Sara Patience is a registered nutritionist and nurse. Here she blogs for Local Mums about nutrition issues for infants and children.
What’s in your child’s packed lunch?
“Packed lunches should be banned from schools to stop children snacking on chocolate, sweets and fizzy drinks during break-times, ministers have been told”
So said government advisors as reported in the Daily Telegraph on the 10th February 2013. What do you think? Does your child’s packed lunch contain chocolate, sweets and fizzy drinks? Do you send a packed lunch because you think it’s healthier?
In May 2010 The Children’s Food Trust published a report on the quality of packed lunches. They took a look into 3481 lunch boxes, (between February and April 2009), of children at primary schools and it wasn’t great. In fact, over all the quality was worse than school dinners.
Packed Lunches were found to contain meat products in the form of sausages, meat pies, pasties, (and surely we are right off of processed meats since the horsemeat scandal?) drinks high in sugar, and food high in sugar and salt, all things that would not be allowed in school under the new school lunch regulations. They found that pupils who eat packed lunches typically have higher average intakes of sugars (free sugar not sugar in milk of fruit), saturated fat and salt than those pupils who ate a school lunch.
So what should your child’s packed lunch contain? Here’s a guide:
1 portion of fruit
2 portions of vegetable or salad - for example this could be carrot sticks as a side dish, and tomatoes chopped up into a pasta salad.
1 calcium portion – cheese, yogurt, milk drink
1 protein portion – this can be meat or meat alternative such as beans, chickpeas, egg, dairy products also contain protein
I wholegrain carbohydrate – so wholegrain bread, wholegrain pasta, wholegrain pitta
1 treat – cake without icing, flapjack, yogurt. popcorn
To help when you buy products a low total fat product has 3gms or less per 100gms of product, a low saturated fat product has 1.5gms or less per 100gms product, a low sugar product has 5gms or less per 100gms product and low salt is 0.3gms or less per 100gms product.
Water and milk are the best drinks for children. The Children’s Food Trust is suggesting water or flavoured milks containing low fat milks with less than 5% (5gm sugar in 100gms product) added sugar. They don’t suggest a brand and I would have to search the shelves to find something suitable as I tend to steer my children away from flavoured milks as they are often highly loaded with sugar. If your child will drink plain milk then stick with that, you may find once you’ve added sugar there’s no going back.
The Children’s Food Trust (www.childrensfoodtrust.org.uk) have nutritionally balanced packed lunch menu ideas that you can download or print off.
Feeding the family at Christmas time – tips for all ages to avoid suffering from excess!
Christmas is about lots of things, and one of those things is food. Enjoying food is a part of Christmas but is there a way to enjoy without eating 4 days of calories in one day? It’s hard for adults to do and even harder when children are faced with huge amounts of treats. I’m briefly looking ‘through the ages’ to see what we can do to enjoy but control what we eat.
Babies under 6 months are the least affected as their feeds will go on as usual. Try to maintain their routines, so that they eat, sleep and feel secure as usual. If you are breastfeeding check your alcohol intake. NHS advises that one to two units, once or twice a week is acceptable when you are breastfeeding. One unit takes about one - two hours to clear, so drink after feeding and ensure there’s at least a 2 hour gap before you feed again. One unit would be about 125mls wine. Excessive alcohol will pass to the baby. If you know that you are going to a situation where you intend to drink you can express beforehand and use that milk until the alcohol has cleared from your body.
If you are formula feeding ensure you have enough supplies of milk, sterilising solution if you use it, ready made cartons etc to last while shops are shut.
Babies and toddlers eating solid foods All the above still applies, and again keep their mealtime routines and sleep routines as best as you can. Your baby/toddler will enjoy the additional opportunities of eating with their family, a great time to encourage them to try new foods, and join in socially. However, at this age do not feel that you need to ‘treat’ them with rich and sugary foods, they aren’t going to miss or stress about what they don’t know. Babies and small children are happier with familiarity.
