Bread pudding from my mother’s kitchen brings back many homely memories from my childhood days. I can conjure up the recipe in her own handwriting in her big recipe book. She used to let me leaf through the pages of her book occasionally. Accompanying the recipe was a picture of the pudding that she had cut and pasted on the book. After looking at that picture, I’d invariably request her to make the pudding at home. The Bread pudding was my all time favorite dessert in those days. She used to treat us to home made bread pudding very frequently those days.

The Bread pudding was a quintessential part of Syrian Christian wedding receptions in my part of Kerala during my childhood. Alas, it was eventually replaced by ice creams. The other day, when I talked to my mom over the phone, she mentioned the dessert and my taste buds started screaming out loud for Bread pudding. As I live too far from my hometown to rush back home to indulge in the pleasures of the home made dessert, I decided to try to recreate the magic at home.

Here’s the recipe for Bread pudding straight from my mother’s kitchen:

Prep time: 45 minutes
Serves 6-8

Ingredients:

1. White bread: 3 slices (sans the crust)

To prepare the custard:

2. Whole milk: 2 cups
3. Eggs: 3
Granulated sugar: 6 tablespoons
4. Vanilla extract: 4 drops

For the topping:

5. Condensed milk: ¼ can
6. Pineapple squash/topping: 3 table spoons
7. Unsalted almonds, cashew nuts or macadamia nuts.

Method:

1. Remove the crust from the bread pieces.
2. Boil the milk
3. Beat the ingredients in #3 together.
4. Blend the boiled milk with #3
5. Cut the bread into small cubes and blend it together with Vanilla extract and the mixture from Step 4 (preferably in a blender) to a smooth consistency.
6. Grease the insides of a heat withstanding container (like Pyrex®). Fill 2/3rds of the container with the bread mixture from Step 5. Steam the mixture for 20-30 minutes until set (a tooth pick inserted into the pudding comes out clean).
7. Spread the condensed milk over the pudding and refrigerate it for 2-3 hours.
8. Top the pudding with pineapple topping and serve.

Helpful tips:

1. The ingredients I used were Central market organic vitamin D enriched whole milk, Sara Lee® Iron Kids special recipe white bread, Central market organic cage free large brown eggs, Borden® low fat sweetened condensed milk, McCormick® pure vanilla extract and Smuckers® pineapple topping. The taste came out to be very similar to my mother’s home made pudding.
2. If you like caramel topping, you can heat 6 tablespoons of granulated sugar in a pan. When it gets melted properly and becomes brownish, pour 200 mL of water and stir it continuously. When it reaches a medium consistency, remove from the stove. Pour the caramel into the greased container prior to adding the bread mixture.
3. If you like your pudding to have a thicker consistency, you can add more pieces of white bread. I used 6 slices of bread (keeping the measurement of the rest of the ingredients same).
4. My mother still loves to steam the pudding in the old fashioned way. I steam cooked the pudding this time. You can bake the pudding in the oven as well. I will try baking the pudding next time and will modify the recipe accordingly.
5. You can serve the Bread pudding warm or cold. I love it cold.
6. You can blend nuts (unsalted cashews, almonds or macadamia nuts) during Step 5 or sprinkle them over the pudding.
7. All the recipes that I have come across the internet for Bread pudding recommend that the bread pieces be layered at the bottom of the custard. Personally, I like my pudding to have a “pudding like” consistency; not a “Tiramisu like” consistency. So, if you do not like the pudding like consistency, then, instead of blending the bread pieces with the custard, layer them on the bottom of the pan and then, spread the custard on top, prior to steaming or baking.

Enjoy the treat! I’d love to hear back from you.

Egg Puffs is an enticing appetizer from the state of Kerala in India, aka God’s own Country. It’s so very easy to make, unless you crave to take on the time consuming and laborious task of making the puff pastry dough from scratch, making sure that you keep the dough at a temperature of approximately 16°C (60°F), and that it rests in between folds. If you’re among mortals like myself, who’re sometimes (note that sometimes is the keyword here) okay with being just a tad short of a perfectionist, then you can rest assured that the frozen puff pastry sheets will yield as great a product as the dough prepared from scratch.

So much for the Prologue!!! Here’s the Recipe for the mouth-watering Egg Puffs. It takes approximately 45 minutes to prepare a dozen.

Ingredients

1. Eggs – 4

2. Big Onion – 1

    Jalapeno pepper – 2*

    Minced garlic – ½ teaspoon

3. Turmeric powder – ½ teaspoon

    Coriander powder – 1 ½ teaspoon

    Garam masala – ¼ teaspoon

    Salt – to taste

4. Oil – 1 table spoon

5. Vinegar – 3 drops

6. Frozen puff pastry sheets – 1 pack**

Preparation

1. Boil the eggs. Chop the hard boiled eggs into small pieces and set aside.

2. Remove puff pastry sheets from the freezer. Place it on a silver foil sheet or a cookie pan to thaw***. Cut the sheets into 12 pieces.

