Dr. Phillips shares her inspiring journey from growing up in Texas to becoming a doctor and a leader in the health care field, all while balancing family and the challenges of being a woman in medicine. 

Annie discusses how her mother’s path influenced her own career choices and the bond they share working together in healthcare. Together, they reflect on the challenges of motherhood, the importance of resilience, and the power of family support. 

Tune in on Spotify, Apple Podcasts or YouTube to hear a mother and daughter who are not only committed to improving children’s health but also to growing and supporting each other along the way.

Finding infant formula on store shelves can still be tricky if you’re shopping for specialized types made for premature infants or babies with digestive complications.

Nutritional experts at Cook Children’s say some patient families are struggling even though formula availability generally has improved in recent months. The 2022 shortages have been blamed on a manufacturing recall and supply chain disruptions.

Brand options tend to be limited for preemies, who require formulas with higher calcium, phosphorous and protein for their bone and brain development. Likewise, infants who undergo surgery on their stomach or intestines might need certain easy-to-digest formulas.  

We spoke with three registered dietitians – from the Cook Children’s Neonatal Intensive Care Unit (NICU), the N.E.S.T. Clinic, and the Gastrointestinal Clinic – about tips and support for parents when the formula their baby takes is out of stock.

Their advice? Consider switching to another appropriate brand. Use the imported formulas that received approval from the U.S. Food and Drug Administration. Ask your pediatrician for samples. Don’t dilute formula or make your own version. And don’t give up.  

“I still see grocery stores with formula shelves that look about half empty or less,” said Hayley Spinks, a clinical dietitian in the NICU. “If you’re looking for a specific formula, it doesn’t really matter if the shortage is getting better overall. If you can’t find the formula that your baby needs, it’s really a big deal.”

One resource the dietitians share is a substitution list they created to help families know which brands fall in categories for particular needs. The substitutions list includes standard formulas, premature formulas, reduced lactose formulas and more. Go here to view the formula substitution chart.

The shortage continues to cause challenges and frustration, but dietitians are working to help parents find solutions. Here are their viewpoints.

In the NICU

Dietitians in the NICU monitor growth of the smallest babies, who sometimes need fortifiers added to their feeding regimen. When a preemie product runs out of stock, Spinks said, they turn to alternatives with the right nutritional components that the infant can tolerate. Signs of formula intolerance may include diarrhea, vomiting and belly bloating.

Before patients are discharged, Spinks and her colleague in the NICU like to ask the parents whether they’ve been able to find the formula they need. “Some moms are telling me that they’ve looked and they can’t find the formula that their baby is on,” she said. Others tell her they’ve enlisted relatives and friends to help search the stores.

Spinks makes a habit of checking the formula aisle when she’s shopping. She also belongs to formula finder groups on social media. “I’m always trying to keep my eye on the situation of what we can expect,” she said.

She encourages parents to have confidence in the safety of formulas that have been imported since May to relieve the shortage in the United States. But she cautioned that the measurements might differ (milliliters versus fluid ounces). Always follow the recipe on the can.

In the N.E.S.T. Clinic

The Cook Children's N.E.S.T. Developmental Follow-up Center (cookchildrens.org) provides support, interventions and care coordination for NICU babies as they transition home.

 “A majority of our patients require specialized formula either to meet their increased nutrient needs from prematurity or to improve their tolerance and absorption,” said registered dietitian Kayla Harrell.

Harrell said the shortage has forced some patients to change formula multiple times, incurring the risk of tummy distress, allergic reactions and other symptoms of intolerance. She has seen some improvement in availability. But parents tell her stories of driving up to two hours to track down formula or shipping it from out of state.    

For children with medically complex dietary situations, Harrell said, the formula hunt can be difficult and heartbreaking.

“You are not alone,” she said. “We are always here to help find the best solution for your precious child.”

In the GI Clinic

Gastrointestinal conditions can include bleeding, inflammatory bowel disease, chronic liver disease, swallowing dysfunction and nutrition absorption disorders. Some patients require formula fed through gastrostomy tubes called G-buttons.

Chelsea Barrow, a registered dietitian, said many children with GI problems have significant allergies, growth failure or reflux that causes them to rely on highly specialized formulas delivered from medical supply companies. Some of these formulas have gone in and out of stock, causing shipments to be delayed or partially fulfilled, Barrow said.

