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Metropolitan Pediatrics

What about Juice?

Say NO to Juice

In addition to avoiding soda and fruit drinks, our pediatricians recommend avoiding all juice — even 100% juice. Juice, soda, and fruit drinks all contribute extra sugar and calories. They can also lead to cavities.

Say YES to Fruit

Children should eat whole fruit. Fruit contains fiber and it takes longer to eat the same amount of calories as fruit juice. Whole fruit increases fullness and decreases spikes in blood sugar. When we drink calories, our body doesn’t get the same fullness signals that it does with food. The feeling of fullness from beverages quickly goes away and leaves us feeling hungry again.

What about constipation?

Small amounts of prune, pear, or apple juice are sometimes recommended for constipation. Talk to your child’s pediatrician before adding these juices to your child’s diet for constipation.

Say YES to Water & Milk

  • Only human milk and/or infant formula are needed to meet fluid needs for infants up to 12 months.
  • Milk and water are the only fluids needed for older children. Talk to your child’s pediatrician about the type and amount of milk that is best for your child.
  • Water is the only beverage generally needed for children exercising one hour or less. Children should rehydrate after exercising to replace the fluids they lost during exercise through sweat. Sports drinks for electrolyte replacement may be needed for moderate to heavy exercise that lasts over one hour.
  • Electrolyte replacement solutions may be needed for dehydration in children during illnesses.

Ways to Break the Juice Habit

  • Dilute juice to a 50/50 blend or add a splash of juice to water
  • Serve water with thinly sliced fruit
  • Provide a reusable water bottle for school, lunch boxes, and after-school activities
  • Don’t bring juice into the house
  • Chill tap water by storing it in a pitcher in the refrigerator
  • Filter the tap water to improve the taste for children
  • Be a good role model!

More Questions?

Discuss any questions you have with your pediatrician.


Heyman, M.B. and Abrams, S.A. 2017. Fruit juice in infants, children, and adolescents: current recommendations. Pediatrics. 139 (6). http://pediatrics.aappublications.org/content/139/6/e20170967. Accessed February 14, 2018.

What juices can help relieve constipation? Healthline.com. https://www.healthline.com/health/digestive-health/juice-for-constipation#modal-close. Reviewed on March 23, 2016. Accessed February 14, 2018.

Treating dehydration with electrolyte solution. Healthychildren.org. https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Treating-Dehydration-with-Electrolyte-Solution.aspx. Reviewed on November 21, 2015. Accessed February 14, 2018.

Hydrate right during physical activity. Eatright.org. http://www.eatright.org/resource/fitness/sports-and-performance/hydrate-right/hydrate-right. Reviewed on March 23, 2015. Accessed February 14, 2018.

Pea Protein: An Alternative Protein Source for Vegetarians

Plant-based protein sources for vegetarians typically include soy, legumes, beans, grains, and nuts. From meat substitutes to dairy alternatives, products made with plant-based protein have increased in the past decade and are expected to take a third of the protein market by 2054. Pea protein is not new to the plant-based protein market, but is getting more focus as a plant-protein source. New products containing pea protein are now available in the dairy, condiment, and meat sections of major grocery stores. This increases the choices for those who follow vegetarian or vegan diets and for those with dairy or soy allergies.

What is pea protein?

Pea protein is removed from yellow split peas. Pea seeds are rich in protein, carbohydrates, dietary fiber, vitamins, and minerals. The amino acid content of pea protein is close to soy (a complete protein containing all essential amino acids). Pea protein is low in one important amino acid: methionine. Methionine is important in new blood vessel growth and is needed to make other amino acids. Combining different protein sources at the same meal isn’t necessary to make a complete protein. Eating protein from a variety of plant foods over the course of a day will provide enough essential amino acids (as long as caloric needs are met).

Environmental Benefits

Pea crops are grown throughout the world and require minimal resources. It takes less than two acres to get one ton of pea protein compared to fifteen acres to get one ton of beef protein. Other environmental benefits include zero greenhouse gas emissions, less water use than almond or dairy milk production, and increased nitrogen fixation in the soil reducing the need for nitrogen fertilizers.

What does it taste like?

Like other plant-based proteins, small flavor molecules add a beany or grassy taste. The process used in manufacturing pea protein removes off-flavor molecules from the protein without adding flavors or sugar to mask them. What’s left is a neutral taste that can take on new flavors.