3. Heat oil in a frying pan. Sauté the items in 2 until golden brown. To this mixture, add the spices in 3 and stir for a few minutes. Stir in the chopped eggs for 5 minutes on medium heat. Add 3 drops of vinegar to this mixture. Set this mixture aside to cool.

4. Place 1 teaspoon of the stir fried egg mixture in each individual pastry sheet and fold each sheet, making sure that the edges are sealed together.

 5. Preheat oven to 350 degrees. Place the folded puffs on a cookie sheet placed on the middle rack and heat for 15-20 minutes.

6. Serve with ketchup/hot sauce and loads of love!!!

HAPPY VALENTINE’S DAY

*The more, the spicier

**I used the frozen puff pastry sheets by Pepperidge farms. It comes in a pack of 2 sheets that can make a dozen puffs.

***Approximately 40 minutes.

Tiramisu has carved a niche in my heart from the first time I tasted it in 2004. Since then, I’ve always made it a point to scan each and every menu at the restaurants that we go to, looking for Tiramisu. I used to visit a local HEB on a weekly basis for their Tiramisu ice creams and shed a few tears when they stopped selling that. For sometime, Baskin Robbins, the ice cream shoppe had Tiramisu as their “Flavor of the Month” and I was the happiest gal on the planet for that month. Then, they stopped making that too….Nowadays, I satisfy myself mostly with the Tiramisu that the local grocery stores sell.

And, then, I came across a recipe for Tiramisu that changed my life. It is an easy one and even amatuer chefs can try it and emerge as a winner. And, WIN I did…I tried my hand at a local dessert competition this month, held by the Malayalee community of Austin and emerged as the winner. So, this recipe will remain close to my heart…as it helped me to boost the confidence in my culinary skills.

Before we go into the recipe, here’s a little history on Tiramisu aka Tuscan Truffle:

Tiramisu was initially created in Siena, in the northwestern Italian province of Tuscany. The occasion was a visit by Grand Duke Cosimo de’Medici III, in whose honor the concoction was dubbed zuppa del duca (the “duke’s soup”). The erstwhile duke brought the dessert back with him to Florence. In the 19th Century, zuppa del duca became popular among the English intellectuals and artists who lived there Consequently, it is also known as zuppa Inglese. They took the dessert to England, where its popularity grew. Zuppa del duca eventually made its way to Treviso, just northwest of Venice, in the northeastern province of Veneto. Treviso is best known for its canals, frescoes and Tiramisu.
Stories are told about how Tiramisu was the favorite of Venice’s courtesans, who needed a “pick me up” (the literal translation of “tirami-su”) to fortify themselves between their amorous encounters. True? Probably not. But it makes for a colorful history. Its American popularity arose in San Francisco, and today, Tiramisu can be found in restaurants throughout the nation. As far as India is concerned, Tiramisu is he most favorite dessert of the Congress leader, Mrs. Sonia Gandhi, who’s an Italian national. 

Here goes the great recipe:
Ingredients
• Eggs, 3 large, with yolks and whites separated
• Sugar, 1/2 cup
• Mascarpone cheese, 8 ounces
• Ladyfingers, 20
• Espresso or Strong Coffee, 1 cup
• Cognac or Brandy, 2 tablespoons
• Cocoa, 1/8 cup

Directions
1. Combine 3 egg yolks, 1 tablespoon Espresso, sugar, and Cognac into the large mixing bowl.
2. Beat 2 to 3 minutes
3. Add Mascarpone and beat 3 to 5 minutes until consistency is smooth
4. In another bowl, combine 3 egg whites and a pinch of sugar. Beat until mixture forms stiff peaks
5. Gently fold into Mascarpone mixture
6. Soak each lady finger in espresso, and layer on bottom of serving dish. If the consistency of the lady fingers is not spongy enough, you can pour some espresso over the layer of the lady fingers.
7. Spread 1/3 of Mascarpone mixture and sprinkle with cocoa
8. Continue layering w/ ladyfingers and finish with a Mascarpone layer
9. Using a tea strainer, sprinkle rest of the cocoa powder on top.
10. Cover and place in fridge for at least 4 hours (Overnight is best for the flavors to develop. It tastes even better after 2 days.)
11. Makes 6 servings.

Finally, a picture of my creation that won me the accolade:

How did I make the heart shape??? I used a cookie cutter!!!! Its THAT simple!!!!

One more view:

And, one more….( I swear..this is the last one!!!!). Here, you can see some of my creation’s competitors as well:

The incidence of eczema appears to be increasing. It may occur in any race or geographic location, although there appears to be a higher incidence in urban areas and developed countries, especially western societies.

The vast majority of eczema has an onset before age five years, and data from kids show a slightly increased risk in girls compared to boys (1.3 to 1).

What is the underlying factor behind eczema?

Eczema appears to involve a genetic defect in the proteins supporting the epidermal barrier of the skin. Disruption of the barrier results in inflammation of the skin. Eczema is also characterized by decreased ceramides (a subset of fats in the skin layer that helps to bind water), leading to decreased water binding.

Anything that can be done to prevent the onset of eczema?