“Families are telling us they are driving around everywhere to find formulas,” she said. “They’re unable to find formula on the shelves or online. There’s limited access to grocery stores and pharmacies in their small rural towns. Families are asking if anyone has formula to spare or looking to social media for options.”

Barrow said it’s important to communicate with your health provider regarding brand substitutions. Not all formulas are interchangeable for individual patients, and mixing instructions can vary between brands. She urges patience as the dietitians navigate the inconsistent formula availability by adjusting orders, communicating with medical supply companies, fielding phone calls and continuing to see a full clinic load.

“There is indeed a light at the end of the tunnel with the return of many specialized formulas,” she said. “We are all working very hard and long hours to ensure families have something safe to feed their child.”

RELATED: Two Cook Children’s pediatricians shared their guidance on the infant formula shortage. Click here to watch videos in English and Spanish. 

During routine yearly checkups, we ask about your child’s nutrition including soda consumption. When I ask this, parents often respond, “no doc, we don’t give him/her soda," but add that if they do drink soda, it's clear, such as Sprite, 7up, Sierra Mist), etc. But parents wonder, are clear sodas really healthier than dark sodas?  It looks clear, it’s not brown, it smells like lemon-lime…it must be OK, right? Not so much. Let’s look into this a little further.

So first let’s first start with the simple fact that clear sodas are still soda! We discourage sodas for several reasons but mainly for the sugar content. For example, a can of Sprite has 38 grams of sugar and a can of Coke has 39 g of sugar. So you can see there’s not much of a difference between the two. That’s about 9 teaspoons of sugar in one can!!

Studies show that kids who drink more than 10% of their daily calories from added sugar are more likely to have abnormal cholesterol levels and a higher chance of getting Type 2 diabetes.

The other main reason we discourage sodas is the caffeine content. It is true that clear sodas do not have caffeine. However, there are many other options for a hydrating drink without sugar such as good old-fashioned water. If your child does not like water, try adding fresh fruit or mint or from time to time try a zero-sugar sparkling water to satisfy that craving for “fizz.”

So what about diet sodas?  Most experts would recommend that children should avoid diet sodas in kids. Many diet sodas are sweetened with artificial sweeteners and long terms effects are still not clear.

There you have it! Clear soda is not a healthy choice for a drink. Opt for water!

Nutrition experts at Cook Children’s want parents to know that lunch in the school cafeteria presents unique challenges and opportunities for students to form healthy eating habits.

First, the challenges …. Foods that some kids don’t like or won’t try. Too little time to eat.  Vending machines. And famished kids and teens who skip lunch and go home so hungry they eat meal-sized snacks after school.

And the opportunities …. Appropriate portion size. Attractive options. Nourishment helps students concentrate in the classroom, power through PE, and hit their growth milestones.  

As the 2022-2023 academic year gets underway with new lunch routines, families are encouraged to have ongoing conversations with their children about what they’re eating or not eating. Best practices will incorporate vegetables, lean proteins and whole grains in every meal. Getting your child’s input on preferences can help make the most out of their lunch period.

“Look at the menu ahead of time and make a plan so that they’re being mindful about eating veggies and other healthful foods,” said Kathryn Wheeler, D.O. at Cook Children’s Pediatrics Clearfork. “Preparation will help empower the kids to make good choices.”

Lunch Line Options

The Journal of the Academy of Nutrition and Dietetics reported that youth between 2-18 years old get almost half of their daily calories from added sugars and solid fats in sodas, fruit drinks, desserts, pizza and whole milk. The National School Lunch Program sets limits on sodium, saturated fat and calories. Five components are included in school-served lunches:

1. Fruits (fresh, frozen, dried or canned in light syrup or juice)
2. Vegetables including dark green, red/orange, beans or peas (fresh, frozen or canned)
3. Grains  
4. Meat or meat alternatives such as beans
5. Low-fat milk

Registered dietitian Lauren Williams works in the Risk Evaluation to Achieve Cardiovascular Health (REACH) program, which serves children and teens with high cholesterol, lipids disorders, diabetes and obesity at the Cook Children’s Endocrine Clinic. Williams sometimes hears complaints about school lunch from her patients.

“They might only eat the fruit because they don't really like the main entree, or they might only eat the main entree because the vegetables are overcooked or unappealing,” she said. ‘They might only like one or two components out of the five that are served. And if they don’t supplement with something from home, they may be left hungry.”

