picky eater

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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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Persistence. The key to combatting toddler fussy eating?

I’ve had lots of people say to me, “You’re lucky your kids are good eaters. It must be easy because you are a dietitian”. Thankfully, my kids do love to eat – now. And I genuinely feel more happy and relaxed at family meal times now with 4 kids at the table than ever before.

But I will be honest – it’s still not “perfect” (is there even such a thing?), and it was a long road to get to where we are.

We haven’t exactly had things easy in the feeding department. All 4 of my kids have had food allergies – 2 still see the Allergist regularly. One had the most sensitive gag reflex as toddler, she would eat an entire meal, vomit then immediately ask to be fed again. And one had a horrible run with enormous tonsils and adenoids, having multiple infections, speech difficulties and feeding aversions before needing speech therapy and surgery.

All of these are minor issues in comparison to the complexities faced by many other families – but they were enough to add stress to an already gorgeously chaotic family life.

So while I haven’t had the easiest run with feeders, I do feel incredibly blessed that our issues were small, that my training allowed me to see what was happening, and that I had the knowledge to know where to get help, and what to do at home.

But as I said, it was a long road to get here, particularly with Mr Tonsils. In all honesty, how we ended up here was not through luck, or my profession, but through sheer persistence.

There were so many times when I wanted to just give him pasta, again, while we ate something else. Times when I picked up food from all over the floor, screaming on the inside, but calmly outwardly saying “Food stays on the table”. Countless times when I lamented the huge waste of food as I throw the veggies in the bin, again.

But it was the persistence with calmly offering without expectation, giving only brief and gentle encouragement, and most importantly, family role modelling that led to where we are today.

Recently, he, the fussiest of my four, finally bit into a cherry tomato (albeit in a effort to squirt his sisters with the insides – but thats how we encouraged him to put it in his mouth) and said “I tasted the juice!”. A few months ago he would’ve pouted “I don’t eat tomatoes, take it off my plate!!!”.

He also ate black charcoal noodles – “Mum, black is my favourite colour”- when they arrived unexpectedly in his beloved ramen noodle soup at a new restaurant. He randomly picked up the broccoli I was preparing for his sisters’ school lunch boxes and said “Mum, I eat this now, I’m strong”. He then proceeded to pop it in his mouth and walk away – the rest of us stunned into jaw dropping silence. He picked up chicken breast of the plate and ate it without a word, after months of not eating it. He drank a green smoothie and called it “hulk juice”, flexing his biceps as he drank.

So, you can safely say we had an amazing week at the dining table that week (cue champagne!), which reminded me that all that persistence with our feeding plan was worth it. We were winning.

I know I’m not alone in this sort of feeding experience. I’ve met so many parents over the years who have faced the same thing. The ongoing trials, but then finally the successes.

This year Julia and I will be putting together a package to help families with their in home feeding issues; so watch this space.

We will share the training and experience we’ve had as Paediatric Dietitians, and the trial by fire we’ve had as parents. We’re aiming to provide families with scientifically sound, but genuinely practical advice.

It works if you work it. We’ve got proof!

 

Find this, and more family eating, health and wellbeing stories in our Bloom quarterly nutrition newsletters. And to subscribe to future updates, click here

Angela @ Bloom 🌿