Infant nutrition

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If you’re concerned about your child’s diet, chances are that you’ve probably already started them on a multivitamin. But what are in these vitamins, and is this the answer to your concerns about fussy eating?

These days there are a wide variety of vitamins aimed at kids that come in a multitude of preparations such as “gummies” (a sort of a soft chewable lolly), capsules with liquid centres, crushable tablets, and of course liquid preparations. The other major variety of vitamin supplement on the market for children, are those that are made into milkshake type drinks, think toddler formulas and more specialised pharmacy products like Pediasure or Sustagen.

The majority of multivitamins on the market are made up of mostly B vitamins. Nearly all will include a good dose of vitamin C, and possibly some minerals like iron and zinc. Some will include vitamin D and E, most do not contain vitamin A or iodine, or larger minerals such as calcium. If they do, it’s usually in small amounts. I’m aware of at least one product on the Australian market that is a multivitamin and Omega-3 fish oil preparation, but you will usually need to purchase a separate supplement if it’s fish oils you’re after. 

Milkshake type supplements offer a more comprehensive range of nutrients and are complete with protein and energy.

But what does your child actually need? 

Most people that make their way to see me are worried because their toddler/pre-schooler/older child is fussy and not eating a wide variety of foods. If I really drill down to what parents are concerned about, two food groups come to mind: vegetables and meat (usually red meat). Most of us are familiar with some sort of population based recommendation as to how we should eat. In Australia, we have the “Australian Guide to Healthy Eating” (AGHE)(https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating). The pictorial below demonstrates the proportions of each food group we should be aiming to eat across the day. For those of us that remember the old food pyramid, Nutrition Australia has revamped it and it now represents current recommendations (see below). Both the AGHE and Food Pyramid are based upon recommendations outlined in our Australian Dietary Guidelines. 

 

Most parents know that their child should be eating roughly 5 serves of veggies and 2 serves of fruit each day along with the above recommendations. If your child’s not eating like this then there’s usually concern about whether they are getting enough vitamins and minerals. Some parents may also be worried about protein if their child isn’t eating meat.

What I know after more than 15 years of practice and analysing hundreds of children’s diets, is that there is more than one way to eat that will meet a child’s requirements. 

Most fussy eaters that I have worked with are reluctant vegetable eaters, they probably eat some fruit but prefer a predominantly carbohydrate based diet (cue crackers, bread, pasta and noodles on repeat!). Sound familiar?

Diets rich in grains and cereals are generally adequate in B vitamins, the major component of most multivitamins. Iodine is worth pointing out as it is not included in most multivitamins and recent studies have shown low to moderate levels iodine deficiency in Australian children. Iodine is important for brain development and deficiencies can lead to mental and intellectual problems. Simple changes to your child’s diet like using iodised salt in cooking, using bread that includes iodine (a mandatory requirement since 2009 in Australia) and including seafood and eggs regularly, will ensure iodine requirements are met without the need for supplements.

Fruit contains a similar range of nutrients to vegetables, so if they are eating some fruit, it’s more than likely they’re getting nutrients like beta-carotene (a form of vitamin A), vitamin K, folate as well as minerals such as potassium and magnesium that are also found in vegetables. A child who is a reluctant meat eater (particularly red meat), may be lacking in Iron, however, there are other non meat sources of iron in ours diets (for example wholegrain, fortified breakfast cereals as well as beans and legumes), and if your child consumes these regularly, their iron intake may well be adequate. Vitamin C requirements are generally adequate if your child eats two serves of fruit each day.

Dairy products are not usually something I see parents of fussy eaters struggling with. In fact many fussy eaters over consume dairy (particularly milk), so calcium is not generally an issue. Some parents are worried their child isn’t going to get enough protein if they don’t eat meat. This is rarely a concern. Protein is found widely in our diet (although the quality varies), including in dairy products and breads and cereals. I usually find that protein intake from dairy alone is sufficient to meet a growing child’s needs. In fact most fussy eaters I deal with, usually exceed their requirements for protein. 

What do I recommend?

For most children that I see I don’t recommend a vitamin supplement and rarely would I recommend a milkshake type supplement (I reserve these for children with extreme fussy eating who may also need to gain weight, but this is very much on a case by case basis). One of the major drawbacks of using milkshake type supplements  is that you are using this product to fill your child up, and not actually making any headway with them eating real food.

Whilst your child may not be eating ideally, it’s highly likely they are still getting what they need to grow. If I do use a multivitamin preparation then I would aim for one that includes iron. The other nutrient that IS usually a concern with fussy eaters is fibre. Fibre is NOT included in vitamin preparations but there are some fibre supplements on the market which can be used for children.

