How Much Calcium Does My Child Need?

Babies begin life drinking only milk. Whether breast or formula milk, all babies drink milk only until around 4 to 6 months of life. After a baby starts on solid food, milk is still regarded as his primary source of nutrition until 12 months of life. Most infants average between 600ml and 1000ml of milk per day (20-30oz). So why is it that so many children seem to stop taking milk entirely at around 3 years of age?

Cow's milk

How Much Calcium Does My Child Need?

For some, it is because parents just don’t think it is important anymore. After all, their child is taking a variety of other foods. For others, it is a conscious choice to avoid dairy. Dairy has been blamed for a variety of different problems, ranging from eczema and allergic reactions to behavioural issues. Some people believe dairy increases sinus congestion, or is generally inflammatory. However, little to no robust scientific data exists to support these claims.

Why Do We Need Calcium?

Dairy has existed in the diets of most cultures for around the last 8,000 years, so this would appear to be a useful part of our diet. Dairy is a nutritional powerhouse, containing high levels of protein, vitamins and minerals such as calcium, phosphorus, magnesium, etc. There are few, if any, foods that can match its ability to provide such a complete nutritional package.

Various studies have linked dairy (particularly full fat dairy) to a reduction in obesity and diabetes type II risk. There is also evidence that high protein dairy such as milk and yoghurt help to reduce risk of cardiovascular disease. Dietary intake of dairy also reduces risk of certain cancers such as colorectal cancer.

Dairy has long been known to reduce the risk of osteoporosis in later life. Risk of osteoporosis is linked to calcium intake within the first 30 years of life, as this is the period of maximum bone growth. People with high dairy intake within the first few decades have improved bone density, and reduced risk of bone fractures in later life.

How Much Calcium Does My Child Need?

As you can see from the table above, children continue to require high levels of calcium after infancy, and after the traditional age of weaning.

Let’s take a look at some of the most plentiful dietary sources of calcium:

As you can see from the table above, getting the recommended daily amount of calcium becomes quite tricky if we exclude dairy (which accounts for the majority of the “high- calcium” food sources on this list. Yes, kale and collard greens do contain dairy. However, your child would have to consume two whole boxes of collard greens- or four whole boxes of kale to get the equivalent of one 8oz glass of milk! Good luck getting the average toddler to go for that!

How about other sources of calcium?

A 3oz can of sardines will give your child around 325mg of calcium; a can of salmon will give him around half that. However, canned foods are often high in salt; most parents wouldn’t want to give their child an entire can (or three) of sardines every day.

What about fortified almond and soy milks? Yes, they do contain similar amounts of calcium to full fat cow’s milk. An 8oz glass of calcium fortified almond or soy milk contains 300mg of calcium. Interestingly, studies comparing the bones of children drinking soy and almond milk compared to full fat cow’s milk showed reduced bone density in the children drinking calcium fortified non-cow’s milks. This may be due to the combination of other nutrients found in cow’s milk, such as proteins, phosphorus and vitamin K2, which are also important for bone health.

If you are giving your child a non-dairy fortified milk, remember to shake the carton before pouring, as the calcium tends to solidify out at the bottom.

Bottom line, calcium continues to be important for your child long after the first year of life. Dairy continues to be loved by health care professionals for its ability to provide the daily recommended amounts of calcium for children in an easy and effective manner. There is also evidence that the combination of other nutrients in dairy gives it an additional advantage in the prevention of osteoporosis when compared to other sources of calcium. 

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Baby-Led Weaning: Fab or Fad?

It seems too good to be true: a new craze to hit the baby feeding scene that doesn’t require any troublesome steaming or pureeing. Instead, you just grab a handful of fruit or veggie sticks and away you go. So is baby-led weaning the answer to all our prayers, or is it just a fad?

Baby led weaning: fab or fad?

First introduction to durian (a very unusual tasting South East Asian fruit!)

Fans of baby-led weaning cite reduced fussiness with food choices, improved eating, and reduced risk of childhood obesity as potential gains from this method of feeding. Critics raise concerns about potential choking hazards and reduced nutrition, as well as limited choices (not everything can be given as finger foods). So what should you do?