Exclusive breastfeeding for the first few months of life may provide protection against the development of eczema in infancy. Some studies have found that partially hydrolyzed formulas aka pHFs (e.g.: Nestle Good Start®, Enfamil Gentlease®) as well as extensively hydrolyzed formulas aka eHFs(Alimentum®, Nutramigen®, and Pregestimil®), compared to conventional cow’s milk formulas, have the potential to reduce the risk of eczema in high risk infants*, when used as a supplement or substitute to breast milk during the first four months of life. Some studies show a slight benefit of eHFs compared with pHFs, although the evidence is not conclusive. Soy formula has not been shown to prevent or delay onset of eczema. Amino acid-based formulas have not yet been studied in the primary prevention of allergy.

Recent research has shown promising evidence to support probiotics in the primary prevention of pediatric eczema, while evidence for the treatment of established eczema was equivocal. The majority of trials chose Lactobacillus rhamnosus GG as their probiotic strain of study. There is a recent surge in formulas with prebiotic or probiotic supplements, that came into the market based on this evidence; eg: Enfamil’s Nutramigen lipil w/ Enflora (Lactobacillus GG ),Similac Advance Earlyshield®, NESTLÉ® Good Start® Protect Plus® with Bifidobacterium lactis.

Note: * An infant is defined as “high risk” for developing allergic disease if there is at least one first degree relative (parent or sibling) with a documented allergic condition (food allergy, asthma, or moderate to severe eczema).

What all things can be done to prevent flare up of eczema?

Exacerbating factors in eczema that disrupt an abnormal epidermal barrier include excessive bathing, low humidity environments, emotional stress, dry skin, overheating of skin, and exposure to solvents and detergents. So, try to avoid these situations as much as you can.

Following are just a few things you can do to help:

• Give your tot lukewarm/cold baths that last about 20 minutes. This will help relieve itching and also give the skin some time to absorb the moisture.

• Do not use any harsh soaps or body washes. Avoid those with fragrance or alcohol content. Use a fragrance free soap, sparingly in areas that get particularly sweaty, oily, or dirty, such as behind the ears, in the neck folds, in the creases of the groin, and in the diaper area.

• Pat the skin dry. Do not rub.

• Keep the skin moist by using an all over- body ointment or cream immediately after every bath.

• Choose loose-fitting, soft, cotton clothes. Avoid clothes that use elastic in the waist.

• Trim fingernails often. This will help limit the amount of damage scratching does to the skin.

• Try to avoid sweating and exposure to heat.

• Try to keep your tot active during the day to distract from itching. If itching is uncontrollable, use antihistamines (the sedating antihistamines like Benadryl® is more effective than their non-sedating counterparts.

Which is preferable: Shower or bath?

Some controversy exists concerning whether showering or bathing is preferable in patients with eczema. Most authorities recommend a hydrating bath followed by immediate emollient application, but others recommend a shower of short duration. Whether bath or shower, rapid application of emollients or prescribed topical preparations is important.

How to take care of the skin when not having a flare up?

Skin hydration is a key component. The rule to use is: match the thicker ointments to the driest, flakiest skin. Lotions, which have a high water and low oil content, can worsen eczema via evaporation and trigger a flare of the disease. In contrast, thick creams (eg, Eucerin®, Cetaphil®, Nutraderm®), which have a low water content, or ointments (eg, petroleum jelly, Aquaphor®, Petrolatum), which have zero water content, better protect against xerosis. Two prescription strength moisturizers have been introduced recently, named Atopiclair® and Mimyx®, which both relieves symptoms of flare and manages recurring flares.

How to take care of the skin during a flare up?

A low potency steroid cream or ointment (eg, 1 or 2.5 percent Hydrocortisone) is effective for a mild flare up. A medium potency steroid ointment may be needed for more severe flare up. Higher potency steroids can be used for up to 10 days in some patients with acute flares, and then replaced with lower potency preparations until the lesions resolve. Topical steroids can be used one or more times daily, although no clear benefit has been demonstrated with more than once daily application.

The topical calcineurin inhibitors (like Elidel®) appear to be effective for the treatment of eczema, and, unlike topical steroids, do not cause thinning of skin with prolonged use. For this reason they may be particularly useful on the face, neck, and in skin folds. They’re approved by FDA for use in children over the age of two. However, concerns have been raised about a possible link to cancers.

Wet dressings help soothe the skin, reduce itching and redness, debride crusts, and limit access to the skin by the kids for itching. Dampened cotton garments are worn over the affected area and covered with a dry garment. You can keep these dressings overnight or change them every eight hours during the day. Talk to your child’s doc prior to resorting to this technique, though.

How likely is that a baby will develop eczema in future?

Eczema occurs in the first year of life in 60 percent of cases, and by the age of 5 years in nearly 85 percent of cases. So, an almost definite answer to whether or not your baby will get to keep her glowing skin can be had within the first 5 years.

Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites.

WHO director general has raised the current level of influenza pandemic alert from phase 4 to phase 5. Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Mexico has reported 822 laboratory confirmed human cases of infection, including 29 deaths. The United States has reported 642 laboratory confirmed human cases, including two deaths. The two fatally infected people (both of them from Texas) had underlying health issues, which may have attributed to the increased severity of their illness.

