Children are at much more risk of dehydration than adults – due to their higher surface-to-mass ratio. I often wonder how it is possible for children to achieve their daily fluid requirements without taking a drink bottle to school as one drink at lunch in the school cafeteria cannot surely be enough. An interesting study of a group of school children (aged 11-12 years) in Manchester proved that encouraging children to drink adequate amounts had benefits on cognitive function, mood, feelings of calmness and feelings of ‘interest’ at school.

Here is the recommended amounts children should be drinking daily:

Age Girls / Boys
4-8 1120ml/day // 1120ml/day
9-13 1330ml/day // 1470ml/day
14+ 1400ml/day // 1750ml/day

The study in question found that sending children to school with a bottle of drinking water increased their water intake by at least 500ml or two cups per day. The benefits were significant.

Children frequently prefer sweetened drinks, but even this study found that children reported they developed a ‘taste for water’ during the 14 day trial.

New research show that teenagers who eat a healthier diet and exercise regularly are happier than their peers. The Institute for Social and Economic Research at the University of Essex has shown that:
– higher consumption of fruit and vegetables, and lower intake of crisps, sweets and fizzy drinks were associated with greater happiness.
– the more hours of sport or physical activity teenagers do per week, the happier they are
– between the ages of 13 and 15, teenagers diets typically become less healthy and participation in exercise decreases, as they gain more autonomy over lifestyle choices.
– only 11% of 13-15 year olds reported reaching 5-a-day, and even in 10-12 year olds, only 20% reported reaching their daily fruit and vegetable targets.

I know I’ve mentioned smoothies previously, but here is another article to back me up: a dentist warning parents about the effects of smoothies on children’s teeth…

healthy smoothies not so innocent

I’ve just completed some work analysing 50 breakfast cereals. Breakfast is considered to be one of the most important meals of the day. Children particularly, perform better academically, socially and physically when they eat a breakfast. Breakfast cereals are a great choice – but during my research I was shocked by the poor quality of cereals aimed at children.

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

I have come across a great resource for searching and comparing supermarkets own-brand goods. Written by Martin Isarck, author of the Supermarket Own Brand Guide, this website provides information on taste, nutrition, allergies and best prices at the UK’s leading supermarket chains.
Have a look for yourself, and let me know if it’s useful.
http://www.supermarketownbrandguide.co.uk/index.htm

Anyone who has tried to feed a toddler knows that how much they eat will vary from day to day and week to week. This is perfectly normal, but sometimes it would be helpful to know whether your expectations are realistic.

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

Food allergy is an adverse reaction to a food that is mediated or brought about by the immune system. By contrast, food intolerance is a non immune-mediated adverse reaction. Both reactions can cause discomfort and unpleasant symptoms, and both allergy and intolerance can be labelled as ‘food hypersensitivity’. These reactions are different from toxic food reactions (such as poison in non-edible mushrooms, or salmonella infection), which will generally cause a reaction in all humans, not just sensitive individuals.

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.

Infant colic may well be one of the most disconcerting problems of childhood. Despite over 50 years of research, the cause of colic remains unclear. An otherwise healthy baby will cry for hours upon end; ‘colic’ being an acronym for “Cause Obscure Lengthy Infant Crying”. Crying typically occurs in the evenings, episodes starting in the first weeks of life and usually ending at 4-5 months of age.

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.

Avoiding dairy products, both in childhood or adulthood, is often the only solution for those suffering from milk intolerance or allergy. But what are the nutritional consequences?

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.

Starting school or nursery can be an anxious time for families who have children with food allergies.

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!

News reports this week of the high salt diet that most UK babies consume were slightly inflated. “Seventy percent of 8-month-olds consume too much salt, UK study shows” was the headline from one news report. The study quoted was actually from a study of children born in 1991-1992, and although the cohort was large – almost 1,200 participants, and yes 70% of these babies did consume over 0.4g sodium (1g salt) per day….this ‘news’ is nearly 20 years old!

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

Fruit juices have been getting some bad press lately….and I think it’s about time. I am not an advocate of drinking fruit juices regularly, and certainly discourage parents from giving their children juice on a daily basis – no matter how fresh/pure/expensive it is.

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.

Millions of adults take vitamins and nutritional supplements in the hope of achieving better health, fewer diseases and to defy the ageing process. In 2009, £674.6 million worth of nutritional supplements were sold in the UK. But are they really worth it and should we be giving our children nutritional supplements too?

A new report by Behind the Headlines, an NHS service that investigates health claims, tells us that despite the wide availability of vitamins, minerals and dietary supplements such as fish oils, we should buy and take them with caution; and particular caution is needed when giving them to children.

Read more

The growth charts in your child’s ‘Red Book’ (Personal Child Health Record) show a graph of the normal distribution of the heights, weights and also head circumferences of healthy children. Understanding their use is key to monitoring your child’s growth patterns. Read more

I would guess that the food group that evokes the most anxiety amongst parents are vegetables. Just why vegetables are the perennial problem, it’s hard to know; possibly because parents see vegetables as super-nutritious, or because parents themselves don’t like them but wish their children would.

We are all born with a preference for sweet foods, but this aside, children will approach all new foods pretty much the same. Including vegetables.