Older Children The temptations are greater for older children who may well be given sweets and selection boxes as presents and have their own stash as well as the extra’s that are all around them. If you can place a restriction on what they have then do so. If your children don’t normally have excess sweets then a little extra will feel like a treat, so you can compare what they are getting with what they usually get. Having said that from a ‘tooth’ point of view you don’t want them grazing on sugar all day as this leaves the teeth under attack and vulnerable to erosion and cavities. So try to get them to decide what they are going to eat in one go, then put the rest away. Giving children their own box or tin to keep their sweets in may give them the security that they aren’t going to be eaten by someone else and they may be happier to save some. You should never brush your teeth straight after eating, but wait about an hour.
Many parents report that their children suffer a ‘sugar rush’ and behaviour is something else to think about before dishing out the goodies. Remember sugar is nutrient free so whilst they are loading on sugary treats, they will be missing out on vitamins/minerals found in other foods.
Adults The above applies to us to – quantity of foods and treats, and oh yes – alcohol is a big calorie contributor over the Holidays. What can you do?
Acknowledging you are likely to overeat means you cantake some action and still enjoy yourselves:
Firstly be realistic about what you buy – yes you want some treats but think about the quantity you really want. Perhaps a relative always gives you biscuits or chocolates so take those kind of annual presents into account when you are shopping. Remember the displays are there to tempt you to buy (more than you need).
Be aware of mindless eating, that is eating those chocolates, sweets and biscuits without thinking, whilst watching TV or chatting. Put some on a plate and put the packets/tins away so that there is a limit to what it available.
Control your portions, as above – putting out small portions of treats, and don’t pile your plates too high, or use larger plates. Eat slowly so that you register when you feel full.
Drink a few glasses of water between meals to feel full, keep you hydrated and help curb dehydration effects of alcohol.
Think of some healthy swaps, put some fruit out, as well as cut vegetables with dips. Fruit is sweet and children may like a mini fruit salad, (you would have to eat substantially more than sweets for the same tooth erosion effect). Vegetables do play a part at Christmas so try to have half your plate covered in veg.
Be as active as you can, but remember a ½ hour walk after dinner is not going to burn off all those excess calories, (see drinks below), try to engage the children (& yourselves) in regular periods of activity throughout the day.
Last word goes to drinks you know that some alcohol is calorie heavy a 175ml glass of wine has about 124kcals (equivalent to 1.5 chocolate digestives and takes 26 minutes of walking to burn off). 1 crème liquor has 175kcals, (equivalent to 2 chocolate digestives and takes 36 minutes to walk off) and 1 pint of larger has 250kcals (equivalent to 3 chocolate biscuits and 53 minutes to walk off) (information taken from World Cancer Research Fund UK – see their website for further information). As far as children are concerned remember fizzy drinks and fruit juices contain a lot of sugar.
Happy Christmas!
This blog was first published on www.nurtureandnourish.co.uk
Disclaimer
The information contained in this article is for general information purposes only and should not be construed as medical advice. Whilst we try to keep the information up to date and correct, the completeness and accuracy may be affected by changes in scientific developments. If you or your child has any medical concerns we urge you to consult your GP.
Weaning
I think weaning has become a bit confusing – there have been debates over age to start, and then you suddenly have ‘baby led’ or ‘mummy led’, mums who use purees and those who don’t….. This blog briefly looks at those points and hopefully clarifies what is important and what’s not.
So what do we mean by weaning?
Weaning is the term generally used to refer to the transition from milk only feeds to solid foods. First foods are often called ‘complimentary foods’ as initially they compliment, rather than replace, milk feeds.
When is the best time to start?
This is important as starting too early, or even too late may affect your baby’s health.
The UK Department of Health advises exclusive breastfeeding to 6 months (this doesn’t mean stop breastfeeding at 6 months, you can carry on as long as you like) and starting weaning ‘around’ six months, with the expectation really of being close to the 6 months mark.
Where did this advice come from?
After a review of evidence the World HealthOrganisation (WHO)1 concluded that exclusive breastfeeding for 6 months is beneficial to the mother and baby. The Scientific Advisory Committee on Nutrition (SACN) reviewed and agreed that there was sufficient evidence that exclusively breastfeeding for 6 months was nutritionally adequate. Based on this the Department of Health Infant Feeding Recommendations2state that the evidence for weaning at 6 months is adequate and should be encouraged, although every baby should be treated as an individual, according to their growth and development, and that if an infant is showing signs of developmental readiness (see below) they should be encouraged.