What your child is missing out on if their diet is low in vegetables are phytonutrients. Phytonutrients are thought to be one of the reasons that diets rich in vegetables (and fruit) might help to protect us against chronic diseases such as some types of cancer. Examples of phytonutrients include lycopene, known for cancer prevention, and leutin, important for eye health. Let’s not forget small oligosaccharides and resistant starches (collectively known as prebiotics) that are found in plant foods either. These are very important for optimal gut health and with more and more research pointing towards the importance of gut health for the prevention of chronic disease, we can’t overlook the need for a diet high in prebiotics. Phytonutrients, and prebiotics aren’t included in vitamin preparations. 

So you may be starting to get the idea that a multivitamin isn’t really the answer to fussy eating and possibly not even necessary.  As always, my main aim when working with clients is to identify nutrients that might be of concern and find ways to increase these nutrients in your child’s diet using real food, not supplements.

 Our population based guidelines above are “ideal” ways of eating that are associated with maintaining a healthy body weight and avoiding chronic disease as we age. It’s what we want to be aiming for with our children long term and what we as dietitians can help you achieve, but it’s not the only dietary pattern that will give them all the vitamins and minerals they need each day. 

One of the reasons I don’t often recommend vitamin supplements is because it’s usually adding another layer of “work” for parents, remembering to 1. offer it and 2. get your child to take it. I’d rather parents put their energy into using practical strategies to try and change their child’s diet. We know that food habits and preferences are formed in childhood, so if we want our children to eat a diet rich in vegetables, fruit and other plant based foods, along with quality proteins, we need to work towards it NOW. Sure, their choices at the moment may not make them deficient in anything, and they may still grow, but for optimal health as they mature, we want to get the dietary foundations and patterns of eating right in childhood. 

If you’re concerned about your child’s diet make an appointment to see an Accredited Practising Dietitian who specialises in children.

Angela and I are working on some exciting strategies to help you in your journey to feed your family real food and optimise your intake of plant based foods. Make sure you sign up to our newsletter so you can be kept in the loop as well roll out our new tools that will make feeding your family easier!

The advice in this blog post is of a general nature only and may not be right for your child. If you are worried about your child’s diet we suggest your consult with an Accredited Practising Dietitian.

 

Julia @Bloom


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We all know buying fruit and vegetables in season makes good sense. Food is fresher, tastes better, and is more economical. But with so many fruits and vegetables available out of their natural season, it can be confusing to know what to buy right now.

Below is a guide to whats available in the southern states in Autumn for March/April/May.

Autumn fruits –
apples, blackberries, cumquats, figs, feijoas, grapes, honeydew, limes, mandarins, valencia oranges,

passionfruits, pears, persimmon, plums, pomegranates, quinces, raspberries, rhubarb, rockmelons, strawberries, watermelons.

Autumn vegetables –
asian greens, beetroot, broccoli, brussels sprouts, cabbage, capsicums, carrots, celeriac, celery, cauliflower, eggplant, jerusalem artichoke, kale, kohlrabi, leeks, onions, parsnip, peas, potato, pumpkin, shallots, silverbeet, spinach, swede, sweet corn, turnip, chicory, zucchini.

Nuts –

chestnuts, pistachios.

(Seasonal Guide with thanks to Adelaide Farmer’s Market)

And what to do with these autumn offerings?

While the weather is still warm in the beginning of autumn, fresh foods served simply, like BBQs, salads and shared platters and outdoor eating remain at the top of the family meal list.

As the weather cools down, consider preserving some of the warmer weather’s fruits and veg for the coming winter. Getting chilly? Start ramping up the roast and soup rotations to help meet the family’s 2 & 5 goals for fruit and veg. Leftovers are great for lunchboxes too!

Remember, if you’ve got a fussy eater in the family, providing both new and familiar options of fruits and vegetables in a buffet or family style offering encourages children to try new foods.

Enjoy!

Angela @ Bloom 🌿

 


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Today I’m continuing our series of questions and answers and in the process, inviting you to send your question into us! Today’s question comes from a Mum in my exercise class who is soon to return to work and is stressed that her baby is refusing to take a bottle.

Milly is 10 month’s old and has only ever been breastfed. Milly’s lovely Mum Esther is returning to work 2 days per week in 2 months time (when Milly turns 1) and despite how hard she tries, she simply won’t take formula or expressed breast milk from a bottle.

Esther’s experience with Milly is a very common concern amongst breastfeeding Mum’s who need to provide an alternative when they are going to be apart from their baby. It’s a concern that isn’t always easy to address, and can be a hugely stressful experience for any Mum planning to return to the workforce.

