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Good Nutrition for Healthy Children (by Dr Alan Stewart)

The health of children is nowadays determined more by their diet than probably any other factor. In times past, poor quality housing and lack of clean water were more important. The benefit of correcting these problems and the success of immunisation programmes mean that nutrition now tops the list of health priorities for children. In […]

The health of children is nowadays determined more by their diet than probably any other factor. In times past, poor quality housing and lack of clean water were more important. The benefit of correcting these problems and the success of immunisation programmes mean that nutrition now tops the list of health priorities for children.

In this article I will look at the importance of good nutrient intake on the health, growth and development of children and ways of tackling common feeding problems in children. I will also look at some common conditions such as asthma, other allergic problems and poor resistance to infection and see what part good nutrition has to play in helping to overcome them.

HOW WELL FED ARE CHILDREN TODAY?

At present there are relatively few published studies that have looked at the nutritional status of children in the United Kingdom. Those that have been undertaken, especially in unwell children leave no room for complacency. A mild deficiency of iron for example is quite common. The responsibility to feed children well is a solemn one and for most parents is not one that is easy to fulfil. There is a battle between the wishes of the parent and the preferences of children which are all too likely to have been influenced by the advertisements on television. Hurried lifestyles for parents means that there is not always much time for preparation of certain good traditional foods. Hungry children are looking for a quick nutrition fix. “Feed me now!” syndrome is a real entity in the modern family household and the oven chip/pot noodle treatment satisfies only the immediate need for calories at the cost of the wider nutritional needs for vitamins and other essential nutrients.

COMMON PROBLEMS IN CHILDHOOD

Fussy Eaters At some stage it would seem that virtually all children take a dislike to eating certain usually healthy foods. This often happens between the ages of two and five years when they realise that there is a choice and that they can have some influence over what they do or do not consume. The child is also beginning to exercise his or her independence and this should be recognised. Furthermore there can be substantial variations in appetite from day to day and some children in the same family may have different preferences as to when they may wish to consume their main meal. Gentle persuasion, encouragement, good parental example, regular meal times and presenting a small choice of healthy food options are ways to encourage good feeding habits. Confrontation, forcing, over-rewarding, emotional strain and social isolation in an attempt to improve eating habits are likely to be counter-productive and lay the foundation for eating disorders in adolescence. The traditional approaches of “Take it or leave” and “Clean plates get pudding” if used judiciously and supported by parental or sibling example are much more likely to be successful. Despite best parental efforts this can still be a difficult area especially when a child has a small appetite. Even a mild lack of iron which may affect ten to twenty per cent of pre-school children in the UK can adversely affect appetite. Similarly the earliest symptom of a mild lack of vitamin B can also be a poor appetite. Often the simplest solution in these situations is to give a multivitamin and iron supplement providing doses close to the Recommended Daily Allowance (NRV), whilst at the same time encouraging as healthy a diet as possible.

POOR GROWTH

It is good practice for all children in the first few years of life to have checks on their height, weight and development monitored usually by their BP or specialist clinic. Children whose growth is not satisfactory need to be assessed in more detail and this includes attention being paid to nutritional problems. A poor intake of calories or protein can limit growth and development and can be due to a poor appetite or part of an underlying illness or long-standing poor dietary habits. Ensuring a nutritious diet which may require protein supplements is central to treatment. Some nutrients play an important part in childhood growth. Severe zinc deficiency has long been known to result in growth retardation and delayed puberty. Milder degrees of deficiency can also occur especially in those with a low protein intake and a small supplement of ten milligrams daily has been shown to lead to catch-up growth in those with evidence of a mild deficiency. Vitamin A deficiency is very rare outside of the developing world. But again a mild lack has been shown to reduce the release of growth hormone from the pituitary gland in the brain. This too may be a factor in some children with growth problems. Liver, the richest dietary source of animal vitamin A – Retinol is rarely a favourite food of today’s children.

ECZEMA

Childhood eczema can often be due to an allergic reaction to a food and typically may first develop as new foods are introduced in the first year of life. Allergic reactions to many foods are now well documented and include cow’s milk and cheese, eggs, wheat, chocolate, citrus fruits, peanuts and many others. A large number of doctors and dietary specialists advocate the use of exclusion diets which, if conducted carefully, can have a high degree of success in controlling childhood eczema. A degree of caution is needed as diets based on only a dozen or so foods are not nutritionally adequate. Very often multivitamin and mineral supplements are required especially of calcium for those avoiding dairy products for anything more than a month or two. Expert assessment of those with a severely restricted diet or marked reactions to foods is essential.

