Monthly Archives: May 2013

Milk – how much is enough?

Milk_glass

For about the first 6 months of life, the only source of nutrition that is required by babies is breast milk or formula milk. After the age of 6 months, other foods need to be introduced (weaning) to provide essential nutrients that milk alone can no longer provide.

Gradually through the first year of life, milk becomes a smaller part of your child’s diet as the amount and variety of foods eaten is increased.

But after the age of one, how much milk do children actually need?

We all know that milk provides children with calcium, which is vital for growing bones and teeth, but what other nutrients does milk provide? And how much milk do children actually need at different ages and stages of development?

Milk and other dairy products are also an excellent source of protein, phosphorus and zinc; all of which are important for bone health.

Vitamin D is also vital for calcium absorption, so try to give your child oily fish at least once per week as well as a supplement if they are under the age of 5.

The table below gives you an idea of the amount of calcium that is required at different ages throughout childhood and the portion sizes of dairy products needed to achieve these calcium needs.

Daily Calcium requirements:

Age                               Calcium needs (mg/day)  Portion sizes (Calcium content)
Infants 525mg Breast milk or formula milk(+ weaning foods from 6 months)
1-3 years 350mg  100ml whole / semi-skimmed milk (125mg) +80g yoghurt (160mg) + 15g* cheese (110mg)
4-6 years  450mg 130ml semi-skimmed milk (160mg) + 100g yoghurt (200mg) + 20g cheese (150mg)
7-10 years     550mg  150ml semi-skimmed milk (185mg) + 125g yoghurt (250mg) + 20g cheese (150mg)
11-18 yearsMales 1000mg  250ml semi-skimmed milk (310mg) + 200g low fat yoghurt (320mg) + 45g cheese (380mg)
11-18 yearsFemales 800mg 200ml semi-skimmed milk (250mg) +200g low fat yoghurt (320mg) + 30g cheese (250mg)

*½ matchbox-size (1 matchbox-size = 30g portion of cheese)

As you can see from the table, after the age of one, calcium requirements drop as the period of rapid growth in infancy slows down and children do not need very much milk and other dairy products to provide them with their calcium needs. Remember cow’s milk should not be offered as a main drink until one year of age (continue breast milk or formula milk until then).

After the age of two, it is recommended that children change from whole milk to semi-skimmed milk if they are well grown and eating a variety of foods, otherwise they can remain on whole milk. Remember, whole or full fat milk, semi-skimmed milk and skimmed milk all contain the same amount of calcium.

After the age of 11 years, there is a time of rapid growth and calcium needs increase to enable the growth of long bones and to strengthen bones.

This is a particularly vulnerable age for bone health, as the latest National Diet and Nutrition Survey revealed that almost one in five (18%) of 11 to 18 year old girls were not getting enough calcium from foods.

What if your child does not like milk, what are other sources of calcium?

Oily fish with soft, edible bones (also a good source of vitamin D)

Sesame seeds

Fortified orange juices

Fortified soya milks, yoghurts and desserts

Tofu

Kale

Okra

Dried figs

Special circumstances:

If your child is on a milk-free diet – seek help from a Registered Dietitian, especially if your child cannot tolerate soya products, as a suitable milk substitute will need to be found to provide all the appropriate nutrients. Contact me to discuss.

Breastfeeding women require 1250mg Calcium per day (females 19 years and over require700mg per day), so this is an additional 550mg calcium per day. If a breastfeeding mum has been asked to avoid dairy products from her diet due to her infant’s symptoms, then I would advice the help of a Registered Dietitian, as careful and meticulous planning is needed to meet these additional requirements.

Any questions or comments? I would love to hear from you and welcome any suggestions for future topics!

P x

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Do children need snacks between meals?

 Toddlers and young children have small stomachs and they are unlikely to eat enough energy and nutrients in just three meals per day. They therefore need two (or sometimes three) planned, nutritious snacks per day in addition to their meals.

