Monthly Archives: June 2013

How to cope with fussy eaters…

Most parents have experienced a toddler that just refuses to eat or does not want to eat what you have made for them. This can be a very frustrating time but the best thing to do is to try and stay calm (take a deep breath!) and not show your anxiety to your toddler.

Remember – food refusal is a normal phase that most toddlers pass through, so you are not alone! Most toddlers have good and bad days (just like adults!) so don’t expect your child to eat the same amount every day.

Here are some top tips to help with managing fussy eaters…

TOP TIP 1: Develop a routine for mealtimes and snacks

Make sure you offer meals and snacks at the same time each day (more or less) so that your child knows what to expect. This also ensures that your child does not become over hungry or too tired to eat.

TOP TIP 2: Try to recognize signals for when your toddler has had enough to eat

You decide WHAT your child eats and let them decide HOW MUCH they eat. Your child is telling you they have had enough when they do the following:

–       Say no!

–       Keep their mouth shut

–       Turn their head away

–       Push away a spoon or fork

–       Hold food in their mouth

–       Spit food out

–       Gag or retch

TOP TIP 3: Check fluid intake from milk and other drinks

If a child is full up on juice or milk they will not have an appetite for their food. Use a drinking cup for water/diluted juice/milk and try to phase out feeding bottles by about 12 months of age, as this will automatically decrease the amount of milk that your child drinks.

Between 1 and 3 years of age, a child needs a maximum of 350ml of milk per day (less if taking other dairy products like yoghurt and cheese), to meet their calcium requirements. So try to limit dairy products to 3 times per day – see previous post on ‘Milk – how much is enough?’

TOP TIP 4: Encourage self-feeding and offer small portions

From about 8 months of age, your baby will want to hold food and attempt to feed themselves. This can be a messy phase but try to put up with the mess as your baby needs to learn this process! Offer finger foods at each meal and allow your toddler to hold the spoon or fork themselves, even if most of the food does not make it to their mouths…they will get the hang of it eventually! Try to offer small portions so that your child is not overwhelmed by the amount of food in front of them.

TOP TIP 5: Try to eat together as a family as often as possible and involve children in food preparation

These days with everybody’s very busy and hectic lifestyles, families often don’t eat together anymore. Try to make this a priority to eat together as often as you can – even if it is only on weekends.

Also try to get your child eating together with other children as some children eat better when with others. Remember…children learn by copying others!

And finally – get creative and start cooking with your children. They will grow up learning about different foods and are more likely to try foods that they have helped prepare.

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TOP TIP 6: Check for medical causes

Constipation and iron deficiency anaemia can decrease a child’s appetite. Previous negative / unpleasant experiences around food and eating, such as pain, vomiting or gastro-oesopageal reflux can also affect a child’s eating behaviour. If you suspect your child may have one of these conditions, speak to your GP.

And most importantly, GIVE PRAISE!! Toddlers love to hear you say that you are proud of them or “well done” or “good eating” even if it is a very small amount that they have eaten.

Enjoy eating a variety of foods and your child will too!

Paula x 

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Constipation in children

Constipation is something that no-one likes to talk about but it can cause a lot of worry for children and parents alike. It is also a very common childhood condition, occurring in around 5-30% of children, depending on the criteria used for diagnosis (1).

The exact cause of constipation is not fully understood but there are many factors that may contribute. These include pain, fever, dehydration, dietary and fluid intake, psychological issues, toilet training and a family history of constipation (1).

Please note:

If your child suffers from long standing (chronic) constipation, please see your GP to discuss appropriate management for your child, which may include medications. I am going to talk about the prevention of constipation in children. Dietary interventions should not be used as a first-line treatment for chronic constipation (1).

Prevention is best!

Constipation can result in a poor appetite, which means a child will not eat very much and this can exacerbate the condition (vicious circle). So it is best to try and prevent this condition. A varied, balanced diet that contains fibre-rich foods and a good fluid intake are the main basis for this.

How much fluid do children need per day?

Offer 6-8 drinks each day as a guide. Toddlers should have 6-8 drinks of 3-4oz per day, whereas older children will drink more at each drink. Offer a drink with each meal and at least one in between meals or with a snack (2).

Age Suggested fluid intake*
1-3 years 900ml
4-8 years 1200ml
Boys 9-13 years 1800ml
Girls 9-13 years 1600ml

* Please note that children who are very physically active or live in hot environments (not the UK!!) will need more water. Also obese children may require more water.

Does milk count as fluid?

Water is the best drink to offer between meals, but you can also offer diluted fruit juices with meals. Milk does count as part of the fluid but be aware that too much milk can be a contributing factor to constipation as it means that a child will be eating less food and thereby less fibre. Limit a toddler’s milk intake to 3 drinks per day of 3-4oz each. (see previous post on ‘Milk – how much is enough?’