The following countries have reported laboratory confirmed cases with no deaths – Austria (1), Canada (165), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (4), Germany (9), Guatemala (1), Ireland (1), Israel (4), Italy (5), Netherlands (1), New Zealand (6), Portugal (1), Republic of Korea (2), Spain (57), Switzerland (1) and the United Kingdom (27).

It is considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention, in line with guidance from national authorities. Individuals are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.

WHO advises no restriction of regular travel or closure of borders.

NOW TO THE MILLION DOLLAR QUESTION: ARE PIGS GOOD OR BAD?

There is no risk of infection from this virus from consumption of well-cooked pork and pork products. So, it’s safe to assume that PIGS ARE NOT BAD!!!!

People with prolonged proximity to pigs are known to have immunity to Influenza A(H1N1) viruses that can prevent the virus infection. So, PIGS MAY BE GOOD!!!!

Unless absolutely necessary, I’d definitely advise you to avoid hanging out with SICK PIGS, for the time being, though!!!!

Time for some Q&A:

What is Influenza A(H1N1)?

Influenza A(H1N1), or “Influenza A(H1N1)”, is a highly contagious acute respiratory disease of pigs, caused by one of several Influenza A(H1N1) viruses. Morbidity tends to be high and mortality low (1‐4%). The virus is spread among pigs by aerosols, direct and indirect contact, and asymptomatic carrier pigs. Outbreaks in pigs occur year round, with an increased incidence in the autumn and winter in temperate zones. Many countries routinely vaccinate swine populations against Influenza A(H1N1).

Influenza A(H1N1) viruses are most commonly of the H1N1 subtype, but other subtypes are also circulating in pigs (e.g., H1N2, H3N1, H3N2). Pigs can also be infected with avian influenza viruses and human seasonal influenza viruses as well as Influenza A(H1N1) viruses. The H3N2 swine virus was thought to have been originally introduced into pigs by humans. Sometimes pigs can be infected with more than one virus type at a time, which can allow the genes from these viruses to mix. This can result in an influenza virus containing genes from a number of sources, called a “reassortant” virus.  Although Influenza A(H1N1) viruses are normally species specific and only infect pigs, they do sometimes cross the species barrier to cause disease in humans.

What are the implications for human health?

Outbreaks and sporadic human infection with Influenza A(H1N1) have been occasionally reported. Generally clinical symptoms are similar to seasonal influenza but reported clinical presentation ranges broadly from asymptomatic infection to severe pneumonia resulting in death.

Since typical clinical presentation of Influenza A(H1N1) infection in humans resembles seasonal influenza and other acute upper respiratory tract infections, most of the cases have been detected by chance through seasonal influenza surveillance. Mild or asymptomatic cases may have escaped from recognition; therefore the true extent of this disease among humans is unknown.

Where have human cases occurred?

Since the implementation of IHR(2005)1 in 2007, WHO has been notified of Influenza A(H1N1) cases from the United States and Spain.

How do people become infected?

Humans usually contract Influenza A(H1N1) from infected pigs, however, some cases lack contact history with pigs or environments where pigs have been located. Human‐to‐human transmission has occurred in some instances but was limited to close contacts and closed groups of people.

Is it safe to eat pork and pork products?

Yes. Influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The Influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.

Which countries have been affected by outbreaks in pigs?

Influenza A(H1N1) is not notifiable to international animal health authorities (OIE, www.oie.int), therefore its international distribution in animals is not well known. The disease is considered endemic in the United States. Outbreaks in pigs are also known to have occurred in North America, South America, Europe (including the UK, Sweden, and Italy), Africa (Kenya), and in parts of eastern Asia including China and Japan.

What about the pandemic risk?

It is likely that most people, especially those who do not have regular contact with pigs, do not have immunity to Influenza A(H1N1) viruses that can prevent the virus infection. If a A/H1N1 virus establishes efficient human‐to human transmission, it can cause an influenza pandemic. The impact of a pandemic caused by such a virus is difficult to predict: it depends on virulence of the virus, existing immunity among people, cross protection by antibodies acquired from seasonal influenza infection and host factors.

Is there a human vaccine to protect against influenza?

There are no vaccines that contain the current influenza virus causing illness in humans. It is not known whether current human seasonal influenza vaccines can provide any protection. Influenza viruses change very quickly. It is important to develop a vaccine against the currently circulating virus strain for it to provide maximum protection to the vaccinated people. This is why WHO needs access to as many viruses as possible in order to select the most appropriate candidate vaccine virus.

What medicines are available for treatment?

There are two classes of such medicines, 1) adamantanes (amantadine and remantadine), and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir).

Most of the previously reported Influenza A(H1N1) cases recovered fully from the disease without requiring medical attention and without antiviral medicines.

Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. The viruses obtained from the recent human cases with Influenza A(H1N1) in the United States are sensitive to oseltamivir and zanamivir but resistant to amantadine and remantadine.

