Paediatric and Teenage Nutrition

food, feeding and nutrition

Tag: calcium

making mealtimes better

8th March 2023 / / 0 Comments
Making Mealtimes Better : Structure, Nurture & Boundaries

Accessible and full of sensible evidence-based information to support feeding young children well, Making Mealtimes Better is on-line workshop series is designed for parents/carers of young children with a variety of food-related behaviours. Delivered by Carine Henry RD, paediatric specialist dietitian, with 30 years of practical working with children and families, in areas of feeding difficulties, growth faltering and tummy troubles.

Making Mealtimes Better provides a space alongside others to listen, learn, share, practice and develop tools and select strategies to make every mealtime better. Carine uses themes of Structure, Nurture and Boundaries to guide topics including:

  • meeting your child’s nutritional needs : key nutrients and food groups
  • expanding food experience : where you are now, next steps and forward planning
  • giving right attention to food and feeding
  • learning to enjoy food and feeding : agency and satisfaction
  • awareness of how emotions impact food, feeding and nutrition, for both parents and child

Making Mealtimes Better is intended for children aged 18 months to 5 years whose nutritional wellbeing and growth may be compromised and/or where food-related behaviours are challenging eg.

  • food refusal, feeding aversion, food fears, feeding anxieties
  • prolonged difficulty with expanding to mixed textures of food
  • difficulty introducing new foods and & limited experience of a range of foods
  • highly selective eating and sensory difficulties
  • tantrums at the table, difficult feeding behaviours, battlegrounds with food

Mindful parenting is skill that can be developed through practice, and impacts both parents and children positively. Carine will be exploring themes with you around mindful approaches as they relates food, feeding, eating and nutrition.

overnight almond oats

Izzy’s Overnight Almond Oats

9th January 2020 / / 1 Comment

I really do get it – it’s hard to make time on a school morning to prepare a nutritious breakfast. My teenage daughter Izzy and I teamed up to produce this blog, after she developed this yummy recipe.  Izzy doing the creative part – great instagram photos and actual recipe development, and me doing the nutrient analysis with my dietetic book “The RSC Composition of Foods“.  Overnight Almond Oats are vegan, milk free, wheat free and  positively bursting with health giving nutrition.

It all started when we both decided to moooove away from cow’s milk for 2020.  We’re experimenting at the moment, trying various milk alternatives: oat, almond and soya are our favourites.  We haven’t yet tried the many different yoghurts like oat and coconut, but soya based yogurt with toasted almond tastes really great. So, look out for more delicious and nutritious recipes! If you are developing your own recipe ideas and selecting more vegan and milk/wheat free choices, don’t forget about calcium. It an absolute must!  Read the label of the milk or yoghurt you are buying, and if it doesn’t have calcium, then find one that does.  You bones will thanks you when you get to my age!  Or quite a bit before!!

Recipe for Overnight Almond Oats Calories Protein Calcium  Magnesium
150g

1 oz

1 teaspoon

1 handful

1 spoonful

Drizzle

Big pinch

 Almond Yoghurt

Porridge Oats

Ground almonds

Frozen raspberries

Almond Butter

Honey

Flaked toasted almonds

 81

112

35

12

97

14

10

 5.8

3.4

2

0.7

3.8

–

–

 180

15

15

12

36

–

4

 20

33

16

10

40

–

5
Totals 368kcals 15.7g 262mg 124mg
Method
  • Place all the ingredients into the cup, to create the layers of colour and yumminess, seal and refrigerate overnight.
  • Enjoy in the morning with no fuss, no rush and fantastic, fresh, energising nutrition for the whole morning.
Nutrition Notes
  • Dairy free, wheat free, vegan
  • Low in sugars, high in plant-based fats but moderate in overall calories
  • Keeps blood sugar levels steady with energy release from digesting complex carbohydrates in the oats and nuts, providing energy and focus throughout the morning
  • 33% daily needs for calcium, essential for bone strength and muscle function
  • 60% daily needs for magnesium, essential for energy metabolism and nervous system
  • Protein, potassium, vitamin C, and the B vitamin Folic Acid for getting your brain in gear
  • Last but not least, a good source of soluble and structural fibre @ 7.6g to keep your gut microbiome bugs happy and digestive system fighting fit