How much fibre do children need?

There is not much information out there as to the exact amount of fibre children should be having, but it is not really necessary to have an exact number. As a guide, try the following suggestions:

  • Offer your child a fruit and a vegetable at lunch and dinner
  • Offer regular meals and planned snacks
  • Include a starchy or cereal-based food with each meal – make it wholegrain as often as you can
  • Always make time for breakfast – include some fruit or dried fruit and wholegrain bread or cereal such as oats

 In some cases, constipation can be caused by cow’s milk allergy

In some children, constipation may be a manifestation of cow’s milk allergy BUT I must explain that the mechanism and prevalence of this are not known. If a child does not respond to appropriate medical treatment, a trial of eliminating cow’s milk from the child’s diet should be considered (3). I recommend contacting a Registered Dietitian for help with this – contact me if you would like further advice.

What would you like the next post to be on? I would love to hear your ideas or questions!

P x 

References:

  1. National Institute for Health and Clinical Excellence (NICE). Constipation in children and young people. Diagnosis and management of idiopathic constipation in primary and secondary care. May 2010
  2. www.infantandtoddlerforum.org
  3. PEN nutrition  – practice-based evidence nutrition (www.pennutrition.com)

Cooking with kids…pancakes!

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This post is a bit of a fun one about cooking with kids and having fun in the kitchen! My 2 daughters LOVE pancakes and are always nagging me to make them, so I have to restrict it to weekends otherwise I would be flipping pancakes everyday of the week!!

So I thought I would try to put a ‘healthy spin’ on the usual pancakes and add a bit of fruit as well as substituting some of the plain flour for wholemeal flour. This recipe is for “American-style” pancakes as I love their fluffy texture and I think they are easier to make than the traditional thin pancakes!

This recipe is from the BBC Food Recipes website (http://www.bbc.co.uk/food/recipes) and then I have adapted it to add a bit of a different take on the usual pancakes!

Ingredients:

100g plain flour

35g wholemeal flour

1 tsp baking powder

Pinch of salt

2 Tbsp caster sugar (can add less) – also try 1/2 Tbsp Truvia as an alternative

130ml milk

1 large egg

2 Tbsp Olive oil

Method:

–       Add the flour, baking powder, salt and sugar/Truvia to a large mixing bowl.

–       In a separate bowl, whisk the milk, egg and olive oil together

–       Add the milky mixture to the flour and mix

–       Add spoonfuls to a hot frying pan

–       Drop the blueberries onto the dough whilst pancakes are cooking

–       Then flip them over and cook until golden brown!

Our girls loved dropping the blueberries onto the pancakes as they were cooking and then watching them go all gooey when I flipped them over!

You could also try other fruit such as raspberries, blackberries or raisins.

They are yummy eaten warm, straight out of the pan or add a drizzle of honey/syrup as a treat!

Another fun idea: 

Beetroot

Add pureed beetroot to the pancake mixture to make Pink Pancakes!! My youngest daughter loved this as it was pink and they both loved eating them. It is fun and super healthy too! Peel and boil the beetroots until soft or alternatively buy the ready to eat beetroots, which are super soft. Puree them in their own juice.

Some facts on beetroot…

–       It can turn your wee pink!! (due to the red colour compound betanin). Don’t be alarmed, this is just temporary!

–       It can lower blood pressure (proven in clinical trials)

–       It is an excellent source of vitamin C and other antioxidants

So why not give it a try??

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Enjoy…

 Paula x


 

What is a healthy breakfast?

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We all know that breakfast is very important for children (and adults) but has it actually been proven to improve school performance? And what sorts of foods should children have at breakfast time?

If your household is anything like ours, it is all a bit chaotic and a mad rush in the morning to get the kids ready and out the door in time for school! But if there is one thing that you should take time over in the morning, it is what you feed your children.

What does the research say?

Studies have shown that children who eat breakfast are more likely to perform better on academic tests. A UK web-based study of children aged 6-16 years, showed that tests of accuracy and speed were impaired in children who had not had breakfast compared to those that had.

Another study of teenagers based in Korea, showed that the frequency of breakfast was positively associated with academic performance (those having breakfast everyday had the best scores).

Yet another study in China, showed that children who had breakfast everyday had better verbal, performance and full scale IQ scores.

So…there is plenty of evidence showing that children perform better after having breakfast, but what is a healthy breakfast for a child?

What is a healthy breakfast?

