NUTRITION Q & A

Click on your selected questions for the answers, or scroll down below for all the Q&A's

1. Are vitamin supplements advisable. How do I know if my child needs a particular type of supplement?

For children who are eating a fairly wide variety of foods, gaining weight normally and who are active, cheerful and healthy, supplements are usually not necessary. However, preschoolers who consistently refuse to eat or consume only pathetically small amounts of food run the risk of becoming under nourished. This could have serious repercussions on their physical growth, mental development and learning abilities. If your child is chronically under eating and is not keeping to his weight gain curve in the growth charts, it is advisable to seek the advice of a dietitian to suggest ways to overcome the feeding problems and to plan a balanced diet for your child. Supplementing the child’s diet with nourishing drinks may be helpful. Milk-based beverages and milk shakes can be made at home easily. There are also several nutritionally complete beverages on the market which you can offer your child. Remember though that supplements must not be relied upon as an insurance policy against bad nutrition. You should still persevere in your effort to inculcate healthy eating habits in your preschooler, as the habits formed now will be likely to last a lifetime.

2. My three and a half-year-old child is rather disinterested in eating regular meals. Should I be concerned?

Parents should avoid making a fuss about eating, as this will only encourage the child to become manipulative and begin using food refusal as a way of getting attention. If the child refuses to eat a meal, then he can simply be excused from the table and hopefully, hunger will ensure that he eats his next meal. However, help and supervision are still needed even though you may want to rush your child to independence. If left to his own devises, your child may happily sit and finish a bowl of plain rice without touching the other dishes - or he may skip his meal entirely and then fill up on sweets later on. So parents ought to take the lead and portion out the food, trying all their powers of persuasion to get their child to finish most of his food at least most of the time.

3. Is low fat milk suitable for a five-year-old? Would the child be missing out on any of the nutrients if low fat milk is used to substitute full cream milk?

Ordinary full cream milk contains about three percent fat. The fat found in milk is mainly unsaturated fat and it contains cholesterol. Low fat milk is two percent fat while skimmed or no-fat milk contains virtually no fat. In comparison to full cream milk, low fat and skimmed milk contains less energy value. Children should only be given low fat or skimmed milk after they turn seven since children below this age need the extra energy and fat. So do not deprive your five-year-old of full cream milk just as yet.

4. My four-year-old does not seem to enjoy drinking milk any more. Is it alright to stop giving him milk everyday since he is taking a mixed diet?

Milk is the sole source of nutrition for babies up until the age of four to six months. A child does not outgrow his need for milk, however, as it is an excellent all round food and by far the best source of calcium available to us. Children require proportionally more calcium in their diets than adults do throughout the growing years. Not only is milk a valuable source of calcium, it is also rich in protein, vitamins, particularly riboflavin and trace minerals especially zinc. Two glasses of milk a day will meet the entire calcium needs of children and teenagers. A glass of milk (250 ml) has about 300 mg of calcium. Children up to 10 years of age require 400 - 500 mg of calcium a day. More is required for the teenage years - 600 - 700 mg for the 10 to 16-year-olds and 500 - 600 mg for the 17 and 18 year-olds.

5. Can different forms of milk provide the same nutritional value? Can dairy products such as yoghurt replace milk in providing the necessary nutrients? What about processed milk?

Milk basically comes in two forms - powdered and liquid. Powdered milk is economical and there is no wastage. Among the liquid milk, fresh air-flown milk is the most expensive and the only difference between this and the less expensive UHT, long life and reconstituted milk are the taste. The nutritional content of all these milks are the same, though some may be fortified with extra calcium. Other milk-derived products such as yoghurt and cheese contain much of the nutritional value of milk, including the protein and calcium. And if we introduce yoghurt to children early, they will develop a taste for it. You have to be careful with cheese however due to the high fat content. Cheese should be taken only in moderation. Hydrolysed milk is lactose reduced and is suitable for children who are lactose intolerant and have stomach upsets after having taken milk. Evaporated milk has a reduced water content and is thick and concentrated. This is best used sparingly and should be diluted. Condensed milk contains 45 percent sugar, therefore its protein and calcium content is reduced accordingly.

6. There are many dietary guidelines urging us to consume less fat, less cholesterol and more fibre. My question is, is it safe for our children to follow this recommendations? Can a child as young as three or four run the risk of high cholesterol levels? Should foods with high cholesterol content be totally banned in the home?

A number of genuine concerns have been raised over imposing severe dietary restrictions on young children. After much debate, the general consensus is that below the age of two, no change in diet should be made. Some authorities have in fact recommended that until the age of seven, only a small degree of modifications should be considered. Thereafter, the dietary guidelines should be followed. If one, or more grandparent or parent has a history of heart disease or high cholesterol levels, the child may be more likely to have a high cholesterol level. The acceptable value for children is 170 mg/dl or less; for those with cholesterol levels higher than this, it is even more important that parents curb excessive fat intake in the diet. For children, the cholesterol intake does not need to be severely limited. It is enough just to avoid excessive cholesterol, and a moderate consumption of foods high in cholesterol can be allowed. Some cholesterol-rich foods are also foods which are suitable for children because they are easy to digest and nutritious in other respects.