Remember, children’s appetites vary not only according to their growth spurts and activity levels, but also on their level of tiredness, minor illnesses and if they feel comfortable with other people around them. So it is important to make sure your toddler is well rested, as they will not eat very well if they are tired and cranky! Plan meals and snacks around their nap times.

What is recommended?

For one to two year olds, it is recommended that they need a meal / snack every 2 to 3 hours during the day or 4 to 6 small “feedings” per day, along with a source of milk.

For children over the age of two, there are no definite recommendations but I would recommend offering 2 snacks per day (mid-morning and mid-afternoon) with the key being the TIMING of the snack. I can’t emphasise enough the importance of SCHEDULED snacks – be prepared! Don’t get caught out and be bullied into buying something inappropriate for your children as they are nagging!! Timing of the snacks is very important – try to make sure that the snack is half way between meals.

Any suggestions?

  • Fresh fruit is ideal – as dried fruit is not great for children’s teeth, its best to be given as part of a meal for example dried cranberries and raisins with plain yoghurt or as part of a recipe (see ‘Oaty snack bars’)
  • Veggie sticks with dips eg. Soft cheese, cream cheese, hummus
  • Cheese cubes, apple slices and a cracker
  • Mini sandwiches with cucumber/carrot/pepper sticks
  • Plain homemade popcorn
  • Breadsticks with fresh fruit
  • Small pot of yoghurt or fromage frais
  • Toast / pitta bread with a spread and baby tomatoes

See www.infantandtoddlerforum.org for more ideas and tips.

Recipe ideas:

Carrot and Courgette Muffins

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This recipe is from ‘Little Cooks’ – a cooking class for toddlers and young children (www.littlecooks.org.uk).

I have been taking my youngest daughter to these cooking classes and she loves them! Try to get your toddler involved with this recipe as it is easy enough for them to make and they will love tasting what they have made!

Ingredients:

1 carrot, peeled and grated

½ courgette, grated

190g self-raising wholemeal flour

A handful of sultanas

1 Tbsp brown sugar

120ml milk

1 egg, beaten

4 Tbsp vegetable oil

Method:

Add the flour and sugar to a bowl and mix together, then add the grated carrot, courgette and sultanas.

In a separate bowl, beat the egg, milk and oil with a fork and add to the other ingredients. Mix all ingredients together.

Spoon the mixture into 12 cupcake cases in a muffin tin. Bake at 180 degrees Celsius for 15 minutes.

Top Tip – if a recipe calls for sugar, try decreasing the amount used by a half – you’d be surprised by how sweet it still tastes!  Or try substituting sugar and butter with mashed bananas – as in the ‘Oaty snack bar’ recipe in my earlier post.

Sweetcorn Fritters 

Sweet corn is great as it contains ‘slow release’ energy, so it will keep the children full for longer. Try as an after school snack on their own or served with tomatoes, carrots, cucumber sticks, peppers and slices of chicken for a delicious meal.

Ingredients:

100g self-raising flour

1 large egg

150ml milk

200g tinned sweetcorn kernels

Vegetable oil for frying

Method:

Sift the flour into a bowl. Make a well in the centre, add the egg and gradually beat in the milk to form a smooth batter.

Drain the sweetcorn kernels thoroughly and add the kernels to the batter mix. Add the oil to the frying pan and fry spoonfuls of the mixture for about 2 minutes on each side.

Enjoy!

P x

Snack ideas

 “I’m hungry!”

Tired of constantly hearing these 2 words? Feeling the pressure to buy cakes at the school gates every week? Children always whining about how hungry they are? Well, these may be the answer for you! These ‘Oaty snack bars’ are healthy and filling too as they contain ‘slow release’ energy from the oats. They are bound to stop those hunger pangs and leave you in peace with no whining children!!

