In my last feature I looked at the alarmingly poor uptake of the Healthy Start Vitamin Drops scheme. Thank you to so many of you who got in touch to ask about other supplements for toddlers. Here is some advice.
Most of our toddlers in the UK are well nourished, their diet provides all the macro nutrients (carbohydrate, fat and protein) they need. In fact many are over nourished when it comes to macro nutrients which is probably why three in five are overweight or obese. However, increasing numbers of toddlers are not meeting their requirements of some micro nutrients (vitamin and minerals) because they don't eat enough nutritious food and also are not being given the recommended toddler vitamin supplement.
It's no accident that toddler's diets lack nutrients:
• Parents either don't know or don't care about nutrition
• Nurseries or child care are serving inadequate meals and snacks
• Some toddlers diets are severely restricted due to cultural reasons, feeding problems or illness
Prolonged nutrient deficiency can have serious effects on health, growth and development, but most can be corrected if spotted early by either changing the diet or supplementing it with the missing nutrients.
Nutrient deficiencies are not caused by toddlers eating poorly for a day or two or even a week or two -when they are unwell for instance. Most toddlers have body stores of a lot of nutrients and poor eating for a day or two won't deplete them. It's also important to remember that just like adults, toddlers eat better some days than others. We need to think about the quality of the diet over the week rather than just judging it on one day in isolation.
Nevertheless, there's no escaping that our relatively affluent, sedentary lifestyle promotes the over consumption of energy rich foods and the under consumption of dietary fibre, fruit, vegetables, whole grains and fish- all of which are valuable sources of key nutrients.
The most common toddler nutrition problems can often be spotted if you know what to look for. As parents, try asking yourself some key questions about how your toddler eats at home and of course check your child's nursery's own records. How well your toddler eats in nursery is very valuable.
Here's the science you need to know to be better informed!
Iron deficiency anaemia:
• Iron is essential to make haemoglobin in blood.
• Up to 12% of toddlers do not eat enough iron rich foods and have poor iron stores.
• The most common age for the problem is between 12 months and 18 months- at this age large amounts of iron are needed for growth and development but also toddlers are going the through transition from infant to adult dietary pattern and many children refuse food.
• Other toddlers at risk of poor iron status are vegetarians and vegans and those toddlers with poor general dietary intake and an over dependence on milk.
• The most common cause for iron deficiency is a low intake of haem iron (iron found in meat) and a failure to eat foods rich in vitamin C which helps the absorption of iron, this is especially important when you eat non haem iron from vegetables or cereals. Toddlers who are given tea to drink or high bran cereals to eat can also struggle to get enough iron- both of these foods restrict iron absorption.
• The best food sources of iron are lean read meat, breakfast cereals, eggs, dark leafy green vegetables and pulses like beans and lentils.
• Toddlers with a low iron status may be pale, lethargic and lacking energy. Anaemia in the early years has been shown to be linked with poor cognitive development.
• Iron supplements may be required if a toddler is anaemic but this should be discussed with the toddlers GP. Follow on milks also contain iron but again should only be given if a toddler is suspected to have a poor iron status.
Vitamin D deficiency:
In summary deficiency of vitamin D causes rickets. The only dietary sources of Vitamin D are oily fish, margarines, follow on formula and some breakfast cereals- these foods all have vitamin D added to them. Vitamin D is also produced in the skin via sunlight.
The Department of Health recommends that all children under the age of 5 take a daily supplement of Vitamin D, A and C- e.g. Healthy Start vitamin drops.
If your family doesn't qualify for Healthy Start vitamin drops, there are a wide selection of children's vitamin supplements available. You should choose a known branded supplement which provides 7.5ug vitamin D per day.
All children under 5 should be given a daily supplement of 7.5ug Vitamin D.
Other less common nutrient deficiencies:
Surveys show an increasing number of toddlers have low levels of other nutrients because they are not eating well. Low intakes of vitamin B6, folic acid, calcium and zinc as well as iron are not uncommon in toddlers. If a toddler has generally poor eating habits it may be advisable to consider a multi vitamin and mineral supplement formulated for the under 5s.
Some toddlers don't eat enough foods which contain fibre such as fruits and vegetables, whole grain cereals like whole meal bread, brown rice or whole grain pasta. A diet low in fibre can cause constipation.
It's important not to over load toddlers with high fibre food, otherwise they become too full and can go off their food. As always it's all about balance.
If a toddler eats a low fibre cereal at breakfast they can have some whole grain pasta at lunch or a sandwich made with a mix of white and whole meal bread at tea time. Ideally, keep a mixture of whole grain cereal foods and refined (white) cereal foods and serve a variety. Vegetables and pulses can be added to sauces, soups and gravies to increase the fibre content ant fruit should be served as part of most desserts in nursery.
Toddlers with chronic constipation may be given mild laxatives and prescribed fibre supplements such as lactulose or fibregel by their GP.
Omega 3 fats:
In recent years diets have changed to contain more omega 6 fats and less omega 3 fats- this is partly because toddlers eat more omega 6 rich vegetable oils and spreads - a good thing to reduce saturated fat intake. However to balance the increase in omega 6 fats toddlers need to increase their intake of omega 3 fats- the best source of omega 3 fats is oily fish like salmon, mackerel, sardines pilchards and trout.
Ideally toddlers need to eat at least two servings of fish per week- one serving can be from white fish or canned tuna (canned tuna doesn't count as an oily fish) the other serving should be from oily fish. Fish is notoriously tricky to encourage toddlers to eat but our grub4life chefs have developed some really popular fish dishes which have become firm favourites in households across the country- have a look at www.grub4life.org.uk
Choosing the right oils can help increase omega 3 fats too. Olive oil and soya oil for dressings and rapeseed oil for cooking gives a good balance of omega 3 and 6 fats. Pure vegetable oil is usually (but not always) rapeseed oil.
For toddlers who do not eat any fish a toddler's omega 3 supplement may be necessary to balance their intake of fats.
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And more information and support at www.grub4life.org.uk