New Choices in the Grocery Aisles

New milk alternatives made with pea protein are available in the dairy section. These products contain eight grams of protein per eight ounce serving. This is the same as soy milk and eight times the amount of almond milk. Other products in the dairy section include half and half and a Greek yogurt alternative. The Greek yogurt alternative contains six grams of pea protein per one cup serving. Sandwich lovers will find an eggless mayonnaise using pea protein in the condiment aisle. For those looking for a meat alternative, a 100% vegan burger with no soy or gluten can be found in the meat section. It packs 20 grams of soy protein per serving and looks, cooks, and tastes like fresh beef burger. Chicken and ground beef alternatives are also available.

According to the Academy of Nutrition and Dietetics, the regular intake of legumes and soy products will provide enough protein and essential nutrients for vegetarians. Plant-based proteins are not digested as well as animal protein so protein needs may be somewhat higher. It’s important to remember peas are in the legume family. Pea protein may pose a possible risk to people who have allergies to other legumes like peanuts and soybeans. If you have a legume allergy, be cautious when introducing pea protein into your diet.

References & Resources

Alternative Proteins to Claim a Third of the Market by 2054. Lux Research website. http://www.luxresearchinc.com/news-and-events/press-releases/read/alternative-proteins-claim-third-market-2054. Last accessed February 8, 2018.

Bernhisel-Bradbent J, Taylor S, Sampson H. Cross-allergenicity in the legume botanical family in children with food hypersensitivity. II. Laboratory correlates. J Allergy Clin Immunol 1989;84:701-9.

Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: vegetarian diets. J Acad Nutr Diet. 2016;116(12):1970-1980.

Palmer, S. Plant Proteins. Today’s Dietitian, 2017;19(2)26.

Pea Protein Is Coming Up Strong. Nutritional Outlook website. http://www.nutritionaloutlook.com/protein/pea-protein-coming-strong. Last accessed February 8, 2018.

Ruscigno, M. Pea Protein, Today’s Dietitian. 2017;18(12)32.

Tips to Help Your Child (& Yourself) Beat the Winter Blues

Authors: Audelia DeCosta, LCSW & Erin Grady, PhD

The Pacific Northwest is known for its many amazing qualities: the outdoors, mountain snow, beautiful coasts, and miles and miles of forests. It is also famous for its rainy, cold, and grey winter. So it’s no surprise that when the winter months bring us indoors, we see an increase in reports of depressed mood.

So short of moving to a sunnier spot, can anything be done to help beat the “winter blues”? Yes! It’s called Behavioral Activation.

How Behavioral Activation Works

We know that disengaging from our routines and withdrawing from our environment makes depressed mood worse. The opposite is also true. Increasing our access to things that reward us helps us to feel better.

By following the easy acronym BASE, you can help beat the winter blues.

Body care

How have you taken care of your body today? Exercise, sleep, eat well, and drink water.


What goal have you accomplished for the day? Keep it simple. Goals can be related to homework, something you’ve been wanting to do around the house, etc.


Have you connected with others today? Have a family meal or spend time with friends.


Do something that you enjoy each day. Take time to have fun, laugh, and smile.

Try It!

We created an easy-to-use worksheet that encourages patients and families to track and plan activities that help to improve mood. Click on the image below to download and use this worksheet at home!

We know it’s tough to get back to doing these things when you are feeling tired, unmotivated, and down. Here are some ways parents can help their children and teens:

  1. Track your BASEs too!
  2. Model behavioral activation and positive thinking.
  3. Reward your child or teen for scheduling and tracking BASEs. Focus on what they are doing, rather than dwelling on what they’re not.
  4. Schedule daily connection time with your child.
  5. Take your child/family outside!
  6. If symptoms persist, take your child to a therapist who specializes in evidence-based treatment for pediatric depression. The best treatment for depression in children and teens is Cognitive Behavioral Therapy (CBT), the first part of which is Behavioral Activation!
  7. Talk to your pediatrician about whether or not your child may benefit from a medical intervention for depression.

This winter, make sure to cover your BASEs!

More than Winter Blues

If your child is experiencing one or more of the following symptoms persistently, it may be more than winter blues. Please contact your pediatrician for an appointment, so we can help!

