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Childhood nutrition

Contents

Child and adolescent nutrition - a few common issues
Sorting out fussy eaters
Hints for preserving protective nutrients in vegetables and fruit
What is a healthy diet (for adults and older children)?

 

Last partial update: January 2018 - Please read disclaimer before proceeding

 

Introducing solids to infants - Normal solids and allergic solids

There is now general aggreement that the best way to introduce solids is as follows.

• Introduce solids at around six months but not before four months (Prior to this the exclusive use of breast milk is the preferred feeding option.)
• Introduce allergenic solids once normal solids have been successfully introduced but before 12 months. These foods include egg (best introduced cooked, such as boiled egg), peanut pastes, wheat products, and dairy. This has been shown to be the best way to redice the risk of developing allergies to these foods. This is a significant change to previous advice and applies to both infants at higher risk of developing allergues (i.e. those wth a strong family history of allergy) and those at lower risk. In fact, high risk infants are the ones who are most likely to benefit from this earlier introduction of allergic solids as they were the ones who are most likely to avoid developing allergic disease. It is hoped that this approach to the introduction of allergic foods will halve the rate of food allergy in the community.

Infant formulas

• A standard cow's milk formula is the preferered option for all infants. There is no evidence that hydrolysed milk formulas offer any benefit with regard to reducing the incidence of allergic disease in either infants at high-risk of developing allergy or those at low-risk infants and their use is not recommended for this purpose.
• Soy formula is generally not recommended as a replacement where the mother cannot or chooses not to breastfeed.

 

Child and adolescent nutrition - a few common issues

It is vitally important for healthy eating habits to become second nature in childhood so that nutritional problems are less common in adolescence With regard to the adequacy of childhood and adolescent diets, two problems areas need to be mentioned.

• That maintaining an adequate calcium intake is important in all children and adolescents (especially adolescents, both males and females). Maintaining an adequate calcium intake is an important part of preventing osteoporosis and is an essential life-long task for all Australians. Healthy habits learnt in childhood are very likely to be carried into adult life.
• That adolescent females are by far the most likely to suffer from multiple deficiencies, the most important being calcium, zinc, iron and vitamin A. The likely reason for this finding is that about 25% of girls choose to be vegetarian at some time during adolescence and red meat is an important source of both iron and zinc. Many adolescent also have relatively smaller quantities of food. Adolescent girls who choose to be vegetarians need to understand how they can ensure their diets contain adequate nutrients. (See below.)

Solving these problems is a matter of providing the correct foods. There should be no need to use supplements.

Calcium - Inadequate intake

The best way to maintain adequate calcium intake is to ensure that all children and adolescents have at least two servings of milk or yoghurt each day. (In children over the age of four years, this should be reduced-fat milk products. A serving is 200g of low-fat yoghurt or 250mL of low-fat / calcium enriched milk.)
See section on calcium for information on 'Adequate calcium and vitamin D'

Iron - Inadequate intake (especially in adolescent girls)

Iron deficiency is not uncommon in adolescent girls, especially once they have commenced menstruating. Inadequate dietary intake is common, especially as many choose to be vegetarians. (Iron from 'vegetarian sources' is poorly absorbed compared to that from 'meat-containing' sources and vegetarians commonly need about 80% more iron in their diet than non-vegetarians to achieve the same iron absorption into the body.)

Symptoms of iron deficiency include tiredness, inability to concentrate, memory difficulties and depressed mood. This topic is discuused more fully in the section on vitamins and minerals, which includes recommended daily intakes and advice regarding good dietary sources of iron.

Other nutrients

Vitamin A: Symptoms from vitamin A deficiency are RARE in Australia as the liver can store about 1 to 2 years supply. Taking supplements can lead to toxic levels occurring and all that is needed to maintain normal levels is a diet adequate in foods containing vitamin A or its precursors, the carotenes or carotenoids.

Foods containing vitamin A (or its precursors)

• High levels: cod liver oil, lamb’s liver, palm oil. (While they contain the highest levels of vitamin A, these foods also have a very high fat content and are suitable for consumption only very occasionally. Palm oil should be avoided as it has a high saturated fat content.)
• Medium levels: carrots, spinach, sweet potato, egg yolk. These foods are much healthier sources of vitamin A and their regular intake will provide more than adequate quantities of this vitamin
• Low levels: Bread, potato, chicken.

Zinc: Zinc deficiency is also not uncommon. A list of foods high in zinc appears in the section on iron deficiency.