7. How often should I allow my child to eat fast food, such as hamburgers and French fries?

If your child eats fast food daily, then it is advisable to try to find alternative ways of feeding him at least every other day. It is quite acceptable for a child to eat fast food about three times a week as long as he chooses his food sensibly. You can help your child to make good choices by teaching him about food at home. Food lessons could be in the form of a game, for example by using a homemade menu which your child can draw and colour himself. Divide food into different categories - one containing protein foods such as burgers and chicken, another containing carbohydrate foods like bread, French fries and mashed potatoes and a third containing fruit and vegetables. A fourth category could contain drinks such as orange juice and fresh milk. Explain to your child that when he orders a meal, he should not choose more than one item from each category and he should always have a protein and a carbohydrate food. You can reinforce this by drawing his attention to your own home-prepared, balanced meals. He will soon get the message.

8. I was told that it is not advisable to place a child on a strict low fat diet. Why is this so?

It is true that you cannot put a child on a strict low fat diet for the simple reason that fat provides a concentrated source of energy. Children have proportionately much higher energy requirements than adults. In babies, about 30 per cent of the energy requirement is used for growth while in older children this is reduced to about five per cent. During a child’s life, even a small energy deficit could constrain growth rate for the following reasons.

• Fat supplies essential components for the manufacture of many important molecules in the body.
• Fat adds to the palatability, texture and taste of the diet - e.g. having your bread with butter is much better for most people than having dry bread.
• Fat contains essential fatty acids which are necessary nutrients for health.
• Fat is a vehicle for the entry of fat-soluble vitamins into the body.

Hence the bottom line is, extreme restriction of fat in a child’s diet is not advisable. What you ought to aim for is the avoidance of excessive fat.

9. My five year old daughter likes to snack on chips and crackers in between meals. What are some more healthy alternatives?

Snacks do not necessarily have to be equated with non-nutritious tidbits and soft drinks. What you have to do is to advise your child on how to choose healthy snacks. If your child often misses breakfast, nutritious snacks play an important role in filling up an empty stomach and providing the necessary nutrients. However snacking close to mealtimes is generally undesirable as your child will undoubtedly spoil his appetite for the meal. Here are some examples of nutritious snacks:

10. I have been led to believe that consumption of fish and eggs can help increase my child’s intelligence. Is this true?

Although food such as fish and eggs are very important in the diet of a growing child, there is no single food item which is responsible for increase in intelligence. Some “brain-food” diets recommend foods that are rich in egg yolks, fish, dairy products, meat, beans and vegetables. Take a closer and you will realise that the so called “brain-food” diet is actually made up of food which constitutes a nutritious diet.

11. I have been advised that caffeine is best omitted from a child’s diet. Is this advice sound?

Caffeine is basically a drug, a stimulant found in coffee, tea, cola drinks, and soft drinks. Adults usually enjoy these drinks because they are refreshing. However when these are consumed regularly by children, it can result in insomnia, nervousness and gastrointestinal upsets. Hence you should try to keep it out of your child’s regular diet.

12. My mother wants me to breastfeed my baby but I am not so sure. What benefits will my baby get from breastfeeding?

Breastfeeding is a wonderful gift for your child. Since your baby is born with an immune system that is yet to develop completely, the immunological properties contained in your breast milk will protect him against disease. It is no coincidence, but another of nature’s wonders that, as a baby develops, the immunological factors in mother’s milk diminishes. However, do not think that breast-fed babies never get sick. Breastfeeding just decreases their chances of contracting infectious diseases like chicken pox, influenza, colds etc. Breastfeeding is also said to reduce the risks of having allergies and obesity in later life. It is also more digestible than formula and reduces a baby’s bouts of colic or diarrhoea. Breastmilk softens the stool so the breastfed baby is less likely to suffer from constipation. Apart from these physical factors, studies show that breastfeeding strengthens mother-child bond that may have important implications for you if you are going back to work.

13. My breastfed eight-month-old refuses to take solids or any other fluids. Its getting me worried. What should I do?

If your baby is thriving and developing well, she is probably still getting enough nutrition but it is time you started thinking about weaning your baby. Beyond the six month mark, it is important to augment baby’s diet with solids. Breast milk can continue to be the breast-fed baby’s main source of nutrition till about the end of the first year when, studies show, it is no longer adequate to support your baby’s growing needs. When trying to wean a baby who shows no desire to give up mummy’s breast, go slow. Don’t hope to achieve anything overnight. There’s still time and it is very possible your baby will prove more willing to be weaned somewhere between nine and 12 months of age than he will as a toddler. Let your baby get used to the idea of getting her food from a source other than you. Remember that a baby who is drinking too much will have little appetite for solids. Try to make mealtimes fun. Stay with her, interact with her, so she does not feel she is losing you by losing the breast. Try dropping one feed at a time and substituting a bottle/cup, with expressed breast milk, if you like. Be a little cold hearted and keep offering it, and ultimately your baby will accept this "poor" alternative. Initially, if some one else apart from you can offer the cup, it may be more acceptable to baby. Once baby is used to that, drop another feed, making sure you keep yourself comfortable as well. Quite a few mothers continue to hang onto a couple of feedings a day until baby is completely weaned. Do not feel guilty about weaning your baby. It is a part of growing up and after all, breastfeeding is only one part of your child’s bond with you.