  • Frequent sadness, tearfulness, crying
  • Decreased interest in activities, or inability to enjoy previously favorite activities
  • Hopelessness
  • Persistent boredom; low energy
  • Social isolation; poor communication
  • Low self-esteem and guilt
  • Extreme sensitivity to rejection or failure
  • Increased irritability, anger, or hostility
  • Difficulty with relationships
  • Frequent complaints of physical illnesses, such as headaches and stomachaches
  • Frequent absences from school or poor performance in school
  • Poor concentration
  • A major change in eating and/or sleeping patterns
  • Talk of or efforts to run away from home
  • Thoughts or expressions of suicide or self-destructive behavior

National Suicide Prevention Lifeline:
1-800-273-TALK (8255)

FREE Workshop: Learn how to build resilience in your family!

JOIN US! March 6th or March 10th

Metropolitan Pediatrics invites you to participate in a FREE event that teaches easy ways to build resilience in your family.

This program was developed by the Children’s Health Foundation, child psychologist Dr. Amy Stoeber, and a team of local pediatricians.

What will I learn?

  • An overview of the impact of trauma and stress
  • The factors and behaviors that promote resilience in children and families
  • Parenting tools and strategies that teach children and families resilience
  • Self-care for families

Two separate training dates/locations are offered (childcare will not be offered at either event):

Tuesday, March 6th | 6pm-9pm
Providence Portland Cancer Amphitheater
4805 NE Glisan Street, Portland, OR 97213

* Light refreshments will be served.


Saturday, March 10th | 9am-12pm
The Oregon Medical Education Foundation Conference Center
11740 SW 68th Parkway, Portland, OR 97223

* Continental breakfast will be served.

Sign up online or call (503) 241-2385 to attend!

Ready for Exclusion Day?

Do you know if your child’s immunizations are up-to-date? In a few days, your answer to that question could really affect your child’s schedule (and yours, too).

Vaccine Exclusion Day is February 21st this year. Children who are not current on their immunizations by that day will be excluded from school or daycare until their vaccines are caught up, or an exemption is received.

Vaccines required this school year

If you discover that your kiddo is behind on vaccines, please give us a call to schedule an appointment to get caught up! We’re happy to help.

Metro Peds would like to remind our patients and families that vaccination is the best defense against vaccine-preventable diseases. Vaccines are given for specific diseases because they can cause very significant morbidity (illness) and mortality (death). The majority of children have no side effects from vaccines beyond a few tears from a needle poke.

Need a copy of your child’s immunization record?

Did you know that you can quickly print your child’s immunization record from your MyHealth account? You can also use the portal to ask non-urgent medical advice questions, view test results, schedule and view upcoming appointments, request prescription refills, and view your health summary!

If you’re not already signed up, get started at myhealth.lhs.org/myhealth/signup.

Credible Vaccine Resources

For more information about vaccines, please talk with your pediatrician. We know that concerned parents sometimes use the internet to gather vaccine information, and while there’s some good information out there, there’s also a lot of poor information. We caution you to be careful about the sources you use to get vaccine information. Here are some great, reputable resources about vaccines and their safety:

AAP’s Healthy Children

Children’s Hospital of Philadelphia: Vaccine Education Center

National Network for Immunization Information (NNii)

Parents of Kids with Infectious Diseases (PKIDs)

Vaccinate Your Baby

Voices for Vaccines

Happy Valley Welcomes Dr. Lincoln!

Happy Valley is excited to announce the addition of Dr. Douglas Lincoln to their team. Although he’s new to 9300 SE 91st Avenue, he’s not new to Metropolitan Pediatrics. He’s been with our Northwest team since July 2016, and is very excited to bring his passion and practice to the Eastside!

Patients are invited to schedule appointments with Dr. Lincoln at our Happy Valley location, starting February 1st. For our growing families, Dr. Lincoln will join our Eastside pediatricians in seeing newborns at Providence Portland and Legacy Mount Hood Medical Centers.

Devoted to providing comprehensive care to every child in a caring and family-centered way, Dr. Lincoln looks forward to working collaboratively with Eastside patients and their parents! His special areas of interest include helping families meet their breastfeeding goals, including evaluation and treatment of tongue tie; incorporating positive parenting strategies; participating in advocacy and public policy around child health issues; and teaching medical students.