Infant Development:

Although an infant as young as 4 months of age can grasp a toy or other object in his hand for a brief period, it is not until around 6 months that he can purposely reach for and hold onto an object. At around this time, he will also be able to put it in his mouth. However, he is unlikely to repeat this action frequently enough to achieve much in the way of nutrition at this age. He is just as likely to drop the fruit or veggie stick on the floor, or mush it into his eyebrows as get it into his mouth.

Infant Nutrition:

Breast or formula milk contains all the nutrients necessary for a baby up to 6 months. Beyond 6 months, a baby requires solid food to supplement the nutrition in the milk, although the milk remains the primary source of nutrition for an infant up to 12 months. Supplementary food helps to ameliorate the dip in iron stores that occurs at 9 months of age; it also provides additional calories for the increased metabolic demand of an increasingly mobile child.

Baby-Led Weaning:

Pros:

  • Easy to prepare: compared to traditional purees, carrot sticks and chopped up fruits can seem a lot easier for a busy working Mom to prepare . However, care has to be taken to ensure a wide range of different foods are provided, including protein and foods rich in iron.
  • As this method of feeding involves a longer time frame (and a lot of patience!) the baby is less likely to overfeed, and more likely to respond to his body’s cues when he is full. This can lead to a reduction in childhood obesity.

Cons:

  • If baby-led weaning is followed strictly, the baby only eats what he puts in his own mouth. In the early days of self- feeding this can lead to prolonged mealtimes and poor intake of nutrients.
  • Once a child has moved past the initial fruit and vegetable stages, it may become increasingly challenging to give sufficient meat and other protein sources as finger foods. It often involves a great deal of thought and preparation to provide a child with a nutritionally balanced food that he can self feed successfully.
  • Recent studies have shown that babies fed solely by the baby-led method are at more risk of iron, zinc and vitamin B12 deficiency. They are also more likely to choose predominantly carbohydrate-based foods. Turns out there is no super- easy way of getting good nutrition into your child after all!
Baby feeding

Baby enjoying feeding herself from a fork

Controversial:

  • Choking: critics of baby-led weaning often voice concerns over increased risk of choking. However, a recent study showed equal rates of choking episodes in babies who were baby-led and those who were weaned onto solids following more traditional methods. The choking episodes occured with similar foods in both groups (slices of apple and other hard fruits,etc.). The episodes were more associated with when and how various “high risk” foods were introduced rather than in the context of which feeding strategy was used. It seems the take home message is that you have to be careful whichever method you use.
  • Reduced fussiness: although there is a huge amount of anecdotal evidence from parents who have baby-led fed their infants, no studies to date have convincingly proven this. Generally,  babies are often very open to trying new foods, whether puréed or via finger feeding: it is usually only as children approach the latter half of the second year of life that food preferences and food faddiness starts to appear for the majority of children. Often this has more to do with their family’s general approach to food and mealtime behaviour, rather that a specific methodology of introduction of solids.
  • Supporters of the baby-led feeding movement claim that this is closer to how our ancestors fed their babies, before steamers and blenders were invented. However, there are countless accounts of ancient civilisations pre-masticating their food for their infants (yeah, I know- delightful- but I guess they did what they had to do!). Turns out blenders aren’t all that necessary for making purees after all!

Purees:

Pros:

  • Mom is in charge of the spoon. This means that she can control the amount of nutrition that the baby takes (more or less).
  • This method of feeding is much easier for the neat-freaks out there! No huge mess all over the floor to have to clear up after dinner (or friends huge tips to waitresses at restaurants!). (Tip- for baby-led weaning parents: buy a plastic sheet from an arts and crafts shop and lay it under your baby’s highchair before mealtime- you will find cleaning up much easier).
  • It is easier to ensure your child gets all the protein and iron he needs when it is blended into a purée rather than trying to get a baby to gnaw his way through a steak or lamb chop. Babies tend to suck on large chunks of meat, taking the oils and fats, but leaving behind the protein and iron.

Cons:

  • I won’t lie to you- it takes effort. Entire Saturday afternoons spent over a hot hob preparing countless chicken casseroles, spaghetti bologneses and salmon and brocolli purees. There is a little hint of satisfaction when you see all those little pots filled up though…
  • You can get stuck in a rut. Even purée babies need to start on finger foods and more textured solids. You must move your baby on from smooth purees onto lumpier, more textured foods by around 7- 8 months to avoid him developing aversion to textures.
  • Choking occurs just as commonly in purée fed babies as baby-led weaning babies. You still need to e a careful about what finger foods you give- and when. And never leave a baby unattended with finger foods.

Controversial:

  • Concerns have been raised that since feeding purees is more passive, babies may be inadvertently over fed using this method. This may predispose to a baby being less aware of satiety, or “fullness” cues, which could lead to an increased risk of obesity. There is limited data currently on this.

So What Should You Do?

Do your research. If you are going to do baby-led feeding, then please don’t regard it as the easier option. You will still need to cook: meatballs; goujons; all sorts of foods that contain the same sort of nutrients found in purees but stuffed into infant hand sized balls or bars.

Similarly, if going the purée route, you should introduce textures and finger foods from around 7-8 months. Put a few sticks of fruit or vegetables, or other finger foods for your child to explore whilst you feed him the purée. Watch for cues that he is full, and don’t try to push beyond what he wants to eat. Increase the texture of the purée at around 7-8 months, either fork-mashing or finely chopping the food, and add pasta or risotto rice for interest.

Don’t be too much of a purist! The idea that spoons and forks shouldn’t be used at all is rather silly. By all means load some food onto your child’s spoon or fork to introduce new foods that couldn’t otherwise be introduced in a “true” baby-led regime. (I dare you to finger feed yoghurt!)

Enjoy the journey! Do what works for you- and be responsive to what your child seems to enjoy most.

7 common mistakes in baby feeding practices in Singapore

7 common mistakes in baby feeding practices in Singapore

I recently had the opportunity to sit down and chat to a journalist from The Asian Parent online magazine. We talked about common feeding practices, and how we can improve nutrition for young infants and children.

I hope you enjoy reading the article. As always, feel free to leave your comments and questions below- I would love to hear from you. What issues have you struggled with in feeding your child? Have you experienced any of the problems in this article?

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Growth Charts: What Is All The Fuss About?

Is my baby growing well? Is it okay if my baby’s weight is on a different percentile to his height? Is it normal that my two year old doesn’t seem to have grown at all in the past 3 months? Growth charts really seem to induce a significant amount of confusion and anxiety amongst parents- especially first time parents of young babies.

Statistics:

Let’s start with a basic introduction to statistics, so that we can understand what growth charts are all about. Weight and height follow a pattern of normal, or “Gaussian” distribution. This means that the mean and the median are the same. For those of you who are now feeling that school math was a very long time ago, here are a couple of examples to refresh your memory:

Mean: imagine you add up all the weights of the 30 children in your child’s class and then divide this number by 30- this gives you the “mean” average weight of the children in your child’s class.

Median: imagine you take those same 30 children and line them up in order of their weight from smallest to largest. The middle child has the “median” average weight of the class.

Displayed in graphical form, it looks like this:

Normal distribution

Gaussian distribution

As you can see, the centre point, or zero, is where the mean and the median lie. Most of the children in the class will fall into the yellow zone between the -1 and the +1, and would be regarded as having an average weight. These children would fall roughly between the 25th and the 75th centiles on the standard growth charts. Then you have the “normal” children; these children fall into the peach coloured zone between the -2 and the +2; their weight may be regarded as slightly below or above the average, but still normal. These children would have weights between the 10th and 90th centiles on the growth charts.

Finally, there are the children whose weights fall more than 2 standard deviations away from the mean (in the orange zone, between -2 and -3, and +2 and +3). These are the children that may have issues with being under- or overweight. I say “may” because some of these children will be perfectly healthy and it is genetically appropriate that they are in those zones. That is why it is important to look at the child’s height, as well as the height and weight of the parents before making a considered judgement about whether the child may have a growth problem.

What Influences Growth?

Growth is influenced by many different factors at different stages in a child’s life. It’s useful to have a basic understanding of these factors so that we can identify when and if a child has a growth problem.

Prenatal Growth:

In the womb, growth is influenced mainly by the ability of the placenta to provide nutrition. If the placenta is small, or affected by maternal illness such as high blood pressure, diabetes or pre-eclampsia, then the baby may not grow as well as he should. Small sized or obstructed wombs (secondary to fibroids, etc.) can also affect growth. Occasionally, an illness in the baby can result in a smaller size than expected.

Sometimes the placenta can provide “too much” nutrition; this can occur in diabetes or in situations where the placenta and maternal nutrition are working almost too efficiently. This can result in a baby who is unusually “large for gestational age”. Many of these babies drop one or two centiles after birth to follow the centile that is more similar to their genetic potential. This should not be regarded as failure to thrive if the child is otherwise well.

Early Infancy:

Growth in early infancy

Early Infancy Growth

Growth in this period is mostly influenced by nutrition. However there are other factors, such as genetic potential, which may influence growth. Some babies shift onto a new centile after birth if the one at birth was inappropriately high or low based on their long term growth potential.

Babies generally lose up to 10% of their birth weight in the first 5 days of life. Most of this is “water-weight”; babies classically regain this weight by around day 7-10 of life. Thus a baby with a birth weight of 3kg may lose up to 300g to drop to a weight of 2.7kg by around day 5 of life; he should be back to 3kg by around day 7-10 of life. A baby who loses more than 10% of his birth weight, or who takes longer than 14 days to regain his birth weight should be seen by a doctor or health visitor to see whether there is a problem with feeding.

Once a baby has regained his birth weight, he should gain around 30g per day, or 200g per week for the first several weeks.

Theory of Fetal Imprinting:

This is something I find hardly any parent knows about- but it’s crucially important. Studies show that babies who have poor nutrition in the womb but then gain weight rapidly in early infancy (rapid “catch-up”) are at risk of developing metabolic diseases. These include type II diabetes, heart disease and high blood pressure from as young as mid-teens to early twenties. This phenomenon is thought to be due to “down-regulating” of blood pressure and insulin receptors in the womb; these are then inadequate to handle the large quantities of nutrition forced on them in early infancy- often by well- meaning relatives wanting to “fatten them up”.

How can we avoid this risk of metabolic disease? We should aim to allow a baby to gradually catch up their weight over a period of several months. For example, a baby born with a weight on the 3rd percentile should hit the 25th percentile sometime in the second 12 months of life- not the first 3-6 months of life.

Late Infancy and Early Childhood:

Nutrition continues to be an important factor in growth in late infancy and early childhood; decisions made in this period impact on eating choices for the rest of a child’s life. As a child becomes more and more active, it often becomes harder for parents to keep up with nutritional demands; additionally, some children can develop fussy eating habits. See Top Tips For Feeding Toddlers and Getting Your Toddler To Eat Vegetables for further information.

Children who drop two or more centile lines or who have two consecutive weight readings below the 3rd centile may be at risk of faltering growth. Such children would benefit from further assessment by a doctor or health visitor.

Dieticians are valuable resources to help parents increase the energy and nutrition density of their child’s food. Dieticians don’t just teach parents how to hide vegetables!

Some children start to eat too much, or too much of the wrong foods from this age onwards. Studies show that childhood obesity at the age of four years is a strong positive predictor of adult obesity. For advice on combatting childhood obesity, see Childhood Obesity: Is My Child Too Big?

Conclusions:

Although growth charts are useful in tracking a child’s growth, they are not the only indicator of good health. Trends are more useful than individual weight measurements; if you are seeking a medical opinion on your child’s weight remember to take along previous weight and height measurements.

Remember that if you and your partner are both short, you are unlikely to have given birth to a basketball player! Similarly, tall and slim parents often have tall and slim children; children don’t always have to be on the same centile for height and weight.

Indicators of good growth are:

  • Roughly following a centile curve: some plateaus and growth spurts are inevitable, but falling past two centile lines on two consecutive visits may require closer attention.
  • Steady catch up growth for children born below the 3rd centile: not too rapid, but some improvement across the centiles should be seen.
  • Weight and height both increasing steadily; they don’t have to be the same, but steady improvement is appropriate.

Approximately one in 20 children will have a weight below the 3rd centile at some point or another. Around one in one hundred will have more than one consecutive weight below the 3rd centile. However, less than 5% of these children will be suffering with any medical disease. Seek appropriate help, make appropriate interventions- but try not to panic too much!

Please leave your comments and questions in the box. As always, if you found this post useful, and would like to receive similar content, don’t forget to subscribe- leave your email address in the subscriptions box and I will do the rest! 

 

Starting Solid Foods: When and How

When to start solids

Starting solid foods

Readiness for starting solid foods:

As your baby starts to approach 6 months of age, you will probably be thinking of introducing solid foods into his diet. Up until this point your milk has been adequate to meet all his nutritional requirements, but as he becomes more active, his nutritional demands start to change.

Signs that your baby is now ready to start solid foods are:
1. ability to hold his head up for prolonged periods when in a seated position
2. loss of the tongue thrust reflex (pushing out an empty spoon when it is placed inside the mouth)
3. Getting more interested in solid food- oftentimes babies will try to snatch daddy’s food from his plate!

At what age should you start solid foods?

You should aim to start your baby on solids by around 6 months. We usually recommend that parents avoid starting solids before 4 months (16 weeks), unless in certain medical conditions. However, you should try not to delay starting solids beyond 6 and a half months. Studies show that there are specific developmental “windows” during which your baby is open to learning the skills of chewing and tolerating solid and textured foods: if you delay starting solids much beyond this time, your baby may be at risk of developing oral hypersensitivity and a dislike of or reduced tolerance for solids or textured foods.

How to start, or “first tastes”:

Once you have determined that your baby is interested in food, you can choose a time during the day when your baby is not too tired or hungry. Around an hour before his usual lunchtime milk feed is usually a good time to start.

You may wish to start with a plain baby rice mixed with some of his normal milk in a bowl. Avoid adding rice cereal to a milk bottle; it is difficult for your baby to suck through the narrow hole in the teat, and it stops your baby from learning the important skill of taking food from a spoon. When choosing a rice cereal, try to choose one with no added salt or sugar; as a general rule, don’t add salt or sugar to your baby’s food for the first 12 months of life.

Other good first foods to start with are single ingredient fruit or vegetable purees such as apple, pear, carrot, sweet potato or butternut squash. You can steam and then blend them to a smooth consistency (adding some of the steaming water or his usual milk as desired to thin the puree if necessary). Allow the puree to reach a comfortable room temperature before serving.

Table Manners:

It is never too early to introduce good table discipline: in fact the earlier you start the easier it is to encourage your baby to adopt good practices.

You should always feed your baby in his high chair at the table, rather than trying to coax him into eating whilst he is playing or in front of the television.

Try to time your baby’s meals so that they coincide with family meal times as much as possible, or at least eat a snack or your own meal at the same time. This encourages your baby to understand that eating at the table is normal, and reinforces the positive social impact of eating together as a family.

What To Give:

Introduce new tastes every three days, allowing yourself a couple of days between the introduction of each new ingredient to observe for signs of allergy or intolerance. Once your baby has a good repertoire of tastes you can start to combine them to add interest and variety.

By the time your baby is around seven months, or has been taking fruit and vegetable purees for a few weeks, you can start adding protein into his diet. Good sources of protein to start with are chicken and oily fish such as salmon, which are high in omega 3 oils.

