My name is Dr. Rohit Gowda. I’m a Paediatrician with special interest in Gastroenterology and Nutrition and work at the Maidstone and Tunbridge Wells Hospitals in the NHS and at Nuffield Health Tunbridge Wells Hospital (private practice). I’m keen to share my thoughts on some nutritional problems that I see in children in day to day clinical care and highlight some resources that may be beneficial for you.
There has been a worrying trend in childhood obesity in the UK. We have seen an increase in obesity nationwide. One in five children are overweight or obese in Reception year and one in three children are obese or overweight when they leave primary school (department of health statistics).
Adopting a healthy lifestyle from the onset is key. Children are likely to adopt the same eating and lifestyle patterns as their parents and hence its important for the whole family to take part. I would certainly recommend looking at the ‘Eat well guideʼ (pictured further below).
Exercise and eating together certainly enhances your overall fitness levels. I use in the clinic the WHO growth chart app. This tells you what the height and weight and BMI centiles are for your child and is a nice way of keeping track of things – something like an online red book.
I found the following links very helpful for parents with regard to nutrition and exercise:
♥ Department of Health UK Physical Activity Guidelines for ages 1 to 5 and 5 to 18 years old – which can be accessed HERE.
♥ Change 4 Life – fantastic website with receipes, charts and lots of practical tips – which can be accessed HERE.
♥ Start active, stay active inforgraphics on phycial activity for children – which can be accessed HERE.
Good eating habits develop with a consistent family approach. Encourage the child to eat the same foods as the rest of the family. As a guide for small children in general (1-5 years) but could also apply to a bigger child, they need the following:
1. A beaker of milk, small chunk of cheese and one yoghurt – (100 to 120 mg pot)
2. Meat, dhal, beans, eggs or fish at least twice a day
3. Fruit and veg – fresh, tinned, dried fruit or frozen with every meal
4. Starch at every meal (rice, pasta, potatoes, bread, chapatti, breakfast cereal)
5. At least one food containing iron (eggs, meat, oily fish, green veg, beans, cereals fortified with iron)
6. Vitamin C – helps absorb iron and can be included with foods that are rich in iron (green veg, diluted orange juice, blackcurrant, an orange or satsuma).
Fluids are also an important part of nutrition and hydration. For little ones as soon as possible, encourage them to drink from a cup as drinking from a bottle increases the risk of tooth decay. You can start your child on full fat milk after one year or semi-skimmed milk after 2 years if your child is eating a good mixed diet.
Water between meals is the best option. Restrict diluted and unsweetened juice to meal times to reduce the risk of tooth decay. Sweet and fizzy drinks including diet varieties can cause tooth decay and spoil the childʼs appetite. Do not give in a bottle. Do not give tea and coffee at mealtimes as they reduce the absorption of iron and do not add sugar to drinks.
Constipation is a common problem in toddlers and young children and I see a number of children who come to me having suffered with this problem for a long time. These children often require medications to help them but a lot of them do have issues with diet.
Fibre and fluid are important ingredients of our diet. They help to prevent development of hard stools and constipation. In children with established constipation dietary measures may not provide immediate benefits but help in the long term. Water at least 6-8 times per day is beneficial. Choose whole meal breakfast cereals like porridge, Weetabix, bran flakes, shredded wheat, Shreddies, or a mixture of these and cereals.
You could add fresh or dried fruit to cereals. Have plenty of vegetables and fruit with meals. Leave the skins on but wash thoroughly. I often use the Bristol Stool Chart in children to help identify problem poos and aid my management plans.
There is a trend towards dietary elimination in children, particularly toddlers who have symptoms like diarrhoea or tummy pains. Often a number of diets are trialled by desperate parents. These diets can be unhelpful and can put the parents under a lot of stress both physically and financially.
Before trialling any dietary elimination it is always best to seek advice from your doctor to ensure the elimination of food is done for the right reasons. If in doubt, the doctor can seek advice from a specialist. Most cases I see in young children are functional gut disorders where there is no significant dietary change required immediately and some of them may need investigations to rule out conditions like coeliac disease. In these patients there may be a delay in diagnosis if they have eliminated some foods.
I hope this information is helpful in answering some questions about childrenʼs nutrition and some common problems in childhood. Look forward to sharing some more of my thoughts in the future about other child health topics.
To find out more about children’s medical services at the Nuffield Tunbridge Wells Hospital, visit the website HERE.