Information is insufficient to make recommendations on the use of the antivirals in treatment of Influenza A(H1N1) virus infection. Clinicians should make decisions based on the clinical and epidemiological assessment and harms and benefits of the treatment of the patient2. For the ongoing outbreak of the Influenza A(H1N1) infection in the United States and Mexico, national and local authorities are recommending use oseltamivir or zanamivir for treatment of the disease based on the virus’s susceptibility profile.

What should I do if I am in regular contact with pigs?

Even though there is no clear indication that the current human cases with Influenza A(H1N1) infection are related to recent or ongoing influenza‐like disease events in pigs, it would be advisable to minimize contact with sick pigs and report such animals to relevant animal health authorities.

Most people are infected through prolonged, close contact with infected pigs. Good hygiene practices are essential in all contact with animals and are especially important during slaughter and post‐slaughter handling to prevent exposure to disease agents. Sick animals or animals that died from disease should not be undergoing slaughtering procedures. Follow further advice from relevant national authorities.

Influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The Influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C corresponding to the general guidance for the preparation of pork and other meat.

How can I protect myself from getting Influenza A(H1N1) from infected people?

In the past, human infection with Influenza A(H1N1) was generally mild but is known to have caused severe illness such as pneumonia. For the current outbreaks in the United States and Mexico however, the clinical pictures have been different. None of the confirmed cases in the United States have had the severe form of the disease and the patients recovered from illness without requiring medical care. In Mexico, some patients reportedly had the severe form of the disease.

To protect yourself, practice general preventive measures for influenza:

• Avoid close contact with people who appear unwell and who have fever and cough.
• Wash your hands with soap and water frequently and thoroughly.
• Practice good health habits including adequate sleep, eating nutritious food, and keeping physically active.

If there is an ill person at home:

• Try to provide the ill person a separate section in the house. If this is not possible, keep the patient at least 1 meter in distance from others.
• Cover mouth and nose when caring for the ill person. Masks can be bought commercially or made using the readily available materials as long as they are disposed of or cleaned properly.
• Wash your hands with soap and water thoroughly after each contact with the ill person.
• Try to improve the air flow in the area where the ill person stays. Use doors and windows to take advantage of breezes.
• Keep the environment clean with readily available household cleaning agents.
  If you are living in a country where Influenza A(H1N1) has caused disease in humans, follow additional advice from national and local health authorities.

What should I do if I think I have Influenza A(H1N1)?

If you feel unwell, have high fever, cough and/or sore throat:

• Stay at home and keep away from work, school or crowds as much as possible.
• Rest and take plenty of fluids.
• Cover your mouth and nose with disposable tissues when coughing and sneezing and dispose of the used tissues properly.
• Wash your hands with soap and water frequently and thoroughly, especially after coughing or sneezing.
• Inform family and friends about your illness and seek help for household chores that require contact with other people such as shopping.

If you need medical attention:

• Contact your doctor or healthcare provider before travelling to see them and report your symptoms. Explain why you think you have Influenza A(H1N1) (for example, if you have recently travelled to a country where there is a Influenza A(H1N1) outbreak in humans). Follow the advice given to you for care.
• If it is not possible to contact your healthcare provider in advance, communicate your suspicion of having Influenza A(H1N1) immediately upon arrival at the healthcare facility.
• Take care to cover your nose and mouth during travel.

More helpful information can be obtained from the links below:

http://www.cdc.gov/swineflu/general_info.htm
http://www.cdc.gov/swineflu/key_facts.htm
http://www.cdc.gov/flu/protect/habits.htm?s_cid=swineFlu_outbreak_internal_003
http://www.cdc.gov/flu/about/qa/preventing.htm

Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites.

The best time to start solid foods depends not only on the child’s age, but also on the child’s ability to sit up, support the head, and meet other developmental milestones. These guidelines apply to all children, including those who have delays with gross motor skills. The infant should be able to do the following:

* Sit with support

* Have good head and neck control

* Push up with straight elbows from lying face down

* Show readiness for varied textures of supplemental foods by placing their hands or toys in their mouth

* Lean forward and open the mouth when interested in food, and lean back and turn away when uninterested in the food or not hungry.

Additional skills are necessary before an infant should be allowed to progress to eating finger foods:

* By eight to 10 months, infants begin to have the skills necessary to eat finger foods independently (can sit independently, grasp and release food, chew food (even without teeth), and swallow).

* By 12 months, fine motor skills improve, allowing the child to grasp pieces of food between two fingers.

WHY WAIT TO START SOLIDS?

Introducing solid foods before age four to six months is not helpful and could be harmful. Other reasons that expert groups recommend delaying the introduction of solid foods include:

* Introducing solid foods before an infant is two months of age may interfere with the child’s ability to take in an adequate number of calories or nutrients and may increase the risk of developing food allergies.

* Young infants do not have the coordination and/or skills to safely swallow solid foods, which could lead to aspiration (inhaling food/liquid into the lungs).

* Infants have a reflex (called the extrusion reflex), which causes them to raise the tongue and push against any object that is placed between their lips. This reflex usually disappears between four and five months of age. Trying to spoon-feed a child who still has the extrusion reflex can be a frustrating and difficult experience for both the parent and the infant.