The current NHS leaflet ‘Introducing Solid Foods’3advises to start weaning around 6 months and that your baby should be able to:
•Stay in a sitting position and keep their head steady
•Be able to look at food, pick it up and put it in their mouth
•Swallow food and not push it back out of their mouth
Important: Babies must not be given solid foods before 17 weeks of age due to gut and kidney immaturity, increased risk of allergies and increased risk of choking.
Why?
Babies need to be developmentally ready for solid food to be able to meet the recommendations listed above. By 6 months a baby’s gut and kidneys are able to cope with a wide range of foods.
Also remember that it is generally accepted that from 6 months babies nutritional needs are not fully met by milk feeds and require additional nutrition.
How?
At 6 – 7 months Baby Led Weaning comes in. Baby led weaning encourages the baby to be in control of how much they eat, allowing them to stop eating when they feel full. It is hoped that by not overriding the baby's feeling of being 'full up' the ability to regulate their own appetite will be encouraged and contribute to the prevention of excess weight gain. If you would like further information on BLW follow this link: Baby Led Weaning
From 6 months, a developmentally ready baby can pick up foods by themselves and put them in their mouth. You do not feed them, you obviously supply the food and baby chooses what and what not to eat.
If you prefer to start feeding your baby with a spoon the consistency of the food depends on their age, and between 6 – 7 months babies can cope with soft lumpy food rather than total puree. I know some mums feel happier offering puree first and if you do try to build up to soft lumps quickly as some babies get reluctant to take them. Starting with a spoon doesn’t mean that you can’t let your baby pick foods up themselves and you can do both.
By 6 months most babies want to try to eat using their fingers and you shouldn’t discourage this.
Remember! Whatever way you choose if should feel comfortable and relaxed for you and your baby, and the food you offer should be appropriate and healthy – that is important!
Start by offering one meal a day. Choose a relaxed time and if necessary give your baby a small milk feed to start to take away any ‘frantic’ hunger, but not so much as to fill them up.
You never have to use baby foods and can give your baby real food from the beginning. Never add salt or sugar to foods you give your baby.
Be aware of when your baby has had enough, they may keep their mouth shut or turn their head away, if you are spoon feeding they may try to push your hand away. Stop and try again later. Remember quantities may vary each day but over a week babies have generally eaten what they need. Trust your baby.
Build up the range of foods you give and include foods from all groups and ensure foods are age appropriate and safe for your baby. Foods with a higher risk of allergy should be introduced one at a time (eg wheat, eggs, milk) but no need to do this with every food. If a food is rejected leave it for a few days/week and offer it again and again. We know that babies like what is familiar to them and it can take many goes for them to become familiar to a food and accept it. Initial rejection doesn’t mean they don’t like it.
Progression of food types and number of meals a day is individual to each baby but by 9 months your baby should be eating family foods and be having 3 meals/day.
When you baby is 6 months or more they are likely to need vitamin D supplements, if they haven’t already started, unless they are taking more than 500mls of infant formula. Ask your health visitor if you are not sure.
Ask your health visitor for advice and whether they run a weaning group to help you get confident.
1.Global strategy for infant and young child feeding WHO (2001) Geneva
2.Infant Feeding Recommendation (2003) DH.
3. Introducing Solid Foods (2011) NHS
Babies, Children and Salt
Once you start giving your baby foods other than breast milk or infant formula, you need to be ‘salt aware’.
Salt is a mineral that is made from sodium and chloride and is commonly referred to as sodium chloride or NaCl. It is the excess sodium, Na, that gives rise to health concerns, and in this blog, the words salt, sodium or sodium chloride refer to sodium in our diet.
Babies are particularly sensitive to salt, their kidneys are not mature enough to cope with too much. Whilst the addition of salt to a babies food, could, in excess, cause more immediate harm, the most likely risk is that habitual salt intakes becomes a life long habit, with continued use leading to greater disease risk in later life*.
