Monthly Archives: April 2013

Iron deficiency

Iron deficiency is the most common and widespread nutritional deficiency in the world affecting 43% of all children worldwide! That is a huge number of children and it is not only found in poor developing countries but also in more affluent developed countries too.

In a recent UK Survey*, the proportion of children with daily intakes of iron less than the lowest acceptable amount was 10 – 14%. In addition, 1 in every 8 children aged 18-28 months in the UK is anaemic and in some ethnic minority populations of the UK the figure might be as high as 25 – 35%.

(*Diet and nutrition survey of infants and young children: 2011; Department of Health and Food Standards Agency)

Why is iron important to infants and children?

Iron is an essential nutrient, as we all need it to make haemoglobin in red blood cells, which in turn is needed to transport oxygen around the body. Iron is also needed as an important part of chemicals called enzymes, which are like “scissors” in the body – they cut up large chemicals into smaller components, so that they can be used to make proteins, hormones and neurotransmitters in the body.

Most children don’t eat enough iron but iron is also potentially toxic, as our bodies have no way of expelling excess iron. So we must be careful not to overdo it with iron, especially in supplements. Fortunately, our bodies are quite clever and we have developed ways of making sure we don’t absorb too much iron when we have enough stores and to absorb more from our food when our stores of iron are running very low.

Why is iron deficiency anaemia a problem?

Iron deficiency anaemia (IDA) causes extreme tiredness/lethargy, pale skin, loss of appetite and in the long term it is associated with delays in cognitive (learning) and motor (movement) development, so it is extremely important to try and prevent IDA by providing iron-rich foods for your toddler.

So how much iron do infants and toddlers need?

Before the age of 6 months, babies do not need much iron as they are born with sufficient stores to last about 6 months, if born at full term and a healthy weight. Breast milk contains very little iron but it is extremely well absorbed or bioavailable, so it is all an infant needs until around 6 months of age. After this age, a good source of iron needs to be introduced.

From 7-12 months, babies need 7.8mg and toddlers 1-3 years just under 7mg of iron per day.

Which foods are good sources of iron? What about iron absorption?

Liver is the best source of iron but I’m not sure many toddlers would go for that (although you could try liver pate’ as an option) so beef and lamb are the next best sources. Oily fish, dark meat of chicken and pork are okay sources too.

I must mention now that iron is found in 2 forms – ‘haem’ iron from meat sources and breast milk, which is very well absorbed and ‘non-haem’ iron from vegetarian sources, which is not absorbed very well but vitamin C aids its absorption.

What if your child does not eat meat? What about vegetarian diets?

The best source of non-meat iron is from iron-fortified breakfast cereals. However, it is not known how much of this iron is actually absorbed, so try to always serve cereals with a vitamin C-rich fruit such as strawberries, papaya, mango, kiwi fruit, or oranges/clementines (naartjies to the SA readers!) to aid the iron absorption.

As a main meal, lentils are a good option and if you make them with a tomato-based sauce then that is providing the vitamin C too!

Hummus, made from chickpeas, as a dip for fresh peppers (good source of vitamin C) is a good option for a snack and dried apricots are also a good source of iron as another snack option.

Look out for my next post, which will include some yummy iron-rich recipes, including some veggie options!

P x

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Infant colic

I remember when my first daughter was born and she just wouldn’t settle in the early evening and would cry for hours on end no matter what I did!

It is difficult for any parent to hear their child cry, especially for a first time parent when you don’t have the experience of having had another child nor the confidence to know what to do! Often parents are told that their baby will “grow out of it in a few months”, which they probably will, but it is not very helpful when you are trying to deal with a fractious baby for hours on end every day!

Colic is the medical term for excessive, frequent crying in a baby who appears to be otherwise healthy and well fed. It is a poorly understood yet common condition, and affects around one in five babies (NHS Choices).

Please note – If you are worried about your baby’s excessive crying – see your GP so that other possible causes can be ruled out.

If your baby has been diagnosed with colic, or there is a strong suspicion that your baby has colic, the question is….Can nutrition influence colic and is there anything that can help with colic?

Breast or formula??

I often get asked if babies fed on infant formula are more likely to develop colic than breast fed babies? But studies have shown that breast fed and formula fed babies both show similar prevalence and amount of crying associated with infant colic.

What about the type of infant formula used?

This is a controversial area…for most infants it is not recommended to chop and change their formula feeds as this has not been shown to be helpful in reducing colicky symptoms. However, in those babies who have a family member with eczema/asthma/allergies of any kind, there may be a benefit to a 2 week trial of a special formula called ‘extensively hydrolysed formula’, which means that the protein in the formula has been broken down into smaller pieces.

What about the diet of a breastfeeding mum?

The evidence for whether a breastfeeding mum’s diet influences colic is conflicting.         Conclusions from very high quality studies (called systematic literature reviews) indicate that there is limited evidence to suggest that if a mum excludes certain allergenic foods from her diet this may reduce colic symptoms in babies younger than 6 weeks of age.       (Allergenic foods include cow’s milk, eggs, peanuts, tree nuts, soya, fish and wheat).

Please remember that if a mum decides to try an exclusion diet she must make sure are getting enough protein, energy/calories, calcium and vitamin D and to stop the exclusion diet if there has been no observed benefit in 2 weeks. I would advise anyone thinking of undertaking an exclusion diet to seek the help of a Registered Dietitian

See www.bda.uk.com for where to find a Dietitian near you.

So….what could help reduce the symptoms of colic?