With two young sons of his own, Dr. Lincoln knows the rewards that come with parenthood, and he’s also experienced first-hand some of the challenges. As your family’s pediatrician, he’ll support you through the ups and downs of raising a healthy family. You can count on him to be your family’s confidant, moral support, and trusted partner in your children’s health and well-being. He can’t wait to get to know you and care for your family throughout the years!

To schedule an appointment with Dr. Lincoln, please call (503) 261-1171.

For more information about Dr. Lincoln’s background, check out his online profile.

Constipation Frustration: A Dietary Approach to Your Child’s Bathroom Woes

Many parents worry that their child is not going to the bathroom enough and may wonder what they should do if their child is constipated. There are many things you can do as a parent to help with constipation!

What is “normal”?

Everyone has a different “normal” when it comes to bowel movements, ranging from multiple times a day to a few times a week. In infancy, the average number of stools could be 3-4 times a day or even once a week for breastfed babies. In general, the number of bowel movements decreases as they get older and reaches adult frequency by the preschool years. A good rule of thumb is if there is a sudden change in your child’s “normal” pattern, your child may be constipated and need your help.

Signs of Constipation in Children

  1. Few bowel movements. This is often the first clue you will notice especially if you are changing diapers or are potty training. Counting how many times your child is going to the bathroom at home and asking if they went to the bathroom at school could be a good start in tracking bowel movements.
  2. Straining while on the toilet. If your child takes a long time in the bathroom, is straining, or looks like they are in pain while going poop, this is often a sign of constipation.
  3. Swollen belly. If your child has a swollen belly or is experiencing abdominal pain, this could be a sign that they have poop backed up.

What are the causes of constipation?

  1. Changes in diet. If your child is eating a lot of sugary foods or junk foods, or starts eating more quickly, this can cause constipation.
  2. Not enough water. If your body doesn’t have enough water, it can make poop dry and hard to pass.
  3. Too much dairy. This is often a cause of constipation in younger children, but can affect children of any age.
  4. Not being active. Not enough activity can encourage bowel movements to stick around instead of moving along the digestive tract.
  5. Resisting or ignoring the urge. Some children have an uncomfortable experience and avoid going to the bathroom, or they don’t want to stop having fun so they stiffen or hide and resist the urge. Some children don’t feel the urge to poop if they are experiencing a lot of stress.
  6. Certain medications and vitamins. This can be a common symptom and should be mentioned to your primary care provider.

How can I help?

  1. Bathroom reminders! Invite your child to go to the bathroom regularly (like after every meal) to help them remember.
  2. Exercise! Get them to run around and increase physical activity to get things moving!
  3. Get more fiber! Eat more fruits and vegetables, whole grains, and beans to help the body move anything that is stuck.
  4. Prune juice, pear juice, and apple juice. Sorbitol is a kind of sugar in these juices that can help constipation. Children can drink 4 ounces a day to help constipation, but avoid extra sugar. The American Academy of Pediatrics does not recommend juice for any baby less than one year old.
  5. Drink more water! As we increase fiber, we want to make sure there is enough water so that we don’t make constipation worse. Warm liquids may help, too.
  6. Limit dairy. Lower the amount of dairy your child is eating until bowel movements return to normal.

When should I be concerned?

If your child is less than one year of age and has not gone to the bathroom in 3 days or is vomiting, has a fever, or blood in their stool, contact your primary care provider.


Constipation in Children. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/constipation-in-children/symptoms-causes/syc-20354242. Reviewed August 12, 2017. Accessed December 14, 2017.

Nurko, S., and Zimmerman, L. A. Evaluation and Treatment of Constipation in Children and Adolescents. American Family Physician. 2014; 90(2): 82-90. https://www.aafp.org/afp/2014/0715/p82.html. Accessed December 14, 2017.

What is Constipation? WebMD.com. https://www.webmd.com/digestive-disorders/digestive-diseases-constipation#2. Reviewed on November 13, 2017. Accessed December 14, 2017.

What juices can help relieve constipation? Healthline.com. https://www.healthline.com/health/digestive-health/juice-for-constipation#modal-close. Reviewed on March 23, 2016. Accessed December 14, 2017.