* By four months of age, most infants usually have doubled their birth weight. When infants have doubled their birth weight and weigh at least 13 pounds (5.9 kg), they may need to begin supplementing their liquid diet with additional foods to support growth and satisfy hunger.

* Delaying solid food intake until after an infant is four months of age may reduce the child’s risk of developing atopic dermatitis (eczema).

* Withholding solid foods until after the infant is six months of age may lead to decreased growth because the child may not consume adequate calories from breast milk or formula alone. In addition, delaying beyond six months may lead to the child’s resistance to trying solid foods. Withholding solid foods until after the infant is six months of age does not appear to prevent the development of atopic dermatitis.

PRECAUTIONS

Foods to avoid — Certain foods should not be given to any child under 12 months, including cow’s milk, hard, round foods that could cause a child to choke (eg, nuts, grapes, raw carrots, or candies), and honey. Cow’s milk is not recommended because it does not contain adequate iron; honey is not recommended due to the potential risk of exposure to a harmful bacterial toxin (botulism poisoning)

Food allergy concerns — An infant is said to be at “high risk” for developing allergic disease if there is at least one first degree relative (parent or sibling) with an allergic condition, including a documented food allergy, asthma, allergic rhinitis, or atopic dermatitis (eczema).

Previously, parents were told to delay giving highly allergenic foods, such as eggs, peanuts, tree nuts, fish, and shellfish, for months or years longer than other foods. However, studies do not show enough evidence in support of waiting to introduce these foods. Experts now recommend that high-risk infants be introduced to traditional supplemental foods between four and six months of age.

If the infant has no signs of allergy (including eczema) with the initial foods, additional foods can be introduced gradually, including the highly allergenic foods (eg, eggs, peanuts and tree nuts (although not whole nuts because of choking risk), fish, and shellfish). Cow’s milk should not be given to any child until after age 12 months.

The safest way to introduce highly allergenic foods has not been studied. It is possible for an allergic reaction to occur the first time the child eats a particular food.

Highly allergenic foods (eg, cow’s milk, eggs, peanut butter, fish, and shellfish) may be given to high-risk children in the following manner:

* The child should be given a first taste of one of these foods at home (rather than at a day care center or restaurant). Have an oral antihistamine (eg, Diphenhydramine/Benadryl® or Cetirizine/Zyrtec®) available in case of an allergic reaction.

* If the child does not develop any signs or symptoms of food allergy (skin rash, vomiting, diarrhea) over the next few days, the food can be offered again in increasing amounts over several days.

* If the child has signs or symptoms of an allergic reaction or develops a skin rash after eating a food, the parent should consult with the child’s healthcare provider and/or allergist before other new foods are offered, especially the highly allergenic foods.

TYPES OF SUPPLEMENTAL FOODS

There is no one food that is recommended as a first food. Single-ingredient foods should be introduced first, one at a time, every few days, to determine if the child has an allergic reaction. As solid foods are introduced, infants should consume no more than 28 to 32 ounces of formula per day. Breastfed children can continue to nurse on demand.

CEREAL

Single-grain infant cereal is a good first supplemental food because it supplies additional calories and iron. Rice cereal is traditionally offered first because it is widely available and is least likely to cause an allergic reaction. However, wheat products (in cereal or other foods) may be offered by six months of age.

Infant cereals can be prepared by adding breast milk, infant formula, or water. The consistency should initially be thin, and may be made thicker over time. Cereal should be offered initially by spoon in small amounts (one teaspoon) at the end of breast or bottle feeding. Spoon-feeding helps to develop the infant’s ability to coordinate mouth and swallowing movements as well as enhance future speech development. The amount of cereal should be gradually increased to one to four tablespoons twice per day.

If the child refuses or appears uninterested in the cereal, try again the following day using a thinner mixture.

Cereal should not be added to a bottle unless this is recommended by a healthcare provider as a treatment for gastroesophageal reflux (GER). Feeding cereal from a bottle prevents the child from learning to eat with a spoon. Infants with GER should be given cereal from a spoon in addition to the cereal in a bottle.

Does cereal help a child sleep through the night? — Most parents are eager for their infant to sleep through the night. However, there is no evidence that giving cereal to a child who is younger than four to six months old will help him or her to sleep better.

PUREED FOODS

Puréed foods, including vegetables, fruits, and meats, should be introduced one at a time, every few days. If the child has no signs or symptoms of an allergic reaction, a second food may be added the next week. Signs and symptoms of a food allergy include hives (skin welts) or other skin rash, facial swelling, vomiting, diarrhea, coughing, wheezing, difficulty breathing, weakness, or pale skin. Parents should consult the child’s healthcare provider if any of these problems occur.

As puréed foods are introduced, the goal is to expose the infant to new flavors and textures of food. The amount eaten is less important. The order in which foods are introduced (vegetable, fruit, or meat first) is probably less important than the texture and consistency of the food.

By the time an infant is eight months of age, the child should consume approximately 1/2 cup (4 ounces) of vegetables and 1/2 cup of fruit per day.

* First foods should be finely puréed, contain only one ingredient, and should not contain additives (salt, sugar). Vitamin C is often added to commercially prepared infant foods.