A friend of mine called Sarah, another dietitian (www.sarahdietitian.wordpress.com), showed me this recipe and I have adapted it as my girls are very into coconut at the moment (I used coconut milk) and they love dates.

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Ingredients:

150g oats

2 -3 ripe bananas, mashed

A handful of dates, raisins, apricots or dried cranberries (any dried fruit will work – I used dates and raisins)

A handful of pumpkin and sunflower seeds (toasted)

1 Tbs honey (optional)

100ml Coconut milk

Method:

Add all the ingredients into a large mixing bowl and mix together. Spread onto a lined / greased baking tray and bake for about 20 minutes at 180 degrees Celsius.

This recipe is brilliant as there is no butter in it at all! The coconut milk gives it a lovely ‘coconutty’ flavour and the honey is optional – you can add it for a little extra sweetness or leave it out if you think it will be too sweet. I cut mine into squares and my girls loved them! No cakes at the cake sale today!! And no more “I’m hungry!”

Some other ideas for healthy, homemade snacks include:

  • Homemade plain popcorn
  • Carrot and courgette muffins (recipe coming soon)
  • Sweetcorn fritters (recipe coming soon)

Want to know more about suitable snacks for children? How many snacks should toddlers/children have each day? See my next post…coming soon!

 P x

Breastfeeding long term benefits

There are well documented short term benefits of breastfeeding for mum and baby…these include protection from infections for the first 2 years of life, particularly tummy bugs, ear infections and chest infections from receiving mum’s antibodies. Benefits to mum include using up 500 calories per day, decreased risk of breast and ovarian cancer as well as saving money and time.

But did you know of the long-term benefits of breastfeeding? You could influence your child’s life into adulthood…I think that is amazing!

The World Health Organization (WHO) has recently updated a systematic review on the long-term effects of breastfeeding. A systematic review is a report that only includes research of a particularly high quality that is read and studied independently and is considered the ‘gold standard’ when trying to answer a particular research question.

Overweight/obesity

The WHO review found that there is a small reduction in the prevalence of overweight/obesity later in life and breastfeeding.

This is a difficult area to study as there are so many factors that influence whether you breastfeed or not. One of these is socioeconomic status and another is how many years of education the mother has had.

Mums from a higher income home and those that are more educated tend to breastfeed more and for longer periods of time. But these families are also the families that tend to promote healthy eating. So it is difficult to separate these issues but even when the studies controlled for these issues, there was still a (small) protective effect of breastfeeding and later overweight / obesity.

Type-2 Diabetes

This is the most common form of diabetes and it also increases your risk of heart disease later in life. The incidence of this type of diabetes has increased worldwide and is also becoming increasingly more prevalent among children and adolescents. Some researchers have found that this type of diabetes may be programmed by the diet a child receives early in life.

The evidence from the updated WHO review suggests that breastfeeding may have a protective effect against type-2 diabetes particularly among adolescents. A possible reason for this is that formula fed infants tend to have higher amounts of insulin in their blood, which may lead to failure of the cells that produce insulin which in turn may lead to type-2 diabetes. However, please remember this is just a theory / potential reason for this association and you are not doing your baby any harm if you use infant formula.

Breastfeeding and IQ

Breastfeeding and child development has been studied for many years – since the 1920’s! There are lots of studies now showing that breastfeeding is positively associated with children’s development.

What could explain this association?

This is what researchers call ‘biological plausibility’ or how this association could be biologically possible.

Breast milk contains many important goodies and one of these is a special type of fat called ‘long chain polyunsaturated fatty acids’ or LCPUFA’s. Two important LCPUFA’s include docosahexanoic acid (DHA) and arachidonic acid (AA). The reason DHA and AA are so important is that they are vital for the development of eyes and the brain.

DHA and AA accumulate in the brain and eyes of baby in the last trimester of pregnancy (more about LCPUFA’s in pregnancy in a future post, so watch this space!) and the first months after birth.