The first point I’d make is consider the age of your baby and how regularly you’re going to be away from them. Milly is going to be one when Mum returns to work 3 days per week. In this case there is really no need for her to be offered formula or breastmilk or even cow’s milk. Many parents are surprised to hear that milk is not an essential part of a toddler’s diet. By age one, babies can get enough energy and nutrients from the food they are eating. So long as they are eating other calcium rich foods (for example yoghurt and cheese and perhaps milk added to porridge or cereal), they will meet their calcium requirements. Offering water throughout the day will provide enough fluid. This is a revelation to many parents who are sure their babies need to progress to toddler formulas or cow’s milk if they are ceasing breast feeding.

For babies between 9 and 12 months it really depends on how often and for how long you’ll be leaving them. I’d usually recommend leaving either breastmilk or formula with the caregiver/ child care staff, but for many it quickly becomes apparent that bubs is going to do little more than take a few sips at best. Worse, continuing to force a bottle at a child that doesn’t want it, can be an unpleasant experience for all. You don’t want your baby making unpleasant associations with their caregiver or new place of care. If you’re only leaving your child for 1 or 2 days per week, I’d suggest you drop the worry and simply let the caregiver offer more food and water on those days. Breastfed your baby in the morning, as soon as you pick them up and then again before bed, and they’ll be just fine.

Between 6 and 9 months ideally you’d leave some expressed breastmilk or formula for baby, but as you inch closer to 9 months and depending on how regularly you need to leave your baby, the above advice may still work. Certainly under 6 months of age you’re going to need your baby to take something from a bottle.

My top tips for getting young babies to drink from a bottle include: Make sure they are sufficiently hungry and offer the bottle at their regular feed time, having allowed at least 3 hours between feeds (2 hours if the baby is very young and seems hungry). Bottles with teats that “mimic” the shape of the nipple are often better accepted than others. I like the Tommy Tippee range which you can find here:https://www.tommeetippee.com.au/product/closer-to-nature-baby-bottle

Some babies will actively refuse the bottle no matter what you do. I have occasionally had success getting such babies (over 6 months of age) to drink from an open cup. This is messy and slow, but can be an option if you really need it.

Ideally someone other than the Mother should offer baby a bottle. As soon as baby is placed with Mum, they are going to want the familiar routine of a breastfeed.
Introducing a regular bottle early on (generally not before 6 weeks of age as during this time babies and Mums are still learning to breastfeed) can be helpful in getting them to accept a bottle long term. If you know you’re returning to work I’d suggest offering a regular bottle once or twice per week to get baby happily accepting a bottle long before it’s required.

In reality, persistence is the key. If you really need your baby to take a bottle, I’d put aside a whole day (perhaps a weekend day when the other parent is around offer it) to work on it. If they have refused the first time it’s offered. Wait an hour and try again. Be prepared to offer a large number of distractions and entertainment during this time as baby is likely to be getting hungry and cranky! The hungrier they get, the more likely they will give in and take what is offered. I won’t lie, this can be the most stressful of exercises, and if it all gets too much for you or your baby, put it aside and try again another day. The vast majority of babies eventually take enough to get them by at childcare and a good breastfeed before and after pick up, will help make up for any shortfall.

I’ve breastfed all four of my kids and have had mixed experiences trying to get each to accept a bottle. When my first child was four months old I returned to work 2 days a week for a short contract lasting a couple of months. Despite all my knowledge, pumping from day 1 and trying to introduce a bottle early, my little boy did not want a bar of it. The closer my return to work date loomed, the more stressed I became. My husband generally had more success with the bottle than I did, although my little boy took small amounts at best, and I generally returned home to a hysterical baby and distraught husband. With no other option, I returned to work and crossed my fingers that he would be okay. Luckily my Mum had volunteered to look after my little boy and her patience combined with my absence, resulted in him taking moderate amounts of expressed breastmilk on the days I was at work. He was never unhappy or stressed and I’m sure he made up for any difference with me breastfeeding him on demand when I returned home (ok so I may have run into the house on those nights peeling my clothes off as I did to feed him 😀).

I found the whole experience of trying to get my first child to take a bottle so stressful that by the time my second child came along I knew I didn’t want to repeat it. I wasn’t planning such an early return to work and so I simply didn’t worry about introducing a bottle in the early months. When he was 8 months old I returned to work 1 day per week. This time I made no plans or great attempts to get the bottle in before I started. I did leave some expressed breast milk with our nanny but after the first few weeks it was clear he had no interest and I was wasting my time. He was clearly happy with food and water and so I just left it at that. I continued to feed him morning and night and on demand as per usual on the other days of the week. Happy baby, happy Mum and his nutrition did not suffer as a result of the 10 hours each week where he got slightly less breastmilk than normal.
With my third and fourth children I planned longer maternity leaves and simply didn’t worry about introducing a bottle. For simplicities sake if I needed time away from them when they were very little, I did a mad dash between feeds. As they got older I used solids and water to stretch them out if I wasn’t going to make it home in time for their feed.

