Children’s Dietary Needs: Expert Opinion from a Dietician

This week we spoke with Penelope Klebe about children’s dietary needs. Penny is a highly regarded Specialist Nutrition Support Dietitian, registered with HCPC and working within the NHS. Penny obtained her BSc in Nutrition and Dietetics from King's College London. She’s also a wonderful mum of two young children and knows the challenges parents face with healthy eating. 

I asked her some common questions parents and care providers have, and asked for advice on how to get children eating healthily.

How do children’s nutritional needs differ to adult’s needs? 

Children are growing fast so have higher energy needs for their body size compared to adults. They also need additional micronutrients of vitamin A and D. 

Get advice from your health visitor on whether your infant needs additional supplementation of vitamins.    

The NHS website recommends:

Taken from NHS England’s website

Vitamin A is important for making immune systems strong and healthy, helping our vision in dim lighting and keeping our skin healthy.

Good sources of vitamin A include:

• Cheese
• Eggs
• Oily fish
• Fortified low-fat spreads
• Milk and yoghurt

Vitamin D is important for calcium and phosphate absorption. These nutrients maintain teeth, bone and muscle health, which is particularly important for the growing body of a child. 

Good sources of vitamin D include:

• Oily fish- such as salmon, sardines
• Red meat
• Egg yolks
• Fortified foods- such as fat spreads or breakfast cereals

Do you think it is important to get children engaged with healthy eating from a young age? 

Yes. It is so important that parents and children are educated to have a better understanding of a healthy balanced diet.  

Children need to be weaned onto a good variety of different foods and textures to avoid fussy eating behaviours, and to ensure they are getting all the nutrients they need.  

If fussy eating develops, it usually resolves in time.  Most babies need to be offered new foods up to 10 times before they accept it.  If you are struggling to get your infant to try new foods, there are some great tips on this link:

https://infantandtoddlerforum.org/toddlers-to-preschool/fussy-eating/ 

For further advice:

https://patientwebinars.co.uk/condition/fussy-eating-in-children/webinars/ 

https://www.nhs.uk/conditions/pregnancy-and-baby/fussy-eaters/

https://www.bda.uk.com/uploads/assets/b6b4554e-487b-413c-a664b18eed782174/Diet-Behaviour-Learning-Children-2017-food-fact.pdf 

https://www.bda.uk.com/resourceDetail/printPdf/?resource=healthy-eating-for-children 

https://infantandtoddlerforum.org/health-and-childcare-professionals/factsheets/

Could you offer any top tips on how to get children interested in healthy eating?

Getting children trying new foods is so important! Here are some suggestions:

• Keep offering foods they reject. Try different colours of the same fruit or veg e.g. yellow tomatoes instead of red, orange peppers instead of red or yellow. Offer different textures of fruits and vegetables for example tinned tomatoes in juice and whole raw tomatoes 
• Take them to the supermarket with you and get them to help you make good choices 
• Practice what you preach... children respond to role models
• Get them involved in preparing food with you. You can buy utensils which are safer for children to get them involved in the preparation of foods
• Grow your own... children love seeing where there food comes from and helping you harvest! 

Eat as a family at the table, avoid TV dinners or toy playing during mealtimes

For further advice:

https://www.nhs.uk/conditions/pregnancy-and-baby/fussy-eaters/ 

https://www.nhs.uk/conditions/pregnancy-and-baby/childrens-meal-ideas/ 

What are the most common nutritional problems seen in childhood and what are the warning signs? 

The common nutritional problems:

• Growth faltering due to an inadequate balanced diet. This could be due to disease/ illness, fussy eating and food refusal, poverty and/or poor parental knowledge and understanding of good nutritious well balanced diet.
• Overweight and obesity. 
• Food allergies. Symptoms of true food allergy can include skin reactions such as dermatitis or eczema, gastrointestinal symptoms such as reflux, vomiting and diarrhoea and respiratory symptoms such as wheezing. Hyperactivity, which affects 1-5 per cent of children, may be caused by an adverse reaction to food in a very small proportion of children.
• Specific nutrient deficiencies e.g. Iron deficiency anaemia, vitamin D deficiency 
• Constipation
• Dental problems. Go to the dentist regularly. Avoid excessive sugary and sweet foods

In pre-schoolers most of these issues would be picked up by your GP, practice nurse, or health visitor.

If you have any concerns, speak with your health visitor. 

For further advice:

https://infantandtoddlerforum.org/wp-content/uploads/2020/02/ITF120-Factsheet-4_1-Common-Nutrition-Problem-Dec19-v1.pdf

Are there any super foods you would recommend for workers that are rich in nutrients to give children? 

There are no such things as 'super foods'. This is a marketing slogan. It takes a mix of lots of food groups to have a healthy and balanced diet and get all of the nutrients you need. 

Follow the eatwell plate guide, although things do differ slightly from adults for toddlers. Toddlers need some more white alternatives - high fibre wholemeal options are very filling and therefore a toddler may struggle to eat enough to get all the nutrients they need if only consuming fibrous options, and give them extra oils, butter and margarine. You can base this on healthier fats such as olive oil or avocado if you prefer.

Source: NHS website. 

The following are very harmful and should be avoided:

• Salty foods should be kept to a minimum
• Sugary, acidic drinks should also be kept to a minimum
• Do not give raw eggs or raw shellfish to toddlers.
• Do not give swordfish, marlin or shark to toddlers, as they may contain high levels of mercury. Limit smaller oily fish to twice a week for girls and four times a week for boys.
• Do not give toddlers whole nuts due to risk of choking, offer chopped or ground nuts instead.

For more information visit: Infant and Toddler Forum. 

Look at this to get some examples of healthy snacks: 

https://infantandtoddlerforum.org/wp-content/uploads/2020/02/ITF199-Factsheet-1_6-Meals-Snacks-Drinks-Dec19-v3.pdf 

For further UK Government advice: here 

Thank you for sharing your time and knowledge Penny! You have given a brilliant overview of dietary needs and advice with children, and its greatly appreciated.

Have you found any of the above particularly helpful?
Are your children fussy eaters?
Do you have any healthy recipes or top tips for healthy eating with children?
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References

Nogrady, B. (24th November 2016). Why there is no such thing as a ‘superfood’, BBC news. https://www.bbc.com/future/article/20161124-why-there-is-no-such-thing-as-a-superfood