* Second foods are puréed or strained, often contain two or more ingredients (eg, fruit and grain, meat and vegetable), and should not contain additives (salt, sugar). Combination foods may be given after the child tolerates the individual components. Once thin purées are tolerated, thicker purées can be introduced.

* Third foods are usually combinations of food types, some of which have texture to encourage chewing. Some are seasoned with spices, although foods should not contain added salt or sugar. Chunkier blends often contain puréed food with small pieces of pasta, vegetables, or meat.

Safety issues — Safety issues regarding baby food include the following:

* After opening a jar or container of baby food, store it carefully to avoid spoilage.

* Jars of infant foods, once opened, should be discarded after two to three days according to most manufacturers.

* Commercial foods should be served from a bowl rather than out of the jar to avoid contaminating the unused portion. Food left in the bowl should be discarded.

* Jarred foods may be served cold, room temperature, or warm.

Preparing baby food at home — Puréed or strained foods prepared at home are nutritionally equivalent to those prepared commercially. However, precautions should be taken when certain foods are prepared at home. Home-prepared or canned spinach, beets, turnips, carrots, and collard greens should not be given to infants younger than four months of age because they may contain enough of a chemical (nitrates) to cause a condition that reduces the amount of oxygen carried by the blood (methemoglobinemia). In addition, home-prepared canned foods should not be given as infant food if they contain large amounts of added salt and/or sugar.

FINGER FOODS

As the child gains the ability to feed himself/herself, a greater variety of “adult” foods can be offered, including finely chopped, soft foods.

Foods that are choking hazards are not recommended in children younger than four years. These foods include hot dogs, peanuts, tree nuts, grapes, raisins, raw carrots, popcorn, and round candies.

FRUIT JUICE

Juices may be introduced when an infant can drink from a cup, beginning at approximately six months of age. Before an infant reaches six months of age, fruit juice is not necessary or recommended.

Fruit juice should be labeled as 100 percent juice (as opposed to “fruit drinks”), and should have added Vitamin C. The American Academy of Pediatrics recommends the following guidelines for consumption of fruit juice:

* Fruit juice should be offered only from a cup (not a bottle or sippy cup).

* A child should not drink more than four to six ounces of fruit juice per day. Individual servings may be diluted with water if desired.

* Fruit juice should be used as part of a meal or a snack and should not be sipped throughout the day or given at bedtime.

* Drinking too much juice can lead to overnutrition or undernutrition, diarrhea, gas, bloating, and dental cavities.

* Fruit juice consumed by infants and children should be pasteurized (heat treated to kill harmful bacteria). For example, infants should not be given fresh-pressed apple cider.

* Calcium-fortified juices provide a good source of calcium. However, juice should not be given in place of breast milk, formula, or cow’s milk, because it lacks other important nutrients.

VITAMIN AND MINERAL SUPPLEMENTS

Some children require vitamin or mineral supplements.

Iron

Iron deficiency is the most common nutrient deficiency in the United States. The amount of iron required depends upon a child’s gestational age and birth weight. Premature and very low birth weight infants are at risk for iron deficiency, and should be given an iron supplement (in the form of multivitamin drops) beginning at one month of age and continuing until the child is at least 12 months of age. Infants who are not premature who are given iron-fortified formula usually do not need any additional iron supplementation. Low-iron formulas are not recommended in any situation and are no longer available in the United States.

After four to six months of age, a full-term breastfed infant may not get an adequate amount of iron from breast milk alone. At this time, some form of iron supplementation (eg, iron-fortified infant cereal) is recommended. An average of two servings (two ounces of dry cereal per serving) of iron-fortified cereal per day is sufficient to meet an infant’s daily iron requirement. Additional iron can be given (in the form of multivitamin drops) if the infant cannot consume an adequate amount of iron-fortified cereal.

After solid foods have been introduced, at least one feeding per day should contain foods rich in Vitamin C (eg, citrus fruits and juices, cantaloupe, strawberries, tomatoes, and dark green vegetables) to promote iron absorption from iron-rich foods (such as puréed meat) consumed during the same meal.

Fluoride

Fluoride is a mineral that is often found in drinking water. Fluoride can reduce the risk that a young child will develop dental caries, also known as cavities. However, not all drinking water contains an adequate amount of fluoride.

A fluoride supplement is recommended for children between six months and three years if the fluoride level in the local water supply is low. To determine the level of fluoride content in the local water supply, call the water department or bottler, or arrange to have well water tested.

Vitamin B12

The body requires a source of Vitamin B12 to maintain blood cells; meat, eggs, and dairy products are the only food sources of vitamin B12. Low levels of vitamin B12 can lead to anemia, developmental delay, and other problems.

A multivitamin supplement that includes B12 is recommended for breastfeeding infants of strict vegetarian (vegan) mothers, and for infants who are fed a vegetarian diet. Adequate B12 is available in most non-prescription infant vitamin drops and in certain brands of nutritional yeasts, most ready-to-eat cereals, many meat substitutes, and some milk alternatives. Fortified soy milk is a good source of B12 for children.

