'm packing up, mama."

she went off for a while and i went back to my task, noticing on the edge of my attention that she was empting an entire drawer and collecting objects from other assorted places. this is what i saw next:



her stroller contained: a bib, a dvd remote, a plastic wind-up fish toy, two pajama bottoms, one pajama top, a journal, a wii remote, an asthma inhaler, a wireless mouse, a blue walkie-talkie ("woppy-hoppy"), a cell phone, two quarters, a bobby pin, and of course bunny. i guess she was all packed up for her business trip. (this assortment also says a lot about our household, i think.)

after i took her picture, she put the quarters on the lens cap and said, "i'm making food for papa and mama and eva." what kind of food are you making? "tofu food!" she then added a yellow block and a bracelet to the plate, artfully arranged, and adorned her table setting with colorful bells, which i believe were reported to be "for coffee". after she was done with food, she passed me certain bells (yellow, orange, and blue), gathered up two green and a red for herself, and belted out a tune, accompanying herself on the bells. "i'm having fun singing a song, mama." you sure are.

earlier this morning, we ate waffles with strawberries and cream cheese for breakfast, cleaned up and washed dishes, went potty twice, took bunny potty after changing his (her?) diaper and giving him mama milk, talked about what our friend baby dashiell might be doing at ella's house, colored, played night-night with papa (a good sleepy papa morning game), made a family pile (eva on mama's back and mama on papa's back), discussed which toys we can and can't throw ("i don't throw hard toys", she just reported), rocked in the rocking chair, played hide-and-seek, and a few other things i'm forgetting.

sometimes i wonder (or just forget) what we do all day. then i see how much we do in two short hours -- some of it eva playing on her own, and some all of us together -- and i am reminded. i so enjoy accompanying her on her grand adventures, and i love that all of it is so full of imagination.

growth

sandbox kids, originally uploaded by Kristy and Eva.

so, before diving into the topic i hinted at last time, i'll start with last week's stressor: larry went to germany for a week (on 2 days notice), and like the last time he went to europe, eva got knocked down by a GI virus within a day of his departure. this time, for added fun, i was also sick with a sinus infection and pretty nasty respiratory troubles from allergies. i'm mostly over it now so the urgency of writing all about it has waned, but she was frighteningly dehydrated. five days in, i was about 20 minutes away from taking her to children's ER on the advice of the nurse at her doctor's office (which had closed at noon on friday, oops! how old will she be before i remember that little fact?) no matter what i tried, she wouldn't drink or eat anything, a few sips here and there. she was flopped out on the couch all day, barely interacting most of the time, with dry lips and no tears. so, i gave up my fertility aims and nursed her on demand (which was at least every hour in this case) so she would get some fluids and not lose any more weight than necessary. chalk one up for extended nursing -- i'd bet my supply of rejected pedialyte that nursing is what tipped the balance kept her from needing IV fluids at the hospital.

speaking of the medical world, that brings me to the other fun stressor of the month. i took eva to her doctor a couple weeks ago because i noticed she hadn't put on any weight (or height, it turns out) since 18 mo, and he said then if she dropped any lower in percentile growth, he'd be concerned. and when i took her in, he was in fact concerned -- not so much with the fact that she was well under the 5th %ile, but more that she had been much higher (above 50th for a while) then fallen so considerably (some drop is normal for breastfed babies, but 50th to under 5th is not). that combined with her lack of change in height was especially concerning. so, he referred us to a pediatric endocrinologist. they had no openings until september, they said -- that is, until they saw her chart, then they got us in the following week. how reassuring! she's bumped right up to the front of the line.

i'll spare you all the details (again, i'm largely over it now), but we went the monday after our long duo-sick scary week with no larry for support, and we were there for nearly seven hours. we did a full history (of her and of family), had her accurately measured and remeasured (3rd %ile in weight, 8th in height, i got to read "failure to thrive" on all her lab paperwork), and i got to answer a lot of questions figuring out whether or not i was an unfit mother who wasn't properly nourishing her child. i met with a nutritionist (who seemed to think i was an idiot and didn't tell me much other than "she needs to take in more calories"... really, you think?), and had an assortment of tests -- bone age (xray to determine the level of ossification of her bones), boodwork, and urine tests. she didn't mind the xray (that was the best of the many waiting rooms we saw that day, too), and was a trooper through the bood draw, but it was the urine sample that had us there all day.

i kept trying to explain that a potty trained kid isn't going to pee her pants just because you taped a bag to her -- nor can she pee on demand like an older kid or adult. she peed after 3 hrs but also pooed, so oops, can't use that. we napped on the chairs in the waitnig room, then kept waiting while i fed her juice and water all day. she was set against the medical potty they needed us to use, and this girl can hold it for like 8 hrs when she decides to (i know from our experience in mexico!). i finally gave up so we could beat rush hour home (and get larry from the airport) and she went as soon as we got home, as i expected. moral: if you have a potty trained kid, don't wait it out, go home. you can take the sample to a sattelite lab, most likely. with a kid in diapers, you probably want to wait (according to some of my new waiting room friends, because the bag will keep falling off if you go home. but i digress...

