Nutrition for babies and Toddlers
By Dr Laura David
Nutrition for babies and toddlers: vitamins, minerals, and common issues
In General Practice parents often ask me about nutrition for their children. I am not a trained nutritionist or dietician however, I can certainly discuss common health topics around food and vitamins, and of course, the effect of the dreaded ‘sugar’ on our children. Having two children myself gives me a good understanding of how hard it can be to give your children a ‘balanced and varied diet’, avoid ‘bad treats’ and ensure good ‘portion control’. Here are some of the common topics I get asked about:
- How much milk should my toddler? And do they need supplements?
- Vitamin D and calcium
- Iron and Anaemia
- How much sugar can they have?
Perhaps the best way to look at nutrition is to go right back to basics and look at a baby’s nutritional requirements.
MILK and CALCIUM:
For the first 5-6 months milk forms complete nutrition for babies. This may be in the form of breast milk or formula.
Breast milk or formula provides enough sole nutrition for babies until they are ready for weaning. Currently the recommendation is to wait until 6 months to wean your baby. However, readiness for weaning (sitting upright even if slightly assisted, interest in food, putting everything in their mouth) can often be displayed around 5-6 months but some babies do not show signs of readiness for weaning until 7-8 months. Some parents may choose to wean their baby at 5 months or even before if it is medically indicated.
Food given before about 9 months does not provide the mainstay of nutrition for babies. Up until 1-year babies rely significantly on milk to provide their nutrition. After around 1-year old babies will drink less milk (up to about 500mls including other dairy sources such as cheese and yoghurt), and food will be their main form of nutrition. This amount of milk (500mls or 350mls +dairy) and dairy will provide enough calcium for a growing toddler up to the age of 2 and the amount of milk will probably taper off thereafter. For children allergic to dairy, there are plenty of calcium-fortified alternatives, however, discussing dairy alternatives is not within the scope of this article.
When giving sources of dairy, ensure you give your baby/toddler the full fat option. Reduced fat options are not recommended and often contain extra sugars and sweeteners. Additionally, the ‘fat-lowering’ process can remove some of the vitamins which are contained in the fat. After the age of 2 you can introduce some lower fat options if your child eats well.
If your baby or toddler does not want to drink milk after the age of 1, don’t stress out too much. As long as they have other sources of dairy/calcium-fortified foods in their diet this should not be a problem (2 portions per day would suffice in a toddler not drinking much milk).
VITAMIN D AND SUPPLEMENTS:
Vitamin D is the most talked about vitamin for babies. The main source of vitamin D is from direct sunlight, however, not many parents are willing to expose their new babies to the sun directly, and of course, this is not medically recommended, especially in the first 6 months. Plus, in the UK, most months of the year the sun is too low for us to get maximal benefit from this source. Other dietary sources such as oily fish and eggs do help us get our vitamin D, however, particularly in the UK, even adults struggle to get enough dietary Vitamin D. It is recommended babies and toddlers eat 2 portions of oily fish per week. In-fact it is not recommended to eat much more than this due to pollutants found in the fish oils.
Breast milk has so many benefits however, it is recommended now that babies are supplemented with vitamin D from birth, if they are breast fed. Mothers who are breast feeding need 10 micrograms of vitamin D daily as well as the drops for babies.
The World Health Organisation (WHO) recommends breast fed babies receive a daily dose of 8.5-10 micrograms of vitamin D per day. This can be given by a syringe, dropper or small spoon. TIP: remember to sterilise the spoon/dropper/syringe. Droppers are quite hard to sterilise, but this can be done using some boiling water to get inside the dropper.
Formula contains vitamins including vitamin D. However, it should be noted that a baby drinking formula needs to drink at least 500mls of formula per 24 hours to get the required amount of vitamin D, according to the NHS website. Therefore, babies drinking less than this should also have a supplement.
The WHO also recommends that all children aged 6 months to 5 years are given a daily multivitamin containing 10 micrograms of vitamin D, and also vitamins A and C. These can all be bought over-the-counter.
Breast milk also contains low amounts of iron, however, the iron that is present in breast milk is much more easily absorbed than the iron found in formula, so it is not generally recommended that young babies are supplemented with iron before weaning unless medically advised.
After full weaning, if you think your child has an iron-poor diet then it is worth looking at vitamin preparation with additional iron (they do not all have it in so please check the label), in addition to trying to increase their dietary iron.
The main source of iron in our diets comes from red meat and dark meat (to include brown meat on chicken and turkey for example), eggs, chickpeas, lentils and leafy dark green vegetables such as spinach and kale.
TIP: Ensure you give lean cuts of meat to your baby/toddler e.g. remove excess fat and skin from meats, as this kind of fat is not good for anyone!
TIP: Dietary iron is best absorbed when taken alongside vitamin C-rich foods, therefore give your little one some citrus fruits, strawberries or kiwi fruit for desert after their iron-rich meal.
Iron deficiency is common in toddlers and the commonest cause of this is a poor diet and too much milk. Parents can sometimes get stuck in a rut and give their toddlers too much milk when they are labelled as ‘fussy eaters’. Toddlers might prefer and fill up on milk, and therefore not eat much food. It can become a vicious cycle.
In my practice I have seen toddlers drinking at least a litre of milk per day and not eating much else. In some cases the toddlers are not thriving and become anaemic, which can have significant consequences. In severe cases this can cause excessive tiredness, poor energy levels, and even heart problems. The key message is to ensure your toddler is not drinking too much milk, and is having a varied, iron-rich diet, supplemented with vitamin A, C and D.
Lots of parents ask me how much sugar they can give their children. Really, the answer is ‘as little as possible’, but the reality is that children will eat some sugar, and this might be natural sugars (mostly found in fruit) or processed sugars (found in sweets, cakes, chocolates and juice drinks). We have to be slightly pragmatic here, as there wont be many children who never eat any sugar, but our children are exposed to so many choices, and we should encourage them to make the right ones. Obesity in children is spiralling out of control, with over 1 in 5 children being overweight or obese when starting primary school.
We should consider fruits as good for children, but in moderation, especially high fructose (fruit sugar) such as mangos and grapes. Dried fruits are generally not advised unless given with a meal e.g. a few raisins on cereal (think of how many grapes there are in a small pack of raisins), as they very high in sugar and are particularly bad for children’s teeth.
We should make a significant effort to avoid sweets, cakes and chocolates, as well as cereals high in sugar and sweetened juice drinks. Juice itself is also very high in sugar, and although this is fruit sugar and rich in vitamins, it is still high in calories and bad for children’s teeth, and therefore should be avoided. Giving your child the actual fruit to eat is much better for them and contains fibre which helps less sugar to be digested. And of course eating one tangerine contains much less sugar than a glass of orange juice (which may contain the juice of 4-5 oranges).
Juice, if given to children, should never be given in a baby bottle, as this causes significant tooth decay.
There should be no illusion that my children are angels who eat a completely nutritious and balanced diet, they have their moments (frequently). But I am sure we can all agree that the effect of sugar on children is a negative one, not to mention the tantrums that come after the sugar high (we have all been there and can commiserate!).