14. What should I do to make bottle feeding safe for baby?

Bottle feeding is now a lot safer then it used be so you have no need to worry. Just use the same good sense you do for handling baby in general. When buying formula, be sure to check the date on the tin. Do not buy a tin that is dented or damaged. Wash your hands before you begin making a feed. Keep the tin of formula in a clean place. Wash and wipe dry the top of the formula tin. Have a separate pan (for boiling bottles) a set of dishcloths, a can opener, a bottle brush, just for baby. Make sure the can opener is clean and rust-free. Clean bottles, nipples, bottle caps thoroughly in warm soapy water. (Soak bottles right after use to make for easier cleaning.) Make sure there isn’t any dry milk clogging the nipple or wedged into the corners of the bottle. Sterilise bottles using whichever method you find most convenient. Follow the manufacturer’s instructions on how to prepare feed. Do not add more water or formula than stipulated as both can be harmful for baby. Always discard leftover formula. Make fresh feeds for baby. If you are travelling, it is better to carry the milk powder in a clean, dry can and mix with sterile water when baby is hungry. Alternately, if you are carrying ready-mixed formula, pack it in ice. The formula will be fresh as long as there is ice. Do not feed baby with formula that is no longer cold.

15. Is rice cereal the best first food for baby?

Once baby is ready for weaning at about age four or six months, rice cereal is the food most commonly served even though it contains a greater amount of starch than other cereals. Iron-fortified rice cereal is easily digestible and is considered a good start in solids. If you are breastfeeding, you could mix the cereal with breast milk. The consistency should be thin, almost like milk and this will help in your baby’s transition from fluids to semi-solids. If your baby is allowed fruit juice, you could mix the cereal with freshly squeezed orange or pear juice. Once your baby accepts this, you could try pureed food like mashed bananas, or pureed soft ripe pears, or mix cereals with bottled food. But initially, do not mix and match foods as that will make it difficult for you to identify a "problem" food if there is one. Offer single foods to make sure your baby is not allergic to any foods.

16. My baby is down with a cold and refuses to eat. Help.

You know how it is when your nose is clogged up and your throat feels sandpapered. Food is the last thing on our minds and how much worse your little baby must feel. But it is imperative that baby keeps up her strength in order to fight the infection. Although you need not worry about giving your baby any special diet for minor coughs and colds, be sure she is drinking enough fluids, be it breast milk, juices, or clear soups. Even if baby turns her head away at the sight of breast or bottle, keep offering them to her. However do not force your baby into eating as that will only aggravate the problem. Give her a vitamin supplement if your doctor recommends one. In the case of an older baby, let her choose what she wants to eat as long as you offer her healthy choices. If cereal and cheese is the order of the day, so be it. You could also try your hand at dressing up oatmeal cookies with a party face or clown hat. Sandwiches could be cut into funny shapes, apple or raspberry gel dressed up with a few drops of cream or custard. Let your imagination fly and you’ll soon have your baby back in his high chair. Do not worry if she doesn’t seem to be eating much, she will make up once she is better.

17. Mealtimes are becoming a nightmare for me. My 10-month-old baby refuses to eat.

Children of this age are notoriously finicky eaters. This is just another aspect of their budding personality and their realisation that they too have a say in things. You need not worry that your child will fade away with hunger. Children have a way of eating as much as they need to eat and grow beautifully. It is the mothers who fade away with worry. But if you are very concerned, check first to see if your baby is drinking too much fluid during the day. If he is still breastfed, more than three or four feeds a day is too much. Up until the eighth or ninth month, milk is the primary food for babies but after that, the need for milk begins to decrease. Too much juice can also drown a baby’s appetite. Do you ply your baby with little titbits all day? All day snacking could be a problem. Or is baby recovering from a cold? If none of these are a problem, try a change in the menu. Perhaps, baby is tired of chicken stew and porridge for lunch and dinner. Offer a few variations to brighten up meal times and work up sluggish appetites. Dress up her food with funny faces or doggy shapes. Let baby go a-la carte but from a healthy menu. Sneak in a few healthy variations even if baby opts for biscuits day after day. Put on a layer of peanut butter on her biscuit. How about a biscuit club sandwich with cheese, biscuit with yoghurt dip, or oatmeal cookies with raisin faces? Dress up a banana cake with cream cheese icing, serve cottage cheese sundae for lunch, papaya medley for tea, or bread pudding with apricot sauce for dinner. Stop mashing up the food. Maybe baby is ready for some chewy food she can really get her first teeth into. Try a few safe chunky foods and hand them to her. Let her feed herself and that may cheer up mealtimes for the little one. Put her in charge. Let baby feed herself (if you dare). Mealtimes may become more traumatic at first but they will quieten down in the long run. Maybe baby is ready to go it herself and is telling you that by refusing to be fed. As an insurance, give baby vitamin drops if her doctor so recommends.

18. My 16-month-old son eats two meals of porridge a day containing fish or chicken, carrot and vegetables. He also drinks three to four bottles of milk in between. I am a little concern that he weighs just 10 kg. Is he considered underweight?

At 16 months, a child could weigh between nine and 13 kg. Your son’s weight is at the lower percentile, but he is still within the normal weight range. As long as he is healthy and does not have any chronic illness, you shouldn’t worry at all. From your description, your son is taking an adequate amount of protein and carbohydrate in his diet. You may want to give your son an additional solid meal and plenty of fruits as well. His milk intake is sufficient.

19. My 22-month-old son is 85 cm tall and weighs 16 kg. Since young, he has always had a huge appetite and will cry if we don’t give him more than he wants to. He drinks one and a half bottle of milk three times a day, but takes a lesser amount of solid food for lunch and dinner. I’m getting worried as he seems to be overweight. Should I give him skim milk instead?

From your description, your son is overweight and he is taking too much milk! Having drank one-and-a-half-bottle of milk, he would not feel like eating solid food later on. You should cut down his milk intake ,then he may and he should want to eat more solid food. Reduce the frequency of fried food like French fries, and refrain from providing high fat snacks on regular basis. Nutrient-dense snacks will help to meet the energy requirements besides building good health habits that can practised into the teen years. An over-weight child or one with a family history of heart disease can be given reduced fat milk from three years onwards but do not give skim milk to a child below seven years of age.

20. When and how should I start my child on self-feeding?

You could start your child on self-feeding as early as the seventh month. Put him on a high chair, with a bib that can catch spills, and lay newspapers on the floor to contain the mess. Give him a bowl of cereal (not too watery) and a plastic spoon. Use an “experiment and discovery” approach to start your child on self-feeding. After many futile attempts and much persistence, the spoon will eventually find its way into the mouth. You should also give your child finger foods which are easy to handle, like raw carrots and cucumber sticks, sandwiches cut into strips, bite-size pieces of sausage and cheese on a blunt children’s fork. Don’t use toothpicks as he may accidentally poke his palate or eyes. Keep the portions small and make some effort to serve the meal attractively on child-sized, non-breakable plates. Try to vary the food in texture and make it colourful in appearance. Offer praise when your child successfully feeds himself.

21. My 20-month-old daughter has been feeding herself since she was one. However, there are occasions when I prefer feeding her again, like when we are eating at restaurant or so that she eats faster and gets to eat more. Most of the time, she’ll protest at my interference and insist on eating herself. Should I let her have her way?

Mealtimes should be fun and not a battleground. Allow your daughter to enjoy eating in her own way. Your concern over her eating more is unnecessary. Like everyone else, your body will get her to eat when she is hungry. Most children know when they have had enough, force-feeding is not encouraged. Alternatively, you may help her to feed herself by loading the spoon for her and let her take it in her hand and putting it in her mouth. She may not mind you doing that.

22. How would you define good eating habits in children?

Good eating habits are a set of attitude towards food and the behaviour shown choosing and eating it. It’s also about eating the right foods in the right amounts at the right times. In defining what good eating habits are, we can look at what bad habits constitute:

• fussiness over many types of food
• frequent wastage
• dislike for foods that involve considerable chewing, like meat
• inability to stay seated to finish a meal before it gets cold
• picking at morsels of food and taking ages to get through a meal
• unwillingness to eat rice, in preference for porridge
• intense dislike for vegetables
• eating the day’s three meals at irregular times
• snacking heavily between meals
• eating predominantly sweet/salty foods
• drinking too much just before a meal
• eating too fast, without chewing sufficiently
• over-eating
• under-eating

23. Under what circumstances does a child require vitamin supplements?

If your child has been keeping a balanced diet, there is no need for her to take vitamin supplements. Your doctor will only prescribe supplements under special circumstances, for example, if the child has had a serious infection or prolonged illness resulting in the depletion of body's reserves and poor appetite. The main sources of vitamins are in vegetables and fruits. If your child has not been eating much of those, you can resort to a daily multivitamin tablet as a temporary measure. However, always consult your doctor before starting a vitamin supplement and make sure you give the correct dosage. Another instance to give vitamin supplements is when the child has been on a special diet for food intolerance. Their nutritional status may be compromised when dietary restrictions are prolonged, especially if the restrictions involve more nutrient-rich foods such as dairy foods. Therefore, appropriate vitamin or mineral supplements may be needed.

24. How can I maximise the intake of vitamins from their food sources?

You should avoid commercialised and processed foods. Apart from powdered milk and margarine, which are fortified with vitamins, fresh foods should be used for children’s diets. Frozen foods are also acceptable as quick freezing preserves the foods in its fresh state, which means that the vitamin contents of frozen meat and vegetables are usually as high as fresh food. However, the canning and drying of foods results in vitamin loss. In the cooking of food, it should be done in the shortest time possible to retain the maximum amount of vitamins as heat destroys most of it. Water-soluble vitamins (C and B-vitamins) leak into cooking water and so steaming is the choice for cooking vegetables.

25. What can be the cause of sudden loss of appetite if the child has been eating well all the time?

There are four reasons which can result in a loss of appetite in your tot:

Sore Throat

He may have a throat infection if he still wants to take fluids but refuses any food. Check it out by looking down his throat with a torch. Using a clean spoon or an ice-cream stick, gently press his tongue down. If his throat is all red, take his temperature. If he has a fever as well, children’s paracetamol should be given. Let him drink as much as he wants and encourage him to rest.

Tummy Bug

Does the child have diarrhoea soon after he refuses food? If so, he probably has a tummy bug. Try giving the toddler small amounts of soft food that requires little chewing frequently during the day. Choose high-energy foods such as such as rice-porridge and protein-rich foods like fish, chicken and eggs. Avoid giving foods that contain a lot of fibre like leafy vegetables, beans and wholegrain cereals. Remember to give him plenty of boiled water to replace the fluid lost. Consult your doctor as soon as possible.

Urinary Tract Infection

A toddler who seems off-colour, has poor appetite and complains of pain when he urinates may have a urinary tract infection. He may also be bed-wetting again, has a slight fever and complains that his tummy hurts. Make sure that he has lots of water to drink and contact your doctor immediately.

Motion Sickness

Children often get motion sickness in cars and playgrounds, especially on equipment that whirls them round very fast. Motion sickness is caused by movement which upsets the balance in the inner ear. The child’s forehead may be cold and clammy. Get him to close his eyes and lie down, if possible. If he experiences car sickness each time he goes to nursery or playgroup, give him a small meal as a full stomach may make him worse. You can make up for it by giving him more later on.

26. What can I do to make my toddler more interested in his food?

There are many ways to help increase a toddler’s interest in food. You could get him to help out with easy kitchen chores and kitchen play, and involve him in food selection and menu planning. Serve the food in a visually attractive way through the use of colourful utensils and pleasing food presentations. Toddlers generally prefer foods that are soft, moist, mild in flavour and attractive in appearance. They most often reject foods which are dry, tough or thick. As young children are more sensitive to flavours than adults, it is best to introduce new food flavours in a mild form. Serve food in smaller portions as large amounts of food can be quite intimidating and discouraging to eat. Cut food into bite-size pieces and the cups and utensils should be small enough for him to use comfortably.

27. I believe I am at fault in forming bad eating habits in my daughter. She has also been skinny and underweight which gives me a lot of pressure to make sure she eats. So she gets to eat at whatever times she likes, and wherever she wants, like in front of the TV. Sometimes, I have to chase her around the house to feed her. She orders her food items as if it comes from the restaurant. I’m getting rather tired about the whole thing. Is there anything I can do now?

One of the biggest problems with a child who will not eat is trying not to let it upsets you, and if it does, not allowing her to see it. To avoid or overcome problems at mealtimes, parents need to have a sensible and relaxed attitude to feeding. If your child considers eating to be an enjoyable experience and a way to satisfy her hunger, she is less likely to develop food fads or cause scenes at the table. Eating should not become a way to either please you or manipulate you. Start by serving meals at regular times as routine is very important with a fussy eater. Meals at regular intervals ensure that she does not get too hungry or overtired, both of which may upset her appetite. If your child does not eat much at one meal, try not to worry and do not force her to finish it. There is no way you can make your child eat if she does not want to, short of turning mealtimes into a battle ground each time. It may be that she is simply not hungry. If you do not have a high chair, perhaps you could interest her into eating by involving her in the purchase of one. Let her choose the design and colour and tell her this is going to be a new way of eating. Then you don’t have to run around the house feeding her, or let her choose any place to eat. It is true that your child will be more enthusiastic about eating if she is allowed to choose what she eats. However, this does not mean that you have to run the house like a restaurant. Limit her choice to two or three, for example, fish porridge or egg noodles and a pear or apple. Sometimes, your child’s food choice maybe very different from what you would like her to eat. Young children, especially those under three, like to experiment with everything, including food. You may not find the thought of soup and baked beans appetising but your child might. If she wants to try it, let her. Try serving smaller helpings of food as large portions can be intimidating and she will be discouraged to eat them. It is still reasonable to allow certain rituals at mealtimes. Many children will only eat carrots if it is cut into long strips, or drink milk from a special cup. As long as the requests are reasonable, accept these fads as they will not last long. Try to interest her in food by making them visually attractive and colourful.

28. Do cooked vegetables always contain less vitamins than raw vegetables?

Although generally cooking of vegetables tends to cause some nutrients to be lost, especially water-soluble B and C vitamins, there are cooking methods which retain much of the vitamins, such as steaming, stir frying and pressure-cooking. To further conserve the nutritive value, the water for boiling vegetables can be used for soups, stews or sauces. The freshness of the vegetables is also important as older, raw vegetables which are improperly cooked may contain less vitamins than sensibly cooked fresh vegetables.

The problem of erratic feeding is unfortunately a very common one and can be quite exasperating for the parents. From quite an early age , some children become very choosy about what they want to eat. For no good reason they reject the milk or food you offer them. In an ideal situation, children should take regular meals consisting of a balance of carbohydrates, proteins, fat and vitamins. A diet comprising predominantly of fruit and cereal cannot be considered a balanced diet because there is little protein and virtually no fat. Having said this, it is still better for your child to eat something than not to eat at all. Try to offer your child a wider variety of food and give him vitamin supplements. However if your child is losing weight or if he behaves abnormally, consult a doctor.

31. My five-year-old daughter is very fond of sweets and soft drinks. How do I ensure that her dental hygiene is adequate?

As five-year-olds are very imaginative, you could teach the importance of caring for the teeth with the help of a good book from the library. (The Tooth Book by Dr Seuss makes an impact through humour and vivid illustrations.) Try telling her a bedtime story about how two enemies - plaque and decay - plan to attack the healthy teeth of a little girl who forgot to brush her teeth before bedtime. Get her involved in a campaign to upset the enemies’ plan. Through the little game you can get her to do the following.

These should help her cultivate good dental hygiene and hopefully help her pick up some healthy eating habits in the process.

32. My four-year-old child is still drinking milk in a bottle. Since he will be attending preschool soon, I worry that he will cry for his bottle. I find it rather troublesome and embarrassing to have to carry his bottle around wherever we go. How can I stop him from feeding from the bottle?

There are basically two ways in which you can solve this problem. The first is to get rid of all his bottles, hence he will not have a choice but to drink from a cup. Alternatively, you could allow the natural forces of peer pressure to come into play once he attends school. When he sees that none of his classmates are drinking from a bottle your son will be inclined to stop the habit too. As to which course of action to take, it really depends on your own temperament.

33. How can I plan a balanced diet for my preschooler?

Children between the age of three and six years of age are notoriously difficult to feed. This is the age when they become picky over their food. They are often too easily distracted with everything going on around them to be interested in eating. In contrast with the rapid intellectual and social growth taking place at this time, physical growth is slow but steady. Food provides nutrients and energy for this continuing growth. Food also meets energy needs for the vigorous activities - running, jumping, playing - that preschoolers are usually engaged in. Having a healthy and balanced diet helps maintain resistance to infections. It also allows the building up of stores of nutrients in the body, which will be important in the event of an illness when intake may be reduced. Preschoolers just like all other age groups, need a balanced diet from the three food groups. Rice and cereals, including breakfast cereals, noodles and bread, provide carbohydrate for energy, as well as fibre, vitamins and minerals. The meat group which includes pork, beef, chicken, mutton, eggs, fish, cheese, milk, beans and bean curd provides protein for growth and maintenance of body tissues. These foods are also rich in iron which is important for healthy blood and have fat for energy, as well as vitamins and other minerals. The third food group which should form a part of your preschooler’s diet is the fruit and vegetable group. This group provides fibre, minerals and vitamins especially vitamin C. Small amounts of fats and oils should be included in children’s diets - they provide energy, essential fatty acids and vitamins, particularly vitamins A and D.

34. My child enjoys milk. Should I be concerned that he is drinking too much milk?

All of us know that milk and milk products are the best sources of calcium in the form which is easily absorbed by the body. It is generally worth encouraging your child to continue drinking milk and to make that a habit since it has been proven that bone building and laying of bone mass continues until our mid-30’s. However you need to ensure that your child does not drink milk excessively at the expense of other food intake, especially meat and cereal products. This is due to the fact that milk is a poor source of iron and total exclusion of other food groups could lead to iron-deficiency anaemia. As a general guideline, once cow’s milk has been introduced into your child’s diet, two to three cups should be the maximum intake. Iron-fortified cereals, liver and meat which are good sources of iron should be taken regularly. Fruit, juices and vegetables which are rich in vitamin C helps enhance the absorption of iron.

35. What is the role of fat in the diet? How much fat does a four-year-old child require?

Fat is recommended to provide 35 percent energy (kilocalories) in the diet of young children. A child between the ages of three and five requires about 1,550 kCal per day so the ideal amount of fat in the diet should be about 60 g per day. Allowing 10 g (two teaspoons) fat for each of the three main meals, to be used as cooking oil or fatty spreads such as margarine and peanut butter, and 16 g from the two cups of full cream milk (500 ml of milk in total), then the fat content of the rest of the foods eaten should not add up to more than 14 g. In fact this would be obtained from three small servings of lean meat, fish, chicken or egg. Plain rice, bread, noodles, vegetables and fruit provide negligible amounts of fat.

36. I understand that too much fat in my child’s diet will not only lead to obesity but also to a high level of cholesterol in the blood. What can I do to avoid excessive fat in my child’s diet?

One of the things that you could do is to replace some saturated fat in the diet with unsaturated fat. This is because unsaturated fat when taken in moderation does not lead to an increase in the cholesterol level as does saturated fat. Saturated fat is the type found mainly in foods of animal origin and coconut oil.

• To replace saturated fat with unsaturated fat, you could follow these pointers;
• Use unsaturated margarine instead of butter.
• Cook with unsaturated oil such as soyabeans, corn, safflower seed or olive oil.
• Trim all fat off meat and remove chicken and duck skin before cooking.
• Try to avoid using coconut milk. Cook fish more often as it contains mainly unsaturated fat, including omega-3 oil which have been found to be helpful in lowering blood cholesterol.