So how do we get children to eat and enjoy their veg? Forcing your child to eat something they’re already slightly wary of will only increase their distrust of the food. Forget waging a war with them over finishing their vegetables. Patience is needed, along with regular exposure to vegetables to develop a sense of familiarity. We could also take some guidance from a new piece of research published in the Journal of the American Dietetic Association in February this year; 434 parents of children aged 2-5 were interviewed, and one of the major factors predicting whether a child liked vegetables was whether or not their parent ate vegetables.

If you’re worried about your child not eating vegetables, perhaps it’s time you ate them yourself?

Children in the UK are routinely weighed and measured on entering Reception (age 4-5 years) and Year 6 (age 10-11 years) and categorised using recognised growth charts as ‘underweight’, ‘healthy weight’, ‘overweight’ or ‘obese’. Being an unhealthy weight as a child can have both immediate and long-term effects; obesity can increase the risk of type 2 diabetes, heart disease, liver disease, certain cancers, and have psychological, social and academic implications.

Recent findings from the National Child Measurement Programme (NCMP) for England in the 2009/2010 school year should that nearly one in five children leaving primary school are obese.

• In Reception, nearly one quarter (23.1%) of children were either overweight or obese. In Year 6, this had risen to one in three (33.4%).
• The rate of obesity doubled between Reception (9.8%) and Year 6 (18.7%).
• The prevalence of underweight was low at around 1% for both ages.

This makes rather depressing reading, but it shouldn’t mean we turn a blind eye to children’s weight issues. Promoting healthy eating and a positive attitude to good food in the early years is certainly a good start, as is encouraging enjoyable exercise and physical activity during childhood.

If you are worried about your child’s weight, I recommend having an assessment by a paediatric dietitian who will provide practical and evidence-based guidelines for you to follow to ensure your child avoids becoming one of these statistics. Have  a look at my Healthy Weight Checker on the Blossom home page to understand how your child’s weight will be categorised.

An exciting new class is about to start in Altrincham, Cheshire called ‘Happy Little Eaters’.

Aimed at children aged between 18 months and 4 years, ‘Happy Little Eaters’ has been developed my myself and a specialist Speech and Language Therapist, Joanne Jones. As health professionals, we have spent many years working with children who are fussy or reluctant eaters, and we also know how to promote a positive approach to food from the beginning.

‘Happy Little Eaters’ are fun activity sessions for parents and toddlers that will introduce your child to new and exciting food experiences, and ultimately aims to create a happy, healthy approach to eating. Learn how to avoid battles at the meal table and help your child embrace healthy eating! Too good to be true? Come and try out the first session for free! Details are found on the following link: www.happylittleeaters.co.uk

I’m often asked about the best brand of feeder cups for toddlers who are almost finished with their baby bottles. My answer is always the same: the best drinking vessels for children over the age of one are open, non-lidded cups – yes, just the same shape as the ones you use!

Baby bottles and also dummies (or pacifiers) should really be discarded by the time your child is 12 months of age. This may sound like an impossible feat to achieve but a great deal of evidence suggests this is the right thing to do. With a bit of practice a child can get the hang of open cups – I have seen whole nursery classes of one year olds take just a few weeks to get used to the change.

5 reasons to throw out the bottles and dummies when your child is one….

Read more

From the moment weaning begins, it is important that your child starts to nurture a life-long positive approach to food, mealtimes and eating. Meals should be happy from the start! Follow my top tips for happy eaters and both you and your child can have stress free, happy meals together.

1. Let your child have the control over what goes into their mouth: try giving them their own spoon or offer some finger foods, allow them to see the food they’re about to eat (don’t hide it in a bowl out of their reach), and allow your child to expore the food by touching it before they eat it. If spoon-feeding, avoid pushing the spoon to the back of their mouths – place the spoon near their lips and let them choose to take it off the spoon themselves.
2. Include a variety of foods in your child’s diet and don’t ignore previously refused foods: it can take 15-20 exposures of one food before a child learns to like the taste.
3. Never force your child to eat anything: this includes persuading them to eat beyond their appetite. Don’t worry about having a clean plate – it is much better that your child learns to understand their own feelings of hunger and fullness. Don’t panic if they haven’t eaten much that day – forcing them to eat will not make anything better in the long term.
4. Role model good eating: children love to mimic and if they see you eating (and enjoying) your vegetables they are likely to copy.
5. Mess is good! Messy meal times are happy meal times. Allow your chld to explore food with all their senses and stop yourself from wiping them clean before the meal is finished. If children are not given the opportunity to immerse themselves in the pleasure of exploring food before they eat it, they often end up disinterested in food and reluctant to eat.

Finally, expect that your child will go through a phase of fussy eating. It is a normal developmental milestone, but if appropriately managed will usually resolve. If you are worried about prolonged fussy eating, nutrient intake or extreme food refusal it is a good idea to get in touch with a paediatric dietitian to help you nip the problem in the bud before it gets out of hand.

The importance of iron in the baby’s weaning diet should not be underestimated. Many parents spend the first few months of weaning letting their babies get used to healthy fruits and vegetables, and forget all about the other food groups including foods high in iron. Iron is a very important mineral needed for red blood cell production, energy and metabolism. Recent research has shown a lack of iron in the early years can have a long term and possibly irreversible effect on brain development, meaning if infants are not given adequate iron foods their IQ may be compromised.

Read more