Vitamin D

The body requires Vitamin D to absorb calcium and phosphorus, which are essential in the formation of bones. Inadequate levels of vitamin D in children can lead to a condition known as rickets, which causes bones to be fragile and to break easily. This is especially true in dark-skinned children.

All infants, including those who breastfeed and/or bottle-feed, should be given a supplement containing 400 IU of Vitamin D per day, starting within days of birth. Vitamin D is included in most non-prescription infant vitamin drops. In some countries, it is possible to buy infant drops that contain only vitamin D.

Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites.

Here are some of those images:

The link below will guide you to the page on Teri’s blog about our session.

Blog: Teri Mason Photography
Post: the D family – Austin Family Photographer
Link: http://terimasonphoto.blogspot.com/2009/02/d-family-austin-family-photographer.html

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• Find out if the one recommended is on ur insurance plan (most important).

• Ideally, ur OB and the hospital that she/he conducts deliveries should be w/i 30 min driving distance. For me, I wanted an all women OB group, as I’m not comfortable w/ the chance that a male OB might be on call when my baby decided to come out.
• Also, try NOT to schedule induced delivery/ elective C-section before u’re at least 39 weeks pregnant, unless u’ve other complications that might ur OB wanna induce u sooner. For normal pregnancies, its best to carry your baby all the way to 40 weeks.

• Also, try 2 pick an experienced OB, more so, if u’re ‘ving complications and might expect a difficult labor. Most of the OB’s nowadays, dont do vacuum extraction, as it can be damaging 2 baby’s brain. But, some do forceps extraction. And, a lot of the newer OB’s dont get enough training in forceps/vaccum during residency, as a lot of teaching hospitals dont encourage those & even if they do, they’ve d more experienced OB’s do the actual procedure, while the residents assist. But, even OB’s fresh out of residency are well trained in C-section; so, dont worry, if u’re gonna’ve an elective C- section. Again, 4 that matter, try not to go to a teaching hospital for ur delivery; but, if u’ve to, double check w/ ur OB that she or her partner will be present at the delivery.

• Also, make sure tht ur OB doesnt ‘ve many malpractice claims against her. Go 2 http://www.fsmb.org/directory_smb.html#b11 & under the specific state medical boards, there’s a section for consumers to obtain information on all the docs licensed (BELIEVE ME!!! U WANNA MAKE SURE THT UR OB IS BOARD CERTIFIED TOO) in that particular state.

• Most important of all, ur OB shuld be approachable & easy to get hold of during after hours and weekends, as u’re gonna ‘ve a lotta Qs and worries during even a totally normal pregnancy.

• Keep an accurate count of those wet diapers. Not the poopy ones; but, the WET ones. If the number is <6, it’s a red flag.
• Is ur baby satisfied after a feed & is going to sleep content or is he still looking around for more food? If you see signs like sucking movements of the lips, searching for the nipple, that means he/she hasnt had enough.
• Another option is to take test weights.

For preterm infants or infants having difficulty with breastfeeding, serial test weights may be used in the home to monitor your baby’s breast milk intake. Serial test weights are pre and post feeding weights obtained on a special electronic scale to determine the volume of breast milk your baby received during breastfeeding. Your care provider will tell you how many test weights to perform every day. Sometimes test weights are done once a day and sometimes they are done with every feeding. You should keep a written log of the feeding volume measurements and show it to your care provider at each scheduled appointment.

Supplies needed:

• Medela BabyWeigh Scale
• receiving blanket
• pencil and paper

Procedure:

1. Clean the scale using a SaniWipe prior to use.
2. If you are going to use a blanket or lap pad, place on the scale.
3. Turn scale on by pressing the “On / Zero Button”
4. Lay baby on scale in clothes, diaper, blanket, etc. **He or she does not need to be naked for the pre-feeding weight.
5. The weight will lock in and will have a small arrow by memory lock. Press the button that says “weight entry”.
6. Remove baby from scale and press zero again.
7. After mother is finished breastfeeding, place baby on scale again.
8. Once the post-feeding weight locks in, press the button labeled “weight gain” and this will give you the calculated intake or the difference between the 2 weights.
9. Record the “Test Weight” on your log sheet. The type and amount of additional fluids should also be recorded on your log sheet.
10. The scale automatically calculates the difference between the two weight measurements. This number in grams (g) equals the volume in milliliters (ml) of your baby’s milk intake. Your care provider will tell you if your baby needs additional fluids based on his or her specific nutritional needs.

Tips:

For accurate weights follow the tips below:

• The scale must be placed on a sturdy level surface such as a table or counter top.
• Check the level indicator on the scale and adjust using the dial button until the scale is level.
• Check to make sure nothing is touching the sides of the scale.
• Make sure your baby’s blankets, clothing, or medical tubing / wires are not hanging over the edge of the tray.
• Weigh your baby in the same clothing before and after breastfeeding.
• Do not change your baby’s diaper until the test weight measurements are complete.

The link below will give u more information about the Medela weigh scale. You can either rent or purchase one.

http://www.medelabreastfeedingus.com/products/diagnostic/227/babyweigh-scale

Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites.