Supplementary Knowledge - There’s More To Infants’ Health Than Just Eating
Sometimes good food isn’t enough to ensure young children receive a healthy dose of vitamins and minerals, explains Grub4Life’s Nigel Denby… Most toddlers in the UK are well-nourished. Their diet normally provides all the macro nutrients (carbohydrate, fat and protein) they need. In fact, many are over-nourished when it comes to macro nutrients, which explains […]
- by Nigel Denby
Sometimes good food isn’t enough to ensure young children receive a healthy dose of vitamins and minerals, explains Grub4Life’s Nigel Denby…
Most toddlers in the UK are well-nourished. Their diet normally provides all the macro nutrients (carbohydrate, fat and protein) they need. In fact, many are over-nourished when it comes to macro nutrients, which explains why three in five are overweight or obese.
However, increasing numbers of toddlers are not meeting the guideline requirements for some micro nutrients – vitamins and minerals. This could be because they don’t eat enough nutritious food, or are not being given the recommended toddler vitamin supplement.
Early interventions
It’s no accident that toddlers’ diets lack nutrients, considering that: • Some parents either don’t know or don’t care about nutrition • Some early years providers are serving inadequate meals and snacks • some toddlers’ diets are severely restricted due to cultural reasons, feeding problems or illness
We know that prolonged nutrient deficiency can have serious effects on our children’s health, growth and development. But most problems can be corrected if spotted early by either changing the child’s diet, or by supplementing it with the missing nutrients. Nutrient deficiencies are not caused by toddlers eating poorly for a day or two, or even a week or two. Most toddlers have body stores of a lot of nutrients, and poor eating for a short period won’t deplete them. It’s also important to remember that just like adults, toddlers eat better some days than others. We need to think about the quality of their diets over a week, rather than just judging them on one day in isolation. Nevertheless, there’s no escaping the fact that relatively affluent, sedentary lifestyles promote the overconsumption of energy-rich foods and the underconsumption of dietary fibre, fruit, vegetables, whole grains and fish – all of which are valuable sources of key nutrients. The most common toddler nutrition problems can often be spotted if you know what to look for. Asking parents some key questions about how toddlers eat at home is very helpful and, of course, the nursery’s own records of how well a toddler eat in nursery are valuable too.
Common nutritional deficiencies
Iron deficiency anaemia: Iron is essential to make haemoglobin in blood, but up to 12% of toddlers do not eat enough iron-rich foods and have poor iron stores. The most common age for the problem is between 12 months and 18 months – at this age, large amounts of iron are needed for growth and development, but as toddlers go through the transition from infant to adult dietary patterns, many refuse food. Other toddlers at risk include vegetarians and vegans, and those with poor general dietary intake and an over-dependence on milk. The most common cause for iron deficiency is a low intake of haem iron (iron found in meat) and a failure to eat foods rich in vitamin C, which helps the absorption of iron. This is especially important when you eat non-haem iron from vegetables or cereals. Toddlers who are given tea to drink or high-bran cereals to eat can also struggle to get enough iron; both of these foods will restrict iron absorption. Toddlers with a low-iron status may be pale, lethargic and lacking energy. Anaemia in early years has been shown to be linked with poor cognitive development. The best food sources of iron are lean red meat, breakfast cereals, eggs and dark leafy green vegetables and pulses, such as beans and lentils. Iron supplements may be required if a toddler is anaemic, but this should be discussed with a GP. Follow-on milks also contain iron, but again should only be given if a toddler is suspected to have a low-iron status.
Vitamin D deficiency: Vitamin D deficiency causes rickets. The only dietary sources of vitamin D are oily fish, margarines, follow-on formula and some breakfast cereals, all of which have vitamin D added to them. Vitamin D is also produced in the skin via sunlight. The Department of Health recommends that all children under the age of five take a daily supplement of vitamins D, A and C – which can be obtained using Healthy Start vouchers. For families who don’t qualify for Healthy Start vitamin drops, there are a wide selection of children’s vitamin supplements available. They should choose a known branded supplement that provides 7.5 micrograms vitamin D per day.
Less common deficiencies
Surveys have shown that an increasing number of toddlers receive low levels of other nutrients because they are not eating well. It’s quite common for toddlers to have low intakes of vitamin B6, folic acid, calcium and zinc, as well as iron. If a toddler has generally poor eating habits, it may be advisable to recommend a multivitamin and mineral supplement formulated for the under-fives.
Fibre: Some toddlers don’t eat enough foods that contain fibre, such as fruits and vegetables or wholegrain cereals like wholemeal bread, brown rice or whole grain pasta. A diet low in fibre can cause constipation. Toddlers with chronic constipation may be given mild laxatives and prescribed fibre supplements such as lactulose or fibregel by their GP. However, it’s important not to overload toddlers with high-fibre food, as they can become too full and go off their food. As always, it’s all about balance.
If a toddler eats a low-fibre cereal at breakfast, they can have some wholegrain pasta at lunch or a sandwich made with a mix of white and whole meal bread at teatime. Nursery cooks should keep a mixture of wholegrain cereal foods and refined (white) cereal foods, and serve a variety. Vegetables and pulses can be added to sauces, soups and gravies to increase their fibre content, and fruit should always be served as part of nursery desserts or snacks.
Omega-3 fats: In recent years, diets have changed to contain more omega-6 fats and less omega-3 fats. This is partly because toddlers eat more omega-6-rich vegetable oils and spreads, which are good for helping to reduce their intake of saturated fats. However, to balance the increase in omega-6 fats, toddlers need to increase their intake of omega-3 fats. The best source of omega-3 fats is oily fish, such as salmon, mackerel, sardines pilchards and trout. Ideally toddlers need to eat at least two servings of fish per week – one serving can be from white fish or canned tuna (canned tuna doesn’t count as an oily fish), the other should be from oily fish. Fish is notoriously tricky to encourage toddlers to eat, but our Grub4life chefs have developed some really popular fish dishes that have become firm favourites in nurseries across the country.
Choosing the right oils can help increase omega-3 fats, too. Olive oil and soya oil for dressings and rapeseed oil for cooking gives a good balance of omega-3 and -6 fats. Pure vegetable oil is usually (but not always) rapeseed oil. For toddlers who do not eat any fish, a toddler’s omega-3 supplement may be necessary to balance their intake of fats.
Nigel Denby is a registered dietician and head of nutrition at Grub4Life; for more information, visit grub4life.org.uk or follow @grub4life