Another concern is inadequate time to eat lunch, which forces children to eat so quickly that they don’t respond to the fullness cues sent from the stomach to the brain. In a hurry, they overeat.

“What they're being inherently taught by having 10 minutes to eat is ‘I have to eat this quickly because if I don't eat right now, I don't eat,’” Williams said. This may also lead to the habit of eating quickly at other meals. Or if their lunch break happens at 10:45 am, they might be hungry and overindulge in snacks later in the afternoon.   

Williams recommends that parents talk to their children about what they ate at school. Bonus points if this is a conversation had around the dinner table since family dinners are another important part of healthy eating. If they’re not liking what the cafeteria serves, then bring a lunch from home.

Packed Lunches

Consider making sandwiches, wraps, pasta or salads. Include a protein (such as turkey or ham, cheese, Greek yogurt, beans or nuts); a starch (beans or whole-grain bread or tortillas); and fruit and vegetables for fiber (carrots, celery sticks, bell peppers, apple slices).  Williams also suggests a side of hummus or a dip to keep things fun and entice kids to eat more vegetables.

“It doesn't have to be fancy,” she said. “It just has to fill their tummy with some nutrition to get them through the day.”

More back-to-school advice from the dietitian:

• Rely on familiar favorite foods. “If you know that your 8-year-old is perfectly fine with having carrots most days with lunch, then that's OK,” Williams said.
• Ask your child about anything that might make them apprehensive in the cafeteria environment, especially on a new campus. Normalize the discussion of their lunch routine. “Don't be too hard on your kids if they don't choose the broccoli or green beans. Find out why.”
• Keep a handy stash of nutritious foods for after-school snacks. Her top picks include peanut butter crackers, non-fat yogurt, cut-up veggies and low-fat cheese sticks. Keep in mind that snacks should bridge the gap until dinner and not be meal-sized portions.

“You can't always guarantee that a child is going to choose fruit over a cupcake or cookie, but having it there and accessible makes it a whole lot more likely,” she said.

At annual check-ups with her patients, Dr. Wheeler talks with children and families about the benefits that come from consuming the right foods. She emphasizes the role that nutrition can play in preventing diseases down the road, one small step at a time, such as eating less processed foods and more fresh produce.  

“We know that all those good habits they have in childhood lay the foundation for a healthy lifestyle as they grow up,” she said. “Parents can be such great models.”

“They often times ask me if they should give their child a vitamin,” Dr. Mangham said. “Generally speaking, kids do not need to take a multivitamin or any supplements, for that matter.”

What is better than a multivitamin a day?

1. A good night’s sleep - every night.
2. A healthy, well-balanced diet.
3. Exercise and outside time
4. Good hand washing before meal time.

Dr. Mangham said going back to the basics with the above recommendations will boost your child’s immune system much more than any supplement could.

Recently, the New York Attorney General’s office cracked down on many major retailers, saying the herbal supplements they were selling didn’t live up to the promises on the label.

Joel Steelman, M.D., an endocrinologist at Cook Children’s said the quality testing program that stores such as GNC plan to put in place is a positive start, a lot of the herbal supplements have little hard science to really back up effectiveness.

“In my opinion, herbal supplements don’t really have a place for use in children,” Dr. Steelman said. “I’ve done research in the past on behalf of families asking about alternative treatments to use along with their child’s diabetes care. Most of the research is very weak. I suspect that very weak describes most data on use in children, and there’s a variety of medical case reports on negative effects of supplements on children.”

Jessica Holy, a Cook Children’s dietitian in Neurology, is frequently asked what vitamins and/or supplements are worth taking. She said that answer differs for parents and their children.

“Most of us have heard that if we tend to eat a variety of foods, then we don’t need a vitamin/mineral supplement. There is truth in that,” Holy said. “If you usually eat several servings of fruit, vegetables, whole grains, calcium-rich dairy and quality protein sources daily, then you are likely meeting your need for most vitamin and minerals. But how many of us have diets like that? Even though I’m a dietitian, I freely admit that I do not have a perfect diet. The busy pace that most of us keep makes it difficult to plan healthy meals for ourselves and our family. We often find ourselves turning to grab-and-go options at the grocery store or fast food. If this resembles you, then taking a regular, adult multivitamin daily may be a good idea.”

In children, a multivitamin might be needed during times of fluctuating appetite and food jags (only eating a few specific foods). For instance, children who aren’t getting enough iron in their diet may need to take an iron supplement for a period of time, until they begin eating more protein.