37. My preschool child refuses to eat vegetables at all. How can I interest him in vegetables?

In this kind of a situation, most mothers tend to force feed the child. Though it ensures that the child eats his vegetables, it does nothing to encourage your child to develop a liking for vegetables. One way of getting him interested in vegetables is through stories and colours and also by cutting the vegetables into interesting shapes. Children generally prefer vegetables with texture than soft, mushy types. For example green peas are always preferred to spinach and cauliflower; broccoli, baby sweetcorn, carrot cubes and celery slices would go down much better than cabbage. With a little imagination, it is just endless the way you can make vegetables more interesting for your child. You should aim to make your child view vegetables as interesting and tasty components to the meal and not merely a necessary evil.

38. Can you suggest some healthy snacks for my preschool child?

39. How do I know my one-month old breastfed baby is getting enough to eat?

Since your breast does not come with ounces marked on them, this is one of the commonest worries plaguing the new mother. But there are a few tips you could be look out for. Firstly, do keep in mind that a breastfed infant tends to gain weight more slowly than a formula fed infant. But does your baby seem content after a feeding? If he does, most of the time, he must be getting enough to eat. (There will of course be times when baby continues to fuss either because of gassiness or because she wants to pass motion.) Secondly, check the diaper when you are changing him before meals. Baby should wet six to eight diapers within a 24-hour cycle. Baby should also have about five bowel movements a day. Some women can also feel the milk coming down, which is known as let-down. This can happen just by thinking of baby. You could feel a tingling or achy sensation in your breasts, or it may be a feeling of fullness which, in some cases, is followed by milk leaking out of the breast. There are other pointers too that you could discuss with your doctor. But do remember, the size of the breast has nothing to do with milk-production. Your body will adjust its milk production according to the demands of your baby. The more baby drinks, the more your body will be stimulated into producing. Nurse frequently and your baby will not go hungry.

40. My daughter, who is two-and-a half-years old, is a healthy and active girl. However, eats regular meals and sometimes I even give her snacks in between. Still her weight has not increased substantially over the past six months. It is even constant at certain months. How can she put on more weight?

If her daughter has been growing taller and gaining some weight, and is healthy and active, you need be too occupied about weight gain. It must be understood that the amount of food which a child requires varies considerably from one child to another. Some children appear to eat next to nothing and yet gain weight while others eat a lot and do not grow very well. Since she is an active child, you may try giving her more carbohydrates to replace those she has burnt out.

41. Besides taking lunch and dinner, my 20-month-old daughter takes three milk feeds daily. She now weighs 13 kg. Is she overweight?

Your daughter’s weight is above average and is at the higher percentile, but she is not grossly overweight. Nevertheless, it is advisable to reduce her milk intake to two a day and substitute her breakfast milk feed with high fibre and nutritious cereals or bread. You may also cut down on her carbohydrate (rice) and fat intake during lunch and dinner and offer her more fish, lean meat and vegetables.

42. What is infant formula ? How do I gauge the amount of milk my baby needs?

Infant formula is milk made from cow’s milk that has been modified to make it more digestible for young babies. Cow’s milk contains more mineral salts and protein than a baby’s delicate digestive system can handle. Broadly speaking, you can say there are three types of formula – whey based, curd based and soy based. Whey based formula is best for young babies as it is the one that is closest to breast milk and easily digestible. Curd based formula which takes longer to digest is better for older babies. The soy based formula is for babies with an allergy to cow’s milk or for strict vegetarians. To know how much formula to give to your baby, follow the manufacturer’s instructions on the tin. Use as many scoops as is recommended and level off the powder with the back of a knife. Do not try to pack in more into the measuring spoon as this will make the milk too formula-rich and may dehydrate your baby.

43. I am not breastfeeding my baby. Do I follow the demand feed method as well or should I stick to a routine?

Today’s formulas are quite similar to breast milk so you can safely feed your baby when he wants to be fed. Soon you will recognise a pattern to your baby’s feeding schedule. Initially he will probably need to be fed once every three or four hours. Feed your baby whenever he wants to feed. Some babies take fewer bigger feeds while others may drink more frequently but in smaller quantities. You will soon know how much your baby’s little stomach can accommodate at one go. The important thing to remember is to respond to your baby’s needs when he is hungry. Do not withhold feeds just because its not time yet. If you let baby scream for too long before handing him the bottle, he may not be able to feed well and doubtless, he will be up again soon, asking for more. Listen to your baby and all will go well.

44. Is it possible to overfeed or underfeed my baby?

If your baby is bottlefed, it is very easy to overfeed him. Since a bottle comes with ounces marked on it, it is very tempting for mothers to try and coax their babies into emptying the bottle. But it is best if you let your baby decide when he’s had enough. On the other hand, if your baby seems fretful even after he’s had his feed, you may not be feeding him enough. You could try increasing the feed by an ounce. If even that doesn’t work, discuss the matter with a paediatrician.