Babies under 6 months of age are able to obtain everything they need from breast milk or infant formula and the small amount of sodium chloride, required for health is found in breast and formula milks in the appropriate amounts.
The best way to avoid excess dietary salt is to cook foods yourself, do not add salt to food you are preparing for babies and children. If you add salt to your own foods now is a good time to think about cutting it out. If you buy processed/ ready meals you should really check the salt content as these meals are the considerable source of excess salt.
The Scientific Advisory Committee on Nutrition (1) advise that 65 – 70% of the sodium in our diet comes from manufactured foods, with 15 – 20% occurring naturally in plant or meat based foods. 40% of our sodium intake comes from bread, biscuits, breakfast cereals, cakes and pastries. Processed meats and obviously table salt being other big contributors.
Point to remember is that processed foods will have more salt in than foods you make from ‘scratch’ and don’t forget it all adds up over a day. It should be noted that commercial baby foods do not contain added salt.
So up to how much salt could babies and children have each day?
The Food Standards Agency recommends:
0-12months less than 1gm salt/day (0.4gms sodium)
1 – 3 years 2gms salt/day (0.8gms sodium)
4 – 6 years 3gms salt/day (1.2gms sodium)
7 – 10years 5gms salt/day (2gms sodium)
11+ years 6gms salt/day (2.4gms sodium)
Nutritional Information on Foods
When you buy foods check for nutritional information and note that salt may be shown as ‘salt’ or as ‘sodium’. Sodium values are less than salt values but don’t let that confuse you, or let you think that the salt content is lower than it really is - multiply the sodium value by 2.5 to get the salt equivalent.
Another point is to check how much of the product the salt/sodium value is for – is it for the whole pack? Or per 100gms. The Food Standards Agency says that less than 0.3g of Salt/100gms is ‘low salt’ and more than 1.5gms of salt/100gms is high salt. Also remember that products portions sizes, suggested servings and packet sizes are likely to be aimed at an adult.
So for your babies and children:
· Do not add salt to foods when you are cooking.
· Manufactured foods often have high levels of added salt (but this does not include baby foods).
· Biscuits, cakes, pastries and bread are a significant source of salt in UK homes.
· If you have older children beware of crisps and pizzas.
· If you use canned vegetables, check added salt/sodium content and rinse before use.
· Home cooking means you know what is in your food.
All of the above applies to adults too, it is a matter or healthy eating for the family, and breaking any bad habits you may have got yourself into.
*Excess salt intake is particularly associated with strokes and high blood pressure (hypertension), (2,3,4). Hypertension is a significant contributor to the risk of premature death in the older age groups, not only through stroke, but through heart and kidney disease as well (5).
You can contact Sara Patience MSc BSc(hons) Registered Nutritionist, Registered Nurse for infant, child and family nutrition advice via www.nurtureandnourish.co.uk
This article first appeared on www.nurtureandnourish.co.uk Sara has written for a number of publications, including for Community Practitioner (HV Journal), Nursing Standard and NCT news, and advised articles in magazines such as ‘Mother and Baby’.
Disclaimer
The information contained in this website is for general information purposes only and should not be construed as medical advice. Whilst we try to keep the information up to date and correct, the completeness and accuracy may be affected by changes in scientific developments. If you or your child have any medical concerns we urge you to consult your GP.
References
1 Scientific Advisory Committee on Nutrition (2003) Salt and Health. TSO.
2 He, F., MacGregor, G. (2004) Effect of longer-term modest salt reduction on blood pressure (Review). Cochrane Database Systemic Review CD0004937
3 Sacks, F., Svetkey, L.,Vollmer, W.et al: for the DASH-Sodium Collaborative Research Group. (2001) Effects on Blood Pressure on Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. The New England Journal of Medicine 344:1 3-10.
4 Stamler, J. (1997) The INTERSALT Study: background, methods, findings and implications. American Journal of Clinical Nutrition 65(suppl) 626S-642S.
5. NHS (2009) Health Survey for England, Health and Lifestyles. The NHS Information Centre