Eczema can also be benefited by the use of Evening Primrose Oil which like breast milk is a rich source of a specialised essential fatty acid gamma linolenic acid. This is needed for the health of the skin and other tissues and it seems that the metabolism of some children especially those with eczema means that they may not be able to make enough of it. A supplement of one to two grams of Evening Primrose Oil is an appropriate dose for children.

ASTHMA

This is fast becoming the modern scourge with as many as ten percent of school children being affected at some time during school age. The last few years have seen a tremendous effort by doctors and health workers to address this problem and there are undoubted benefits to careful and appropriate drug therapy. Nutrition plays a part too. Repeated chest infections, often a trigger for asthma, can be influenced by a lack of iron, zinc and B vitamins which all affect the immune system. Modest supplements of vitamin A retinol have been shown to reduce the rate of minor respiratory infections in children and this may be because this vitamin makes it harder for some bacteria to stick to the lining of the airways. Furthermore the mineral magnesium found in wholemeal bread, meats and green vegetables may help determine how severe wheezing is because of its possible anti-spasm properties. Poor dietary intake has recently been shown to be associated with increased severity of allergic reactions. High intakes of sodium (table) salt in our diets may be another factor not in causing asthma directly but by making the consumer more vulnerable to the wheezing that may follow a chest infection or that occurs on exposure to cold weather or during exercise.

Consequently nutritional supplements of multivitamins and minerals may be appropriate for some asthmatic children especially where the diet may not be adequate. They are no substitute for necessary drug therapy and in the author’s experience may assist in their effectiveness. Good advice for all asthmatics includes; eating a healthy diet with strict limitation of poor quality high fat, high-sugar foods; avoidance of preservatives (sulphites found in squashes and some packaged foods) and artificial colouring agents (in sweets and some soft drinks); avoidance of other known triggers such as housedust, exposure to cat or dog hair (sensitivity to these should be checked when possible); limit the intake of salt and salty foods eg. crisps, bacon etc. Eat plenty of healthy foods including fresh fruit and vegetables; regular physical exercise is almost always beneficial provided that it is appropriate to the child’s capabilities.

MIGRAINE HEADACHES and OTHER FOOD INTOLERANCE PROBLEMS

Migraine headaches are a surprisingly common problem in children who may suffer as much as adults. A lack of nutrients is not a factor but food allergy or intolerance may account for ninety percent of such headaches according to one large study conducted by doctors at Great Ormond Street Children’s Hospital in London. They found that cow’s milk, cheese, chocolate, artificial colouring agents, citrus fruit, yeast extract and wheat were common dietary triggers of migraine. Additionally complaints such as colic, chronic catarrh and asthma may respond to the avoidance of these and other foods. Again many children whose diet is restricted in this way will need nutritional supplements to ensure an adequate intake.

CONCLUSION

It appears that despite the benefits that prosperous Western economies have brought there are still sub-groups of the “normal” population who may experience mild nutritional deficiencies. Iron and the B vitamins seem especially likely unless there are significant attempts by parents to resist the lure of poor quality convenience foods. These mild deficiencies are not without effect as they can influence growth, resistance to infection and, in the case of iron, classroom performance. Ensuring a good diet is essential and for some a multivitamin supplement often with iron may be indicated when nutrient intake cannot be guaranteed.

Consider the following ten questions as a quick guide to how you may be feeding your offspring

I always give my children a good breakfast before leaving for school?

Does breakfast include one of the following: an egg, wholemeal bread or a bowl of a fortified breakfast cereal?

Do they always have at least one portion of fresh green vegetables or frozen peas daily?

Do they always have at least one piece of fresh fruit per day?

Do they have two servings of meat, fish, chicken, beans, eggs, or vegetarian protein per day?

Do they have at least half a pint of milk or yoghurt daily?

Does your child(ren) usually eat all of the main course of their main daily meal?

Score one point for each “yes” to the above

Do they consume sweets every day?

Do they drink soft drinks eg. cola and lemonade more than twice a week?

Do they have a snack meal in the evening instead of a cooked meal with salad or vegetables?

Score one point for each “No” to the above.

As a rough guide, if you scored seven or more then you are probably doing quite well. Between four and six means that there is a need for improvement and three or less is a cause for real concern and further assessment by a dietitian, doctor or nutritionist may well be necessary.

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