From around seven to eight months, you can start adding carbohydrates in the form of tiny pasta shapes or soft rice (risottos). This allows your baby to experience some soft lumps and texture in the food. It is important to allow your baby to start to experience some more textures from around 8 months to teach chewing and swallowing skills. Again, do not delay this too long beyond 8 months so as to avoid your baby developing aversion to textured solids.

Your baby may dislike textures and even gag initially; continue to offer the textured food in small spoonfuls up to ten times per feed until your baby becomes gradually more tolerant. If your baby continues to reject textured solids, try pureeing half the food and mixing in more lumpy textured food to the puree.

Further Reading

Starting solids

A useful resource for advice on how to wean your baby, as well as lots of lovely recipes to try can be found at www.annabelkarmel.com. Annabel Karmel also has many books available on weaning and childhood nutrition.

What challenges did you face when starting solids with your child? What tricks and tips did you find helpful? Feel free to share your comments below. If you enjoyed reading this article, remember to enter your email in the box above to subscribe to receive weekly blogs direct to your inbox. Have a great week ahead!

Childhood Obesity: Is My Child Too Big?

Childhood Obesity and Overweight

Childhood overweight and obesity

Childhood obesity: is my child too big?

It’s a touchy subject, but unfortunately childhood obesity is increasing at an astronomical rate. According to the World Health Organisation (WHO), global childhood overweight and obesity rates have increased worldwide from 32 million in 1990 to 42 million in 2013. In the USA, obesity affects around 12.7 million children and adolescents aged 2-19 years; in the UK, one third of children aged 10-11 years, and nearly one fifth of children aged 4-5 years are either overweight or obese. And it isn’t just a disease of the West; in Singapore, 12% of schoolchildren are obese.

What is Childhood Obesity and Overweight? 

We use body mass index (BMI) to define overweight and obesity. A child with a BMI of greater than the 85th percentile on the BMI for age charts is regarded as overweight, and a child with a BMI greater than the 95th percentile is obese. We calculate BMI as:

Weight in kilograms ➗(Height in metres x Height in Metres)

For example, a five year old boy has a weight of 28kg and a height of 115cm (1.15m). His weight is above the 97th percentile and his height is on the 90th percentile. Is he just a big boy, or is he at risk of childhood obesity?

Growth charts boys age 2-20 years

CDC Boy’s height and weight charts age 2-20 years

https://www.cdc.gov/growthcharts/data/set2clinical/cj41c071.PDF

BMI Calculation: 28 ➗ (1.15 x 1.15) = 21

We take the calculated BMI and then plot it on the BMI for age charts. A BMI of 21 in a 5 year old boy is greater than the 95th percentile on the BMI for age charts, and so this child is actually obese.

Children BMI age 2-20 years

CDC child BMI charts 2-20 years

https://www.cdc.gov/growthcharts/data/set1clinical/cj41l023.PDF

Why Does It Matter? 

Childhood obesity is associated with significant short and long term health problems, ranging from the misery of being teased and bullied in school, and all the psychological trauma that it brings, to the medical complications of high blood pressure, high cholesterol, increased risk of heart disease and diabetes, and even certain types of cancer.

Studies show that approximately 70% of obese children go on to become obese adults. A child who is obese by the age of 4 years is likely to struggle with weight related issues throughout his adult life.

What Causes Overweight and Obesity in Children?

There are three main factors contributing to the 21st century obesity epidemic:

1. Poor dietary choices: there is increased availability of high fat, high energy “fast foods”. Many of these foods are cheaper and easier to obtain (as well as being more appealing to young children and adolescents) than so-called “healthy options”. In fact, childhood obesity rates are increasing in many developing countries in urban areas where fast food options are often the cheapest food available.

2. LIfestyle choices: less children are playing outdoors today than a few decades ago. Previously, it was common to come home from school and then play soccer in the back garden, or a game of hide and seek in the street.  Multiple studies as far back as 25 years ago have highlighted the relationship between screen time and childhood obesity.

Risk factors for childhood obesity

Child playing computer games

Interestingly, TV appears to have the strongest link with obesity; studies cite passive snacking whilst watching TV and the effects of junk food and snack advertising (which then impact food choices), as well as the lack of active exercise.