Probiotic drops are a possible treatment option.  Results from 2 recent studies show that the use of Lactobacillus reuteri probiotic drops may have a role to play in reducing the symptoms of colic in breastfed babies. Babies given the probiotic drops spent significantly less time crying than the placebo group.

More research is needed until this can be routinely recommended but I think it is a promising area of research for babies with colic and as probiotics generally have a very good safety profile and few if any side effects, it could be worth a try.

Probiotic drops are available without a prescription – ask your Pharmacist.

Paula  x

Portion sizes for toddlers…

Have you ever wondered if you are feeding your toddler enough food? Or too much food? Do you know how much food to dish up for your child? Sometimes it is difficult to know how much is enough!

A good guide is your toddler’s appetite but it can be difficult to judge when they have had enough, especially if they are a fussy eater! Remember that toddler’s appetites will vary from day to day and try not to expect them to eat the same amount each day.  It is better to look at your toddler’s average intake for the whole week to assess the amount and variety of their diet over this time period.

A good rule is that you decide what your toddler eats, and they decide how much they eat!

So how can I tell when my toddler has had enough to eat?

Try to pick up on the “clues” that your toddler gives you when they have had enough. Don’t be tempted to urge your child to finish everything on their plate. Try to watch for these signals that your child has had enough:

–       turning their head away

–       pushing a plate away

–       shutting their mouth

–       refusing to swallow or holding food in their mouth

–       crying / screaming

–       spitting food out

So what should I feed my toddler?

It may sound obvious, but it is important to feed your child a variety of foods from all food groups:

Food group 1 – bread, pasta, potatoes and other starchy foods

Offer at each meal and some snacks

Food group 2 – fruit and vegetables

Offer 1-2 portions at each meal and at some snacks

Food group 3 – milk, cheese and yoghurt

Serve about 3 times per day*

Food group 4 – meat, fish, eggs, nuts and pulses

Offer 2 – 3 times per day

Food group 5 – foods high in fat and sugar

Up to a maximum of twice per day**

*Take care to avoid excessive amounts of milk and other dairy foods as they can decrease the appetite for other foods especially iron-containing foods.

**These foods add enjoyment to meals but as they are high energy and low in other nutrients they should be limited.

Remember…children aged 1-4 years don’t need portion sizes as big as yours!

The Infant and Toddler Forum is a great website with lots of useful tips and information for parents and carers: www.infantandtoddlerforum.org

Look out for the section on ‘Little People’s Plates’ and their fantastic ‘Tot it Up’ calculator where you can enter everything your toddler has eaten and drunk in one day and get a general overview of their diet and an idea of the balance of food they need. Have fun with it and enjoy!

Another great website is the First Steps Nutrition Trust – they have some fantastic pictorial resources. See: http://www.firstepsnutrition.org

Paula  x

Weaning…

There has been a lot of talk in the press and on parent chat sites recently about baby led weaning (BLW). So what is BLW and what are the current weaning recommendations?

What is the definition of weaning?

“Weaning is the process of expanding the diet to include foods and drinks other than breast milk or infant formula”. BDA paediatric group Policy statement on Complementary feeding.

The baby led weaning approach is when infants are allowed to self feed with finger foods only and no food is given from a spoon, such as fruit puree or baby rice.

The Department of Health in the UK recommends that solid food should commence ‘at around six months of age’. These guidelines also recognize that each child is an individual and some babies will be ready for solid food before this age and some after. However, weaning should commence no later than six months or 26 weeks of age and no earlier than 4 months or 17 weeks of age.

So are there any benefits to BLW? And are there any possible harmful effects?

One observational study based on a survey of parents in the UK, suggests that the BLW approach compared to traditional weaning approach is associated with healthier food preferences and lower infant BMI. However, please note that observational studies are not considered very high quality and more research is needed to look at growth and developmental outcomes.

Are there any possible concerns about BLW?

Interviews with healthcare professionals suggest concerns about the increased risk of choking, iron deficiency and inadequate energy intake. I personally would be most concerned about iron deficiency, as a baby’s iron stores run out at about 6 months of age (if they were born full term and at a healthy weight), so they start requiring a source of iron quite soon after this time. I will be doing an iron deficiency post soon so more on this later…!

This is a very controversial area, but one thing is for sure….more research is needed!

I think a sensible approach is to offer your baby some purees from a spoon and to allow them to self feed whenever they show a readiness or interest….such as reaching out for the food off your plate! This is usually around 7 months or so.

Offer finger foods alongside purees so that they learn how food feels in their hands and how to reach their mouths! Allow them to get messy! Often they like to hold a spoon too and attempt to feed themselves, even though none of the food actually reaches their mouth!

For example: You could offer your child a sweet potato and apple puree from a spoon and have some soft, cooked broccoli on their high chair tray or table for their hands to explore and maybe even take a bite of, if you are lucky!

Weaning can be a stressful time for parents but try to enjoy it and have fun while your baby learns and explores new foods!

Paula  x

Why write a blog?

I am always complaining to my husband about nutrition messages that I read in the press or hear about from other mums, so he finally said to me “Why don’t you start writing your own blog?” So that is what I have decided to do!

On this blog, you will only find reliable, evidence-based nutrition messages, and if there is no evidence then I will explain this. I am aiming to dispel all those nutrition myths out there!

Hope you enjoy reading it!

P x

p.s. PLEASE NOTE – there are a few links on this blog to other people’s blogs / websites…this does not mean that I endorse the content or agree with their opinion!