A healthy breakfast should consist of a variety of food groups:

  • Starchy foods such as cereals, bread, rice, potatoes or pasta to provide energy, B vitamins, fibre and some iron (if fortified). Choose wholegrain varieties whenever possible.
  • Fruit and vegetables as these are a good source of vitamins and fibre. Fresh, dried, stewed, canned (in juice not syrup), frozen and pureed/blended are all fine. Try vegetables too, such as tomatoes, mushrooms or avocado.
  • Milk and dairy foods provide protein, calcium and B vitamins. Try to include milk or yoghurt (fruit or plain) or a lower fat cheese as options.
  • Meat, fish, egg or alternatives provide protein, iron and vitamins. These are not essential at breakfast, but they can add variety when you have more time, perhaps on the weekend. Try different forms off eggs such as scrambled, poached, boiled or “eggy bread”. Other ideas could include smoked salmon or haddock as healthier options to fried bacon.

Some ideas of healthy breakfasts:

–       Oats porridge, made with milk and topped with banana and raisins

–       Toast and peanut butter with glass of milk and apple slices

–       Scrambled or poached egg on wholemeal toast with mushrooms (sauteed in a little olive oil)

–       Boiled egg and wholemeal toast “soldiers” with grilled or fresh tomatoes

–       Fruit salad and yoghurt with a slice of malt loaf

–       Toasted wholegrain English muffin or fruit bread with low fat spread with a glass of milk and a piece of fruit

–       Half a toasted bagel topped with cream cheese and tomato

–       Stewed prunes and apricots (pureed) and stirred into oats porridge

–       Smoked salmon with scrambled egg on toast is a delicious treat

Remember to include a drink at breakfast, as being well hydrated will help children to concentrate better at school.

Which breakfast cereals are suitable?

There are so many choices available these days, it is difficult to know which breakfast cereal to choose! Try and go for wholegrain options with no added sugar. And try to use a variety so children don’t get bored of one particular type!

Look out for “toasted” muesli as these often contain added oil/butter and sugar. Choose “raw” muesli instead as this contains raw oats with no added butter or sugar.

I’ve mentioned fibre quite a lot, but how much fibre do children need? Breakfast can provide a good “boost” to fibre intake.

More on this in a later post about childhood constipation….

P x

 

Gastro-oesophageal Reflux

Many of you will have experienced the difficulties of a child with gastro-oesophageal reflux (GOR), as it affects up to 50% of otherwise healthy, full-term infants. It can be very distressing and painful for infants and equally distressing for parents to hear their baby cry for hours on end and have difficulty with feeding.

But what is GOR and what can help improve the symptoms?

What is GOR?

GOR is defined as the passage of stomach contents into the food pipe (oesophagus). It is a normal physiological process occurring several times per day in healthy infants, children and adults.1 It occurs readily in infants because the muscle of the food pipe is very relaxed in many babies and this allows acid from the stomach to flow back up into the food pipe. This causes a burning sensation and can cause irritation of the tissue in the food pipe, which can feel sore or painful.

Gastro-oesophageal Reflux Disease (GORD) in infants occurs if GOR is severe and occurs with other symptoms such as failure to gain weight, distressed behaviour, difficulty swallowing and unexplained crying.

Special circumstances

It should be noted that GOR and GORD is more common in premature babies and those with neurological disorders as they could have some problems using their muscles and nerves.

Is breast best?

GOR and GORD can occur in both breastfed and formula fed babies. Studies suggest that formula fed versus breastfed babies do not differ in the frequency of GOR but breastfed babies may have a shorter time of reflux episodes.

What about thickener?

Research shows that thickening baby formula can be “moderately effective” in reducing the symptoms of GOR/vomiting in otherwise healthy infants. However, thickening can only cause a decrease in visible reflux (ie. vomiting) but it does not decrease the frequency of reflux episodes.2 Thickening a formula can also increase coughing and some infants may develop diarrhoea. I would advise caution and not to attempt this without the help of your GP and a Registered Dietitian.

What about formula type?

For most babies, the symptoms of GOR do not decrease when changing from one milk formula to another or to a soya formula. However, in babies who present with vomiting, GOR may be associated with a cow’s milk protein allergy. In this case, a two to four week trial of a special formula which has the protein broken down into smaller pieces (called an ‘extensively hydrolysed formula’) may be beneficial in formula fed babies. Contact a Registered Dietitian if you think your child has a cow’s milk allergy. My email address is paula.hallam@yahoo.co.uk if you would like to contact me.

Are children with GOR/GORD susceptible to feeding difficulties?

The evidence in this area is inconsistent to demonstrate whether children with GOR suffer more from feeding difficulties or not. One study showed that feeding problems affecting behaviour, swallowing and food intake affect children with GORD, who also displayed a lack of development of age-appropriate feeding skills.3

References:

  1. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2009 Sep 9.
  2. Practice-based Evidence Nutrition (pennutrition.com)
  3. Mathisen B, Worrall L, Masel J, Wall C, Shepherd RW. Feeding problems in infants with gastro-oesophageal reflux disease: a controlled study. J Paediatr Child Health. 1999 Apr [cited 2009 1 Dec];35(2):163-9.

P x