3. Portion size: I see obesity increasing even in families where the parents are well educated and are making so-called “healthy” choices regarding the types of food they give their children. Unfortunately, even healthy food will result in obesity if given in large quantities. Fresh fruit is, of course, preferable as a snack or dessert to processed, high fat- high sugar desserts, but even fruit contains sugar, and if given in large quantities unchecked several times a day will still result in an energy imbalance (energy in is greater than energy out). Similarly, of course whole grain carbohydrates are preferable to highly processed carbohydrates, but a child should still be restricted on the amount he takes.

What Can I Do?

1. Healthy food choices: reduce high energy, high fat foods to a minimum. Allow fast food “treats” once every few months, rather than once or twice a week. Encourage other treats: for example, in our house, a favourite alternative to eating out at a fast food restaurant is sushi (my four year old inhales salmon sashimi!). Replace processed carbohydrates with their healthier alternatives: wholegrain pasta and bread, and brown rice, rather than the “white” processed versions.

Adopt the “healthy plate” approach:

2. Limit screen time and increase outdoors exercise. Aim for one hour of outdoors exercise per day, which raises the heart rate and leaves your child slightly sweaty- sweaty is good! This will also have the added benefit of increasing his body’s vitamin D production and reducing his risk of myopia (short-sightedness). Find an activity your child enjoys doing, or even find a hobby you can both enjoy together, such a cycling, swimming or running.

PReventing Childhood Obesity

Exercising as a family is fun- and good for you!

Previous recommendations on screen time were to aim for no more than 2 hours per day; however, more recent studies suggest that two hours may be too much, and we should aim for significantly less than this.

3. Portion size: Forget your personal hang ups about melamine Hello Kitty and Transformers plates, and go buy them for your child. The use of these plates helps in controlling portion size much more than trying to put a child-size portion on an adult-size plate.

The other major pitfall in controlling your child’s calorie intake is second helpings, and the belief that as long as you are serving “healthy choices” your child can have unlimited servings of them. Stick to just one appropriately sized portion. If you want to reward your child, don’t use food as a reward.

What problems have you come across in preventing obesity and overweight in your children? Have you found any other strategies that have worked for you? Leave you comments below.

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Top Tips For Feeding Toddlers


Feeding toddlers can be a tricky business. Food on the floor, on the curtains, in Mommy’s hair… and that’s on a good day! On a bad day, your toddler can flat-out refuse to eat the meal you’ve painstakingly spent the morning preparing- even if he ate it delightedly just last week.

Here are my top tips for hopefully having more good days and less of those not so good days:

1. Eat with your toddler.

When we first start feeding our babies at around 4-6 months, it’s usual practice to put baby in the high chair and sit in front of them shovelling in spoonfuls of whatever purée we have cooked. Although this strategy often works for the first few months, it is not unusual for it to stop working by the time your baby reaches toddlerhood.

This is because we are essentially social animals, designed to do certain things together. The French model of feeding children is often held up as the “Gold Standard” when it comes to this, as the French are renowned for turning mealtimes into social occasions. Parents often complain to me that their young child will not eat the food that is cooked for them at home, but will happily eat a less expensive or nutritious meal in nursery; it is not because the food is any more delicious than what they receive at home, it is because they are eating together with their friends.

2. Eat the same food as your child.

This is an extension of the first idea. Your child should see you eating the same meal as them (and enjoying it!). As well as eating with your child, you should show that you are happy to eat the same food as they are eating. If you are not, then perhaps you should rethink what you are feeding your child.

Although we generally recommend not adding salt or sugar to food for children under 12 months, you can start to (gently) relax those rules after their first birthday, which means that there is really no reason why they can’t eat the same meal as you as long as vindaloo is not on the menu.

3. Feed your child at the table.

Make sure your child eats their meal sat at the table in an age-appropriate chair at the right height to the table. Don’t chase your child around the house with a bowl and spoon, or try to sneak in spoonfuls whilst they’re playing. Your child needs to be aware of their relationship with their food, and needs to develop good mealtime habits.