If you’ve got tips on how you got your child to take a bottle, we’d love to hear them!

Julia @ Bloom

This post is not sponsored


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Given that I spend my life around other Mums, it’s not surprising that as soon as people find out what I do for a job, they inevitably have a question for me.
Today’s question was one that I have answered time and time again, and given our soaring temperatures here at the moment, I suspect it’s something on a lot of parent’s minds. So I thought I’d share my answer with you all and extend the offer for you to ask us anything! If you’ve got a burning question, pop it in the comments section below, send us a message on Instagram or FaceBook or just drop us a line over email.

Anyway, onto today’s question which was “ My baby is 10 months old, she’s only ever been breastfed and isn’t taking much water. I’m worried she’s not getting enough fluids, especially in the heat”.

On Further questioning Mum said she had introduced water around 6 months of age but noticed that her baby drank very little of it. Mum had also tried (multiple times!) to get her baby to take either expressed breast milk or formula from a bottle but she had always outright refused. The baby was still breastfeeding 3 times a day and taking about 1/2 a sippy cup of water throughout the day.

It’s perfectly normal for babies to take very little extra fluid beyond what is offered via either breastmilk or formula. Baby’s first foods (be they pureed or mashed) have a high fluid content and this combined with the fluid they are naturally getting from breastmilk or formula will be enough for most babies. I always recommend introducing water from around 6 months (or the time that you introduce solids), but I wouldn’t expect a baby to get through more than about 1/4 of a sippy cup a day until they are 9 – 10 months old. As they start moving onto more solid food (and the fluid content of their meals drops and they also start reducing their breast or formula feeds), their intake of water will naturally increase. Most 12 months old babies will be taking close to a sippy cup (ie around 250ml) of water across the whole day. If your baby is taking less and you’re concerned, check their nappies. If they’re wet enough that you need to change them several times per day and they are also passing regular bowel motions, then that’s generally a sign that your baby is getting enough fluid. Their lips should also appear moist, not dry and cracked.

My top tips for encouraging babies to drink water include: persistence – don’t give up just because you think they aren’t drinking much. Many parents panic and start to introduce dilute juice as a way of tempting babies to drink. This only leads to the expectation that beverages should be sweet, and usually in my experience, further exacerbates the problem. Your baby will most likely to be thirsty immediately after eating, so always have water available at the end (or during) every meal or snack that is offered. Many babies are also thirsty when they wake from sleep. If you’re not going to be offering them a breastfed or formula, it’s a good time to try some water.
It’s worth remembering that breastfed babies under 6 months of age don’t need any extra fluid, just feed them on demand. Formula fed babies may be offered some cooled boiled tap water if they seem thirstier than usual (eg on a hot day). All babies can be offered tap water from 6 months of age. You may like to first offer water in a baby bottle, but I would suggest moving him or her onto a sippy cup after a few months (we like the Tommy Tippee range of adapters for baby bottles here: https://www.tommeetippee.com.au/product/weaning/cups). These are good all rounder cups/bottles if your baby is breastfed.

There are a large variety of sippy style cups on the market and the drinking style needed will vary from brand to brand. For example, some sippy cups require more of a “bite” to get water out style, others require sucking from a straw (generally babies won’t be ready for this until closer to 9 months) and others will require a suck somewhat similar to breastfeeding. Some come with valves to regulate the flow and others the water will simply pour straight out. If you’re really confused about cups and have a baby who’s really reluctant to take one, I would suggest consulting a paediatric speech pathologist who specialises in infant feeding. Another option would be to try an open cup but this will obviously be messy!

So my advice to this Mum today? Her baby was getting enough fluid and she just needed to hang in there offering water regularly as per my recommendations above. I had a feeling he was probably about to take off on the water as Mum was actively reducing breastfeeds, and his diet was expanding considerably. The other thing that’s worth remembering is that babies do have the ability to regulate their own thirst so long as the water is being offered regularly. It’s only in rare circumstances that babies won’t do this, usually as the result of a medical condition, or infants with extreme feeding disorders and food refusal. These babies are special cases that warrant individual assessment and advice.

Julia @ Bloom

This is not a sponsored endorsement