most things came back normal. the bone age was low but within the wide normal range. however, her levels of IGF-1 came back low. low IGF-1 ("insuline-like growth factor") is basically like saying she is lacking growth hormone. (the longer answer is that the pituitary gland makes growth hormone, which has only one job, to tell the liver to make IGF-1, which in turn tells the cells to grow. the reason they don't test for growth hormone right away is that to do so requires hospitalization. but you can be low in just IGF-1 or both IGF-1 and growth hormone.) anyway, it's a bit of a chicken-egg debate with low IGF-1: either you have low IGF, which makes you not grow (and i would assume cause you to not be very hungry either if you're not growing?), or, if you don't eat well, you produce less IGF, and thus don't grow. we don't know which it is for eva, but my guess is that it's a bit of a compounding effect, and that both are partially responsible. (i base this on the fact that she's never eaten food, it's not a new toddler willpower thing, and she's not picky and is easygoing about most things, so i don't think it's just a personality thing either. it "feels" like there's a reason she doesn't eat. i get that toddlers are notoriously picky eaters, but she simply does not eat. i've seen toddlers, this is definitely unusual.)

so what's next? well, what's next is for her to be hospitalized for further tests. i presume that would include a growth hormone test (they have to stimulate it's release by giving IV drugs that trick the body into thinking it is asleep and measure it over the course of 8 hrs or more), and possibly have her fed through an IV for several days or a week to see if she grows when given sufficient calories (solving that chicken-egg thing with the IGF-food causality, i guess). none of this sounds fun, so we're waiting until after her follow-up appointment in september. we'll measure her growth then and retest her IGF-1 and decide from there how to proceed. we have the luxury of time since she's still so young, most people start this kind of testing with 4 or 5 year olds, i'm beginning to learn.

so, if she is growth hormone deficient, or IGF-1 deficient (or both), what does that mean? will she just be short? i've done some research and found out that contrary to public perception, there's more to it. basically, growth hormone controls the growth of all tissues, so it's not just your bones that don't develop as they otherwise would, your organs are affected as well (most notably, the heart and lungs, leading to cardiovascular issues and so on). so, someone with normal hormone levels who grew to 5"2" (a plausable adult height for eva) has better outcomes than a growth hormone deficient person who would otherwise have been taller but grew to that same height due to the deficiency. we have no idea if all this affects eva, and likely it doesn't, but i'm clarifying because i've been finding all of this worrisome, and i've been getting a fair amount of "well she'll just be short and cute" responses.

that, and totally conflicting advice from all corners. from medical professionals alone i've been told to: continue nursing as you are, reduce nursing to no more than twice a day, give her more calories via liquids, don't give her any calories via liquids, give her pediasure, give her instant breakfast but use the sugar free kind, feel free to give her sugar when needed, use reduced fat milk, give her whole fat milk, don't give her milk, feed her whatever she'll eat that isn't junk food (her beloved goldfish), don't feed her things that are not nutrient-dense (no goldfish), give her ice cream (since she'll eat that), don't give her ice cream, do whatever you can to convince her to eat, be laid-back and don't make an issue over what she eats.

okay, um... i'll do all that then. the best advice was from our own doctor, who said (in response to my questioning some questionable advice from various other sources) "i'd trust your own instinct and logic on that." so i am. i'm pleased to report that she ate relatively well for 3 of the past 4 days, so that has gone a long way to relieving some stress on the issue (basically, it feels like "hey, if she doesn't eat enough in the next 3 months, she'll be in the hospital" but no pressure, right?) honestly (and i hope this doesn't offend anyone), i feel like larry is the only other person who really, truly gets it. i mean, if you're not in the throws of feeding a non-eating kid, it seems like, "well, offer a variety of nutritious foods in interesting ways and eventually she'll eat". that's what i used to think, too, until she stopped growing for 6 months. and trust me, i've tried every single thing (because i've been thinking aout this every day for at least a year, so i've thought of pretty much everything a person could think of.) in fact, that's what makes this hard -- i have to think about it at every mealtime and snacktime every day. it's mentally exhausting.

this all sounds dramatic. i get that the most likely outcome is that she's totally fine, and eventually she'll grow. but that doesn't invalidate that she's in an abnormal growth pattern now, and that i have to do everything i can all day long to get her to take in more calories. that's why it took me nearly two weeks to write about this, i just get tired of thinking about it. but, i'm trying to just let it absorb back into our daily routine and we'll see. all i can do is make my best effort, eva's utimately the one who decides if she's going to eat. so we'll just march on and see what happens.

belly

splashing, originally uploaded by Kristy and Eva.

so much has happened in the past couple weeks, that i am still sort of processing and can't seem to get myself to write about all of it just yet (or so it seems by my choosing to do anything but blog the past several days). so i thought i'd break back in by relating a conversation i had today with eva as we were driving away from the grocery store.

eva: "mama, eva want that magazine. eva want to read it."
mama: "okay, um... (wrenching my arm back trying to reach it while not driving into a tree) ... here you go. what's on that magazine?"
eva: "a woman!" (it's a copy of "pregnancy" magazine.)
mama: "oh, there is?"
eva: "uh-huh. that woman have a baby inside her body."
mama: "oh, she does?"
eva: "uh-huh, in her belly!"

wow. i've told her that maybe twice (in relation to sarah's pregnancy, i think). kids are such sponges! so we proceeded to have a conversation about how the baby starts out so tiny (eva's new thing is distinguishing between "small" and "tiny"), but then they grow bigger and bigger and then they come out... (remember, fiona used to be in sarah's belly and now she lives at liam's house?). i even explained how auntie karen has a baby in her belly, but it's still so tiny, and how mama's trying to have a baby in her belly, too, but so far it's "not working" (a favorite phrase of hers). so... not a conversation you generally have with a kid under two, but she seemed interested so i went with it. :)

i'll catch up on all that's been going on soon, once i give my brain a rest first. oh, and can anyone believe eva will be TWO in less than a month? she's fond of saying oh-seven oh-seven oh-seven (the date of her birthday this year.) "eva gonna have a birthday. eva's birthday in alak-sa." aww. she and her grandparents are going to fall in love all over again, i can see it already.