Breastfed infants have been shown to have higher concentrations of these fats in the brain and studies have also shown that breast milk promotes structural changes in the brain. Three studies have also shown a positive effect of breastfeeding on school performance in late adolescence.

Even more reasons to promote and support mums to breastfeed!

If you’d like to read more detail about the WHO report, see http://www.who.int/maternal_child_adolescent/documents/9241595230/en/

Happy reading!

P x 

Do children need vitamin supplements?

Vitamins, minerals and trace elements are called ‘micronutrients’ as they are needed in very small quantities. But that is not to say they are not important, as they are vital for the health and wellbeing of children (and adults).

Most children and toddlers do not need a comprehensive multi-vitamin and mineral supplement, provided that they are eating a varied, balanced diet including foods from all five food groups. That is easier said than done I know! But there is an exception to this, particularly in the UK and northern Europe, and that is vitamin D.

Some statistics of vitamin D deficiency

Vitamin D deficiency is widespread in the UK and we are even seeing the emergence of rickets (soft, misshapen bones) again. National surveys of dietary intake have shown that very few toddlers in the UK can meet the recommended vitamin D intake through food alone.

Of course, low vitamin D levels in pregnancy means that babies are born with low levels of vitamin D, so it is important for pregnant women to take a vitamin D supplement of 10ug/day.

What are the recommendations?

In the UK, the Department of Health recommends a daily supplement of vitamins A, C and D (containing 233ug vitamin A, 40mg vitamin C and 7.5ug vitamin D) for all children from 6 months (breastfeeding infants) to 5 years of age.

For infants who are formula fed, it is recommended that they be given a supplement from the time they are drinking less than 500ml infant formula until 5 years of age.

The sunshine vitamin??

Vitamin D is known as the ‘sunshine vitamin’ as it is formed by the action of sunlight on the skin. In the UK we only get the “correct” sunshine or ‘critical wavelength’ to make enough vitamin D from April to September. So in the winter months, children are particularly vulnerable. Other groups of children that are vulnerable include dark skinned children and those that wear clothing to cover the skin for religions/cultural reasons.

Why is vitamin D important for children?

Vitamin D is needed for the absorption of calcium and phosphorus for healthy bones and teeth. It is also important for the proper functioning of the immune system.

What foods contain vitamin D?

Very few foods naturally contain vitamin D. Oily fish such as sardines, salmon, mackerel, pilchards or trout is the only significant source. Eggs and meat provide very small amounts. Breast milk also contains small amounts, which is dependent on the mother’s own vitamin D levels.

Some foods in the UK are fortified with vitamin D, such as margarine, infant formula milks, evaporated milk, a few breakfast cereals and some brands of yoghurts. Other countries, such as the USA, Canada and Finland have fortified cow’s milk and other foods too.

A cautionary note on supplements…please take care!!

Please take care to store vitamin/mineral supplements out of children’s reach. I have had the unfortunate incident of my youngest daughter guzzling a whole pack of chewy “sweets” which were actually vitamin supplements!! (Had a trip to A&E that day…how embarrassing for a dietitian’s daughter to overdose on vitamin supplements!)

There are certain groups of children who are particularly vulnerable to micronutrient deficiencies and they will most likely need vitamin and/or mineral supplementation. I would recommend the help of a Registered Dietitian in these cases:

  • Children with restricted food intake / extremely fussy eater
  • Children who have a medical condition that results in malabsorption
  • Children who have to follow a restrictive diet for a medical condition

If you would like further information, see the excellent website www.infantandtoddlerforum.org for sensible advice on sun exposure to top up on vitamin D and other tips/guidance on preventing vitamin D deficiency.

P x 

Iron-rich recipes…

Following on from my previous post on iron deficiency, these recipes give you some ideas of how to provide iron-rich meals for your child – there is one meat option and one veggie option.