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Sorting out fussy eaters Getting children to eat a wide range of healthy foods is difficult for parents and can cause many family disagreements. About 30% of children are fussy eaters. This is a pity as eating is part of who we are and meal times are important family-together times. Thus, while it is important to ensure children learn to eat well, it is also important to try to achieve this with as little angst as possible. (There will be plenty of other issues to disagree over.) Parents have many years to achieve good eating habits in their children and learning good habits is usually a gradual process. (Most children take at least two to three years to develop adequate feeding skills.) Here are some suggestions that might help in this process. Try not to make too much of a fuss about children refusing to eat. Just take away the food that is not eaten. Do not then produce dessert. A food often needs to be tried many times before it is accepted. (Try up to 10 times before giving up.) Don’t create a meal that only includes things they do not like or have not tried before. Make sure there is something that they will eat but not so much of it so that they can fill up on that food item alone and not try something new. Try putting the food on several serving dishes rather than on plates. All family members can then help themselves. If the child chooses nothing or very little, the child will go hungry. The parent needs to put out just enough of each food item so that each member gets a normal serving. This will prevent the child just stacking his or her plate with one item of food that they particularly like. If a child eats little of his or her meal and is thus still hungry, provide healthy snacks (such as a piece of fruit) in between meals so that the child gets sufficient to eat. Not too much though as the child needs to be hungry for the next meal. And make sure that such snacks do not include treat-foods as this will just reinforce the poor behaviours. Keep to a regular meal routine each day (including morning tea / afternoon tea / snacks) Try not to eat too late when children are tired. Allow the use of fingers if that helps. Sometimes making food ‘fingers friendly’ helps acceptance. Present vegetables attractively. Be creative. Try making faces out of them. Do not bribe children with treats (high-fat, high-energy foods) for eating good foods. Remember that treats are only treats if they occur occasionally; not every day. Try not to have stores of unhealthy snack foods, such as biscuits, cakes, muffins, ice blocks and chocolates, in the house. Rather, buy one-off items for consumption on that day. When making biscuits etc, don’t make too many at a time and ration them out. Watch the drinks. Drinking lots of fluids between eating times will make children less hungry at dinner. In between main meals and afternoon and morning tea, use water as the drink of choice. Healthy drinks such as milk and unsweetened juice can be kept to designated eating times. Other poorer drink choices, especially cordials, sweetened fruit juices and soft drinks, are best avoided altogether. It is especially important not to let toddlers roam around for extended periods with bottles of any drink but especially sweetened drinks such as fruit juices and cordials. It adds too many calories and is very bad for their teeth. Do not watch TV while eating meals. For infants: Breastfeeding for the first six months Once solids are commenced, usually at about six months, try to make sure they have some texture and flavour. Home mashed / pureed foods are best and try to avoid purchased sloppy foods. Allow children to feed themselves when they are able. This will avoid parental overfeeding. Finally, it is important to remember that parents need to retain control over what is eaten and when. While healthy contributions to the family diet by children should be embraced, unhealthy preferences should not be allowed to adversely affect the content of the family diet or eating habits to a significant extent. More severe problems, where parents are worried about whether their child is receiving adequate nourishment, require help from a dietitian or psychologist, who can implemtent programs to assist the development of good eating skills, such as Sequential Oral Sensory Approach

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Tips for healthy eating and increasing physical activity at school

Top 10 ideas for keeping school children active and healthy

• Pick a day you can walk to/from school together – even consider parking the car a little further from the school and walking for 10 minutes.
• Cut up food so it is easy for little fingers to eat.
• Select comfortable school shoes that are great for walking, running and riding.
• Dairy food is a great snack, choose reduced fat cheese or a tub of yoghurt.
• Find some time to do some ‘free range’ activities like exploring your neighbourhood
• Include a frozen water bottle - it will help keep lunch cool and provides an icy cold drink.
• Plan a quick play at the local park on free afternoons.
• Plan ahead to avoid grabbing ‘easy’ pre-packaged foods and involve the kids too.
• Join your children in an after school swim, ball game, chasey, hopscotch or skip.
• Pack it safe! Use a good lunch box that insulates well and use ice bricks to keep food fresh

Simple swaps to keep the lunchbox healthy

• Swap White bread for wholegrain bread (Energy-producing wholegrains will help power your family through the whole day and gain extra fiber.)
• Swap full fat dairy products - yoghurt, cheese - for reduced fat versions (You’ll instantly reduce the amount of saturated fat in your family’s food, without compromising on calcium. And low fat versions are fine for children over two years old. )
• Swap chocolate and chip snacks for fruit or vegie sticks with hummus (They are colourful, tasty and offer a range of vitamins, minerals, fibre and sustained energy)
• Swap butter for margarine made from canola, sunflower or olive oil or avocado (Butter is a whopping 50% saturated (unhealthy) fat compared to 14% in margarine. Avocado is rich in healthy fats and tasty too.)
• Swap sweetened drinks for water (Sugary drinks are filled with calories but no nutrition – water will do a better job of hydrating and it’s free!)
• Swap salted foods for reduced salt versions (More than 75 per cent of our salt intake is hidden in packaged foods. Children are eating more than three times the salt they need in a day – reducing it will help them to have a healthy heart as they grow. )
• Swap packaged snacks for a home baked muffin (You can control the ingredients to create a healthier snack using low fat and salt reduced products; piklets, muffins and scones generally use less fat and swapping white flour for wholegrain or wholemeal, and adding fruit will increase the fibre.)

