http://www.telegraph.co.uk/health/healthnews/9013144/Healthy-smoothies-not-so-innocent-for-teeth-says-dentist.html

Of the 14 cereals I looked at, only 1 was not high in sugar. Many were high in salt – even for adult standards. I would encourage parents to choose breakfast cereals wisely for their children. If it means foregoing a cereal box with a cartoon on it, so be it. If you introduce a chocolate cereal from the beginning, it is very difficult to change little taste buds onto a wholesome cereal. Ignore the ‘children’s cereals’ section of the supermarket and head for the nutritious wholegrain options and give your children the best start possible!

Here are some links to media coverage of my report…

http://www.nhs.uk/news/2012/02February/Pages/breakfast-cereals-still-too-high-in-sugar.aspx

http://www.supermarketownbrandguide.co.uk/index.htm

The Infant and Toddler Forum have published evidence-based guidance on healthy portion sizes that meet UK Estimated Average Requirements for energy (EAR) and Reference Nutrient Intakes (RNIs) for toddlers. It can help ensure your child receives the best nutrition possible at a really crucial time in their development. The portion size models can be downloaded for free here:

http://www.infantandtoddlerforum.org/article_13+Portion+Sizes+For+Toddlers+13+Years_id-596.html

Adverse reactions to food are common in infants. Cow’s milk protein allergy is one of the most common causes and occurs in 2-6% of infants. Cow’s milk protein allergy is an immune reaction to one or more of the proteins in cow’s milk. It is often confused with lactose intolerance, which is caused by a (usually temporary) enzyme deficiency, not an immune response.

Initially, it is important to see your doctor to rule out any underlying problem or condition. Losing weight, vomiting and abnormal stools are not signs of colic and must be investigated. Possible causes of colic are; allergy or intolerance (though breastfed babies get colic too), an immature gut, swallowing air while crying, smoking in the house, and under- or over-stimulation of the infant.

Treatments for colic include:

• Efforts to soothe your baby; lots of cuddles, gentle rocking, walking or taking for a drive, warm baths, distraction techniques.
• Some parents find that changing the formula milk can help (see a Paediatric Dietitian for advice).
• Some find that changing the teat on the bottle may also help.
• If breastfed, changing mum’s diet may also provide some relief. A Paediatric Dietitian can also help with this.
• Smaller feeds more frequently and regular winding is recommended.
• Colic drops, gripe water, and Lactobacillus reuteri probiotics have been found to be of benefit for some.
• Prescription medication is not recommended due to possible side-effects.

Although colic often takes a toll on the whole family, it doesn’t appear to have any long-lasting medical consequences. Babies who have colic grow and develop normally.

Calcium is the main concern. Milk and dairy products make a significant contribution to calcium intake in our diets. Milk alternatives such as soya, rice, oat or coconut milks are naturally poor sources of calcium, but fortified versions contain similar or higher levels. This is why it’s important to choose calcium-added milk alternatives (usually these are not organic unfortunately). The bioavailability of the calcium in fortified products is similar to that of milk.

For children, other nutritional concerns are the energy, protein, fat and fat-soluble vitamins that a dairy-free diet may be deficient in. Again, cow’s milk contains a whole host of benefits aside from just calcium, so avoiding milk means either finding a substitute that can mimic some of milk’s properties, or by ensuring the rest of the diet can make up for what is lost in avoiding milk. For this reason, it is really important to have your child’s diet assessed (and periodically re-assessed) by a paediatric dietitian who will ensure your child is getting everything they need. Children under the age of 2 will typically need a prescription milk. Older children can have soy (if tolerated) but other milk alternatives such as rice, oat or coconut milk are not usually recommended for toddlers. Rice milk is not recommended for children under the age of 4 due to arsenic levels.

Soy, rice and oat milks contain between 38-47kcal/100ml (about the same as semi-skimmed milk). Coconut milk has less than 30kcal/100ml (ie. lower in calories than skimmed milk) and therefore is not always suitable for growing, active children. The protein content of milk alternatives tends to be lower (some significantly lower). Quite often the sugars in milk alternatives are high, and the effect on teeth should be considered. I always suggest open cup drinking for children on milk substitutes (see my previous blog on open cups). Calcium content of any milk substitute should be at least 120mg/100ml.

Here are some top tips to help reduce the risk of your child having an allergic reaction, and to keep the new school term as stress-free as possible.