45. I want my six-month-old to try meat. Is he ready?

Adding meat to a baby’s diet is an important step in weaning and is usually introduced in the seventh or eight month. So far, your baby has been used to smooth textures like cereal or strained vegetables. Meat is not only a new taste he will have to get used to, it is also a different texture. Incorporate meat gradually. Be prepared for refusals. But if your baby has been feeding well and is well adjusted to his meals, you could try a bit of soft fish or chicken. But make sure you present it in a form that is easy to swallow and digest for baby. Baby may start out by taking a teaspoonful and then work up to a tablespoon or more.

46. How do I get my baby to eat meat?

It is best to strain meet when you offer it to baby for the first time. There are a few different ways in which you could do this.

47. What are the different ways in which I can serve meat to my baby?

Meat is protein rich and should be served as a complement to the carbohydrates in our diet. To get your baby used to the flavour of meat, you could try mixing chicken or beef stock with your baby’s cereal, or mashed potatoes, first. Once that goes down, your baby could be ready to try the real stuff. Once baby is ready for coarse textures, which will be around seven to nine months, you could serve cooked minced meat mixed with rice porridge, mashed potatoes, or finely chopped noodles. At about age nine or ten months, you could try offering baby some chicken or beef stew. This is made by boiling a piece of chicken with a wedge of potato, diced or grated carrots, one small onion, a few peas and whichever other vegetable you want to serve. Simmer these over a low fire until the meat and vegetables are very tender and comes apart at a touch. You could also drop in a spoonful of washed rice into the stew so that the rice cooks in the stock. Mash these up for baby or see if she can chew on a piece of soft carrot or potato. The alternate could be commercial preparations. There are quite a few meat preparations and all are clearly labelled indicating the age it is meant for.

48. A friend of mine told me not to eat spicy food as that will turn off my breast-feeding baby. Is that true? What is known about the baby’s ability to smell?

Your friend does have a point. Its a good idea to stay off strongly flavoured foods until you’ve weaned your baby as garlic or shrimp-flavoured breast milk can put off your baby. Though the sense of smell is not as well developed in humans as it is in animals, human babies are quite discerning and show a strong preference for their parents’ natural odour. Babies are very sensitive to smell. In fact, a newborn can distinguish the smell of their mother’s milk from that of all other mothers. Isn’t that clever?

49. How do I inculcate healthy eating habits in my child?

Eating healthily is a habit that needs to be taught from a young age and continually nurtured. We should make the effort to do so in their most impressionable years to give them a good headstart. The first step towards teaching your children to eat well and healthy is to do so yourself. Make sure you keep a balance diet. Educate your child in a simple manner the basics of nutrition – the sources of the body-builders (proteins, which can be found in chicken, fish, seafood or small portions of lean red/white meat), the energy-givers (carbohydrates such as rice, noodles, or potatoes), and the protectors (vitamins in the form of vegetables, and fruits). If your child likes eating rice or potatoes and is picky about meat, you can tell him, “Rice and potatoes give you lots of energy to run around, but you won’t grow muscles if you refuse to take the meat. Wouldn’t it be nice to have nice muscles so you look good in your clothes, too?” If your child takes only meat and very little carbohydrates, you may say, “It’s no use having fine muscles that look good, but not much strength in them. That’s why you need to eat the meat with your rice.” As for the vitamins food, you can encourage your child by saying, “It’s really nice to have a good built and the energy to play and run around. But you can’t really do that if the protectors are not there to keep the sickness at bay. So a healthy meal should consist of all three categories of food.” You would be surprise at how well the children accept these facts and follow them! Repeat them often and these habits formed will follow them through their teens and adult lives!

50. What are vitamins and what role do they play in a child’s diet?

Vitamins are essentially a group of nutrients which, although needed in very small amounts, are essential for the maintenance of life, and for normal growth. In children, growth is normally measured by the externally measurable gain in height and weight. Another important part of the growth process is the development of the various body organs and tissues. A deficiency of a vitamin essential for growth process may result in abnormalities. This means that organs or tissues may not form properly or function normally. This may be reversible upon replenishment of the vitamin. Sometimes, the result of vitamin deficiency may be permanent, as in bow legs that result from damage to bones in vitamin D deficiency; or blindness caused by vitamin A deficiency.

51. Are there any negative effects in the taking of vitamin supplements in children?

Yes, there are dangers with excessive doses of the fat-soluble vitamins A and D, and even overdosing on vitamin C can have damaging effects. Note that in the condition known as G6PD-deficiency, vitamin K in excessive doses can cause damage to the blood cells. Also, you should avoid giving chewable vitamin C tablets to children – these can cause erosion of the tooth enamel due to their acidity.

52. My 14-month-old toddler has a mind of his own when it comes to food. He seems to eat only a particular type of food one week and another type the next week. Sometimes, he simply refuses to eat whatever food I offer him. Why is he behaving like that?

Your son is going through a period of food fads and food refusals. This is common among toddlers between one to three years old. Many parents resort to force-feeding in order to get that extra mouthful of food into the child. Normally, food fads and food refusals are short-lived and do not affect the overall nutritional status and health. However, you should find out the reasons why your child refuses to eat and try to make adjustments. Toddlers may refuse food because of irregular mealtimes, distraction with activity or disinterest in one particular food server. Or they may be trying to get attention or just plain tired.