4. No distractions.

Don’t bring TV or toys to the table in an attempt to distract your child so that they don’t realise you are feeding them. Although it seems to work well in the initial stages, you soon find that you have to escalate the distraction, all the time getting less and less food into your child.

I call it the law of diminishing returns- soon you will be dressed in a clown suit dancing a tap dance on the table…

5. Do not reward a failed mealtime with a treat.

We all know the foods our child will always eat: fruits and yoghurt. Many parents resort to producing these “treats” when a child won’t eat their meal, unwittingly sending a message that if they do not eat their meal they will get their preferred food.

Of course we want our children to eat fruits and yoghurt. However, rather than giving these immediately after a failed mealtime, schedule them at snack times or as part of breakfast.

6. Don’t become the option #1, option #2, option #3 parent.

The meal is the meal is the meal. Don’t run off into the kitchen to prepare another meal if your child is not taking the one you prepared. Children are clever manipulators, and soon learn to reject all options until their preferred one arrives. Therein lies the path to the “beige” diet – the infamous toddler diet of chicken nuggets, fries, plain pasta and bread.

It is not the end of the world if your child ends a meal having eaten none of it – learning to feel hungry for a short while won’t have any lasting ill effect and will teach him to eat the next meal better. Vary the meals: if lunch is a “challenge” meal, with new or less favourite foods, then dinner can be one you know he generally eats well.

Finally, try to have fun at mealtimes. Make mealtime a social occasion where the family gathers together, asking each other how their day went, and catching up after a long day. As your child grows older, they will enjoy being included in this special daily event.

Getting Your Toddler To Eat Vegetables

Getting toddlers to eat vegetables

My 14 month old daughter devouring olives! 🙂

I am often asked questions like this:

My son is 18 months and refuses to eat any kind of vegetables. I’ve tried mashing it and hiding it in his food and pasta sauces but he refuses to eat it and often spits out his food. On the other hand, he is pretty accepting of quite a number of fruits. How can I get him to eat his veggies?

Well done for getting your son to take some fruits; that is a good start. Many parents struggle to get their children to accept vegetables; sometimes, but not always, parents’ own feelings about vegetables predict how the child views them.

Firstly, make sure your child sees you eating (and liking) vegetables. At this age, children should be sharing their mealtimes with the rest of the family, and eating the same foods as the rest of the family. Offer a wide variety of vegetables, without considering media stereotypes (Hollywood movies are convinced all children detest broccoli; whereas in reality many children really like it). Try to avoid feeding your child on his own, or feeding him “baby food”.

Think of innovative ways to display the vegetables. Whilst hiding some vegetables in pasta sauces may help a little, it isn’t a long term strategy. As your son likes fruits, try starting him with vegetables that are more similar to fruits, such a cherry tomatoes and cucumber. Cherry tomatoes can be chopped into quarters and given as finger feeds. Cucumber strips work well with dips (as do steamed carrot sticks and steamed broccoli florets); try dipping them into hummus (chickpea puree) or guacamole (avocado puree) – after all, children love playing with their food!

Food presentation counts too. Making a meal visually appealing can help entice a child into eating it. Chopping vegetables of various different colours into fried rice and naming it something appealing like jewel rice or sweetie rice often changes a child’s perspective on a meal: try adding petit pois (tiny sweet peas), sweetcorn kernels and tiny diced pieces of tomato, red and yellow capsicum, etc. to rice to make it look pretty. Salmon and spinach risotto is a firm favourite in my house, partly I think due to how attractive the pink and green look together.

Roasting root vegetables such as carrots, pumpkin and butternut squash in the oven with some olive oil brings out their natural sweetness, and makes them taste more like fruits. Enhancing their flavours by using various spices such as nutmeg, cinnamon and even cumin works well too. Cumin is particularly good sprinkled on roasted carrots.

Remember that it can sometimes take several attempts with a new food before your child decides that he likes it, so a certain amount of patience and perseverance is necessary.