Firstly, before starting school/nursery make sure you discuss your child’s allergy with the staff (preferably a manager) and highlight any perceived high risk times eg Christmas, birthdays, trips out etc. It always helps to bring a letter from your GP, dietitian, allergy nurse or other health professional to clarify the allergy and foods to avoid. A Management Plan can then be developed to minimise risks and documents a strategic plan for worst-case scenarios. If your child suffers from anaphylaxis reactions (severe, IgE type reaction), your doctor or allergy nurse should provide the school with an Action Plan and medical kit with epipen for emergencies. Include phone numbers/contacts for emergenices, and make sure the medical kit is stored out of direct sunlight. Make sure the staff are trained in administering the epipen. Most allergy nurses will be happy to visit nurseries and schools and provide staff training.

Make sure you get a copy of the school/nursery menu and ask staff about how the children eat snacks and food – is it at tables, on the floor, small groups, and how are they supervised? Will your child need one:one supervision? Is the food served ‘buffet’ style where everyone can help themselves, and thus increase the risk of contamination? It is usually helpful for you to bring in a comprehensive list of ingredients to avoid and those allowed – I have heard of children with milk allergies be refused any puddings in case they contained milk, so were only ever given fruit! If you are sending in your child’s food, make sure everything is clearly labeled – get a load of stickers made up in advance and stick them on everything!

Ask about trips out, special events and activities that may involve food. How do staff intend to supervise your child and how will they ensure that visitors to the school know about safe foods your child can eat. Can you send in ‘safe’ food that your child can eat during special occasions? I know of one mum who sends in wheat-free cupcakes that are kept in the nursery freezer and defrosted when needed.

Don’t forget to keep staff informed about any changes or updated allergy tests that may occur during the year. It helps if everything discussed is also written down – just to be on the safe side!

Finally, I have come across an excellent resource for children with allergies – t-shirts, stickers, badges and epipen totes that are really handy for sending in to nursery/school Have a look at: http://www.alwaysreadthelabel.info

Good luck!

So is salt still an issue now and can we learn anything from this study?

It is well known that a high salt intake in adults is associated with high blood pressure (hypertension). This in turn increases the risk of heart disease and strokes three-fold. High salt intakes are also linked to other conditions such as osteoporosis, stomach cancer, kidney disease and kidney stones, and exacerbating the symptoms of asthma, Meniere’s Disease and Alzheimer’s Disease.

There is now evidence that a high salt intake in childhood also influences blood pressure and may predispose an individual to develop; high blood pressure, osteoporosis, stomach cancer and obesity. Dietary habits in childhood can influence eating patterns in later life. Liking salty foods is a learned taste preference.

The study published in the European Journal of Clinical Nutrition in July showed how the majority of the salt came from foods such as cow’s milk, bread and savoury food. Remember this was the 1990′s. Since then, baby food companies have reduced the salt content of their jar foods considerably, cow’s milk is not recommended as a main drink until over 12 months of age, and parents are told to be aware of added salt.

Current recommendations for salt consumption are:

Age                                  Maximum salt recommendation

0-6 months                   <1g/day (<0.4g sodium)

7-12 months                  1g/day (0.4g sodium)

1-3 years                         2g/day (0.8g sodium)

4-6 years                         3g/day (1.2g sodium)

7-10 years                       5g/day (2g sodium)

11+ years                         6g/day (2.4g sodium)

Salty foods to watch out for are: bread (0.18g sodium per slice), gravy (0.15g in one tablespoon made-up gravy), breakfast cereals (up to 0.06g sodium per portion), canned foods and ready meals (canned spaghetti = 0.42g/100g). Also, one bag of salted crisps (25g) contains 0.4g salt or 0.2g sodium.

Study reference:

Cribb VL, Warrn JM and Emmett PM. Contribution of inappropriate complementary foods to the salt intake of 8-month-old infants. European Journal of Clinical Nutrition, July 20 2011.

Research by a group at the University of Bangor has shown how drinking fruit juice regularly enhances a subconscious liking for sweet tastes and leads to a cycle of sweet food and drink consumption – a big risk for obesity, dental decay, and for children; refusal to eat ‘main’ meals and savoury foods. Whether fruit juice is 100% and no added sugar is irrevelant; both are loaded with sugar and calories. Think about how many pieces of fruit are needed to make a glass of juice – many more than you’d be capable of eating alone. Once the fibre is discarded from the fruit (when squeezed), the ability to feel full is lost and we can drink litres of juice (and it’s sugar, fructose) without feeling full.

The Bangor University study has called for juice to be excluded from the 5-a-day portions, and I agree. Have a look at my table below to decide for yourself.

What to drink instead? Water! Milk! Let children get used to plain tastes and that’s all they’ll ask for. Juices and sweet drinks can be kept for special occasions only.