This post is all about having fun and getting messy in the kitchen cooking with your toddler! Getting your child involved in cooking and preparing food will help them to learn about food and healthy eating. Research shows that toddlers who help with cooking are more likely to make healthier food choices later on in life.

Get your toddler involved by:

  • Mashing the potatoes to make the mash
  • Getting messy by mixing up the mince, egg, oats and bread
  • Shaping the mince mixture into balls
  • Stirring the lentil stew mixture (with your help)
  • Weighing out the lentils
  • Helping to spread the mash over the lentil mixture
  • Sprinkling the cheese over the mash

Remember… children learn by copying adults, so always try to eat the healthy foods yourself that you are asking your child to eat!

Being a South African, I am going back to my roots with the first recipe. It is one of my Mum’s (mom’s) best recipes…and one of my favourites when I was growing up. We called them “Frikkadels” which is the Afrikaans word for meatballs.

“Frikkadels” / Meatballs (full of well absorbed ‘haem’ iron) 

"Frikkadels!"

500g lean beef mince

2 slices of bread

Milk – about 150ml

1 large egg or 2 medium eggs

1 onion

Soup…I used Heinz mushroom and parsley squeezy pouch (you can used powdered soup too)

About ½ cup of oats

Fresh parsley or some dried mixed herbs, if you don’t have fresh

Plain flour for dusting

Olive oil for frying

Method:

First thing to do is pour the milk over the bread and allow the bread to soak up the milk for a few minutes. Chop up the onion into fine pieces and add to the mince along with the eggs, squeezy soup pouch and fresh parsley or dried mixed herbs. Now it’s time to get messy….squeeze the milk out of the bread and add the “wet” bread to the mince mixture. Now your child can get their hands stuck in and mix everything together. The mixture is quite sticky, so now add the oats (add a little at a time until the mixture is not too sticky but not dry either). Now you can shape the mixture into meatballs. Roll in a little flour and flatten the meatballs slightly so you can fry them in a little olive oil until cooked through. Allow them to cool slightly and enjoy! Serve with some raw peppers, cucumber and carrots with some pasta, toast or a few baby potatoes.

This recipe contains 2mg of haem-iron (very well absorbed) per meatball (based on 8 meatballs)

Lentil cottage pie (packed with veggie goodness!)

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150g Green lentils, dried

1 tin chopped tomatoes

Garlic puree tube – 2 squirts!

1 onion

1 leek

1 red pepper

1 carrot, grated

1 Tbs Olive oil

About 200ml Vegetable stock – I usually use Marigold Swiss vegetable bouillon

3-4 Potatoes

Milk and margarine – just enough for mashing

Grated cheese

Method:

First thing to do is peel the potatoes, chop into cubes and add boiling water. Boil until they are soft and ready for mashing.

Next put the lentils on to boil – add approximately 2 teaspoons of the vegetable stock powder to the water. Cook without a lid for 10-15 minutes until the lentils are soft.

Next chop up the onion, leek and pepper and add to a frying pan with the olive oil and garlic puree. Sautee for a few minutes, then add the grated carrot and fry for a further minute or so.

Open the tin of chopped tomatoes and add to the lentils (keep the stock water in the pan). Add the onion, leek, pepper and garlic mixture to the pan and cook without a lid for about 10-15 minutes until the sauce has reduced slightly. Add the lentil mixture to an oven-proof dish.

Mash the potatoes with a little milk and margarine and spread over the lentil mixture. Sprinkle with the grated cheese and grill until cheese has melted and gone a little golden. Yum yum…

This recipe contains 1-1.5mg iron per portion, depending on portion size. Don’t forget to add vitamin C -rich veggies to improve the absorption of non-haem iron!

Top tip:

You can use 2 sweet potatoes and 2 ordinary potatoes as an alternative mash, providing a good source of vitamin A. This recipe is also high in vitamin C from the tomatoes, peppers and potatoes, to aid in the absorption of ‘non-haem’ or ‘non-meat’ iron from the lentils.

P x