For the most part, children are able to get their needed vitamins through what they eat. Infants get their necessary vitamins through breastmilk (including routinely fortified with supplemental vitamin D) and/or formula intake and toddler and school-aged children are often able to achieve their need for calcium and vitamin D by drinking milk.

But beware excessive milk intake (greater than 24 ounces daily).

“Milk has some good nutrients, but it is lacking in iron,” Holy said. “Children who drink large quantities of milk are not often hungry for regular meals that provide iron-rich foods.”

If your child is allergic to milk, talk to your pediatrician for alternatives.

The report published in The Lancet states the amount of children and adolescents rose to 124 million in 2016, compared to 11 million in 1975.

More than 20 percent of children in the United States were found to be obese in the age groups of ages 5 to 19 years of age.

While the study focuses on children, experts at Cook Children’s say the parents have to take accountability in keeping their children healthy.

Joel Steelman, M.D., an endocrinologist at Cook Children’s, said unhealthy food choices are more accessible with the increase of fast food choices across the world. These foods are usually higher in sugar and lower in not only nutrition, but cost of the food.

The other factor in the increase in obesity is sedentary behavior. But Dr. Steelman said increasing activity is easier said than done for many families, who are faced with children relying more on electronic media for entertainment and parents facing unsafe environments to let their kids go outside and play. Still, he said changes begin with the entire family making as many health changes as possible.

“Families have to be involved in helping a child with weight management,” Dr. Steelman said. “Often times this is not just a child issue, but a family-wide issue that needs to be addressed. I think that the biggest issue for families though is not to become militant and overly rigid in trying to help a child with weight management. Definitely, no shaming. The things you can do right now are pretty basic. That is changing your diet and encouraging more physical activity. I know it sounds simple, but this seems to be the best solution.”

Don Wilson, M.D., an endocrinologist at Cook Children’s, is the medical director of the Risk Evaluation to Achieve Cardiovascular Health (REACH) Clinic. The clinic is committed to improving the lives and well-being of children who are at risk or affected by obesity.

“The only way to be successful in the struggle with obesity is for all adults and children (with the assistance and encouragement of their parent/caregiver) is to embrace therapeutic lifestyle changes,” Dr. Wilson said. “Success starts with a positive self-image and a ‘can do’ attitude. We in the medical profession can help educate and encourage, but need to avoid blame and comments that demean the victim. Obesity is, and always has been, a disease. It should be treated as such. In general the public needs to understand the short-term and long-term consequences of obesity, including diabetes, premature heart disease, and several forms of obesity-related cancer. Only then will successful management/prevention be achievable.”

Virginia Landrum, a dietitian in clinical nutrition in Gastroenterology at Cook Children’s, said she stresses to parents and children that the entire family must be involved in making changes.

She lets her patients who are working to lose weight not to look at their changes as diet, but as a lifestyle change.

Landrum advises parents to help their kids get healthier by taking these steps:

1. Help your children be involved in the meal. Let them pick out some healthier food options that they may want to try.
2. If they are old enough, let them be involved in food prep.
3. Offer new foods. Studies show it can take as much as 20 times for some children to accept new food options. Landrum said parents may have to start by simply placing the new food item on the plate.
4. Parents have to set the example. Eat the healthy foods with your child. Let your child watch you eat vegetable. Go outside and walk with your child, play a sport or ride a bike.
5. Turn off the TV, video games and eat together as a family.

The CDC points out that commercial toddler foods and infant or toddler snacks, desserts, and juice drinks are of potential concern due to sodium or sugar content. 

But it doesn't end with toddler foods.

Food and drink companies are finding ways around the U.S. Food and Drug administration (FDA) regulations to mislead consumers into thinking their products are healthy. We highlight a few deceptive terms frequently used on food and drink labels that you should know about.

1. “All Natural”

The FDA currently has no definition for this claim. Foods and drinks that do not contain added color, artificial flavors or synthetic substances are allowed to write “All Natural” on their labels. This allows a lot of room for interpretation for the food companies.

2. “Reduced Fat/Sugar”

Beware of claims about reduced amounts of fat and sugar. According to the FDA definition for “reduced”, the item only needs to have 25 percent less of the claimed nutritional value than the original referenced item. Many times items that claim to be reduced are not necessarily healthier. Companies make up for ingredients taken out in other areas. For example, a reduced fat item might increase the amount of sugar in the product to keep the taste consumers prefer. Always check the nutrition label to see if the product is actually healthier.