(Source: https://www.heartfoundation.org.au/news/top-tips-to-keep-school-kids-healthy-and-happy)

Hints for preserving protective nutrients in vegetables and fruit

• Start with fresh vegetables and herbs whenever possible
• Do not store fresh foods for long periods (a week at most).
• Store them in a cool, dark place.
• Keep pieces as large as possible when chopping/slicing.
• When cooking vegetables, minimise both cooking time and cooking water to reduce vitamin losses. Vitamin losses with cooking vary from about 10 per cent with steaming or micro-waving to about 50 per cent with boiling. Most of the vitamins lost are the water soluble ones. The preferred cooking method should be micro-waving (with little water), followed by steaming, stir-frying and lastly, boiling. If boiling, add food only when the water is boiling and boil in the smallest amount of water possible. Do not soak vegetables before cooking.
• Do not use copper pots or utensils as they can increase losses of some vitamins, particularly vitamin C.
• Use cooking water and liquid from canned foods in sauces, gravies etc.
• Do not use baking powder to preserve vegetable colour during cooking as it increases vitamin losses.
• Water soluble vitamins are the ones that are destroyed by cooking and dissolve into water. Maximum losses during cooking vary from 10 per cent for vitamin B12 to 100 per cent for more unstable vitamins, such as folate and vitamin C. Fat soluble vitamins are more hardy and don’t dissolve in cooking water.
• Heating is not always bad. While heating tomatoes decreases its vitamin C content, it increases the availability of antioxidants including lycopene.

 

Juice bar drinks Juice bars have proliferated in Australia over the past few years and while many of the fruits and vegetables used are both fresh and nutritious, there are a few problems. Many of them have added sugar which makes them very high in energy. They can really aid in putting on the kilograms. They occasionally include guarana, a product that contains caffeine. This making them mildly addictive. (This is often the source of caffeine in so called ‘energy drinks’. They often make claims about nutritional benefits which are hard to justify. This is especially the case with drinks that contain herbs as well. They are relatively expensive.

 

 

 

 

 

 

 

 

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What is a healthy diet (for adults and older children)?

There are many nutritional factors that require consideration in formulating a healthy diet and these will be discussed in the rest of this section. Below is a table summarising what most nutritionists and dietitians would consider a healthy diet.

Recommended food intake for a healthy diet low in fat

Bread, pasta, potatoes (prepared without fat), grains Six serves a day. One serve equals one cup of mashed potato or cooked pasta or cooked rice, three quarters of a cup of breakfast cereal, or one slice of bread or fruit loaf or a small roll.

Meat (lean / no fat), fish, chicken (without skin), eggs, legumes One serve a day. One serve equals 80g of red meat, 100g of cooked chicken or fish, one to two eggs, or 2/3 of a cup of cooked legumes. Foods should be prepared in as little fat as possible. Avoid frying / roasting.) Meat must be lean with all visible fat removed and chicken should be skinless.

Vegetables Eat as much as liked, but at least 4 serves per day. One serve equals about half a cup or about 60 to90g. Try to make them the central part of at least some main meals. (For example, vegetarian lasagna or ratatouille.) A wide variety of vegetables is best. Adding a variety of herbs and spices (preferably fresh) to vegetarian dishes improves flavour and they should be an integral part these recipes. They are also nutritionally very beneficial.

Fruit Eat two to three serves a day. One serve equals one medium or 3 small (e.g. apricot) pieces of fruit, about 20 grapes, a cup of berries, or half a cup of canned/stewed fruit; about 120 to 140 g. Fruit is great after a meal or as a filler during the day.

Nuts A small handful several times a week (unsalted). Nuts, especially peanuts, should not be given to young children due to the risk of inhalation.

Milk products Two to three serves a day of low-fat dairy products. One serve equals one cup of low-fat milk or skim milk, or 200g of fat-reduced yoghurt. Low fat cheese is still relatively high in fat and should be used in moderation, Avoid butter and cream.

Fats and oils A maximum of two serves per day. One serve equals one teaspoon of oil for cooking, one teaspoon of margarine or a quarter of an avocado (50g). Monounsaturated oils are best. If using spreads, those containing plant sterols can help reduce cholesterol; or try using avocado.

Indulgences Enjoy a maximum of one to two serves each day. One serve equals two standard alcoholic drinks, a tablespoon of jam or honey, or one cup of home made popcorn. Try to avoid high-fat foods, such as potato or corn chips, sausage rolls and meat pies, chocolate, sweet biscuits and pastries. (For example, a commercially made muffin contains about 24g of fat and 2,200kJ of energy.)

Fluids Water is best. Try to drink at least two litres a day. A jug of iced water at every lunch or dinner should be a household ritual. Low-fat milk (as allowed above) is an equally good choice. A good way of ensuring an adequate calcium intake is to have two to three cups of calcium enriched low-fat milk per day. Alcohol needs to be restricted to two standard drinks per day and alcohol intake should be part of ‘indulgence allowances’. You should also have at least two alcohol free days a week. This does not mean no occasional nights out; although It is important not to increase the risk of harm when consuming alcohol. See section on alcohol use. ) Non-sweetened fruit juices should be restricted to one serve per day, about 150ml. Soft drinks and sweetened fruit juices need to be avoided.

 

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