3. “Zero Trans Fat”

In the U.S., if a product contains less than 0.5 grams of trans-fat per serving it can be advertised with “Zero Trans Fat.” In this case, the nutrition label will often read 0 grams of trans fat. The problem is once you eat more than one serving the product no longer has zero trans-fat. Make sure to check the ingredients for hydrogenated oils which indicate trans fat in the product.

4. “Organic”

There is a common misconception about the powers of the term organic. Organic refers to the way a product is produced. It has to be produced by an approved method sanctioned by the U.S. Department of Agriculture (USDA). People think buying organic is the key to weight loss, but buying organic items does not necessarily cut down the calories. Just remember to look at the nutrition and ingredients labels, even if the product is organic.

5. “Cage-Free and Free-Range”

Most people read this claim and picture chickens running free in an open farm pasture. This is not the case. The term cage-free only implies that each hen is not locked in an individual cage, but in an open barn. Many times these hens are never given outside access. Similarly, the USDA only regulates that a free-range hen must have access to outdoors.

We spoke to Lisa Pegram, a registered dietitian at Cook Children’s, about how parents can decipher through marketing messages and know which foods are actually healthy. Pegram teaches her patients that “fresh is best.” The fresher the food, the more nutrients it will give you. Look for nutrient rich items in the grocery store. It is important to consume calories that give you nutrients which make you feel full. For example, eating a chocolate chip cookie gives you a lot of calories, but no nutritional benefits. It can leave you feeling hungry and unsatisfied.

Don’t rely solely on the wording on the front of the label. Pegram said, “I always tell parents to turn the food product around and look at the ingredients list to see what you are actually buying. If you see a chemical equation, you should probably do away with it.”

Pay attention to the order of ingredients listed on a label. The first few ingredients listed are the most used ingredients in the product. Pegram said that in most cases, the fewer ingredients, the better. The final thing to look at is the serving size because companies will often make it far less than a consumer would normally eat. Pegram warns that if you are going to eat double the serving size, you need to double the calories, fat, sugar, etc.

Parents have the most influence over what their child eats on a daily basis. Make a commitment to learn about these deceptive marketing tactics used by food companies to trick consumers. You and your family will feel better and live a healthier lifestyle.

For more information on food and drink regulations, visit the FDA and USDA websites at www.fda.gov and www.usda.gov.

By now you’ve heard about trans fats so much, you may start to tune out how dangerous they can be for your child. We hear these buzz words all the time and it’s hard to tell any more what is and isn’t a serious threat.

How bad are trans fats for you? Toward the end of last year, the U.S. Food and Drug Administration (FDA) made the decision that hydrogenated oils may no longer be generally recognized as safe. That means if a final determination is made (which should be any time now), food manufacturers could no longer sell food products with trans fats or use them as an ingredient without prior FDA approval.

Here are four things you should know about trans fats to help you the next time you’re out shopping or ordering at a restaurant:

1. What are trans fats?

Trans fats are one of the “bad fats.” Some do occur naturally in foods, but most are created by adding hydrogen molecules to liquid vegetable oils. You’ll see them on food labels as “partially hydrogenated oils” or “hydrogenated oils.”

2. Where are they found?

Companies use trans fats because they’re inexpensive, last longer than other fats (increased shelf life), and give foods a good taste and texture. Trans fats are most often found in processed foods or fast foods.  Examples of trans fats are fried foods, baked goods, shortening and margarines, canned frosting and baking mixes. 

3. Why are they so bad?

Trans fats increase your LDL (“bad”) cholesterol and decrease your HDL (“good”) cholesterol.  They can increase your risk for heart disease and stroke, and there’s an association between trans fat consumption and higher risk for Type 2 diabetes mellitus.

4. What should we do?

• Look for trans fats on nutrition facts labels and look for partially hydrogenated oils in the ingredients list. Try to avoid trans fat (0g and no partially hydrogenated oils).
• Cook and eat at home as much as possible.
• Limit processed foods, especially at snack time. Reach for fruit, almonds or a light string cheese instead of chips or processed snacks.
• If eating out, choose baked or grilled proteins and watch “extras” like breads and sauces that may contain trans fat.

Trans fats are dangerous, but the good news is you can protect your kids from them. Start today by reading nutrition facts labels, ingredient lists, and eating at home as often as possible.