 

 

alternative milks

reintroducing lactose back into the diet

30th October 2019 / / 0 Comments

Following a 2 – 6 week low lactose diet to treat lactose intolerance, your child should now be well on their way to recovery from symptoms.  Reintroducing lactose back into the diet in a controlled way is the next step. Starting with low lactose foods, then adding in medium and, once you’re satisfied all is being tolerated, finally adding in high lactose-containing foods. Use the guidance below on lactose content of dairy foods to assist you, taking about 2-4 weeks, gradually increasing, will do several things:

  • stimulate production of lactase, the small intestinal digestive enzyme that digests lactose
  • help establish and then increase the amount of dietary lactose that is tolerated
  • assist in the build up and return of normal lactase production in the small intestine

Re-establishing tolerance to lactose
Re-establishing tolerance to lactose varies from child-to-child, depending on age, habitual diet and degree of severity. Because infants and young children are more dependent on a high milk diet, the lactase enzyme returns more readily and lactose intolerance is usually temporary.  Resumption of a normal diet is somewhere between 2-6 weeks for most infants and children. Referred to as secondary lactose intolerance this is often the result of nasty gut bugs like rotavirus, or can be secondary to small intestinal damage caused by untreated cow’s milk protein allergy or coeliac disease. Individuals including older children and teens may develop primary lactose intolerance or a permanent reduction in lactase enzyme, more typically affecting non-caucasian children and those with a habitually low milk/no milk intake following a similar route via infection of small intestinal irritation.  Amounts of 2 – 4g lactose per day are usually well tolerated despite the lack of lactase enzyme.  Instead lactose is digested by the lactobacillus bacteria, naturally residing in the large intestine.

Other points worth noting about lactose intolerance and reintroduction

Special care with infants
Formula fed babies with lactose intolerance, need a lactose free formula. Lactose intolerance may also occur in breast-fed babies but is less common; only in very rare congenital primary lactase deficiency would there be a need to stop breast feeding and use a lactose free formula. What is important, is to correctly identify if cow’s milk allergy are the cause of the symptoms, to ensure that infants get the right dietary treatment. Products in the shops vary enormously in nutritional composition, and are not suitable to drink because of poor nutritional quality.

Lactose content of dairy foods

Very Low Lactose

< 2g per portion

 Medium Lactose

2-4g per portion

 High Lactose

4-6g per portion
The foods in this group contain very low amounts of lactose and are tolerated by most people with lactose intolerance.  If consuming these foods does not give any symptoms, try medium lactose foods per portion. Continue to introduce lactose containing foods, including foods with medium lactose. If symptoms return, go back to the previous tolerated stage for 2 weeks and try again. In addition to very low and medium lactose content foods, continue to introduce lactose-containing foods, including one portion from the high lactose category.
Cheese 1oz
Most hard cheeses have very small amounts of lactose and are unusually well tolerated. Eg. cheddar, red leicester, caerphilly, stilton, parmasan Cheese spread, cottage cheese, soft cheeses eg. ricotta, marscapone, dolchelate Cheese spread, quark

 
Yoghurts & fromage-frais 60g 125g Larger portion
Greek yoghurt, Goat’s yogurt, all yoghurts and fromage-frais Yoghurts and fromage-frais, Low fat fruit yoghurts, Organic whole milk yoghurt Natural whole or fruit yoghurt, Low fat natural yoghurt, Diet/low calorie yoghurts
Dairy desserts & creams 2oz 4 – 6oz Larger portion
Half fat cream, Single, Double, Whipping, Clotted cream, UHT Spray Cream, Fresh Cheese Cake 1 scoop ice cream, Frozen cheesecake, Trifle with cream, 1 chocolate mousse 2 scoops ice cream, 10mls Angel Delight, 150g tinned rice pudding, 100mls Custard
Hidden milk
1 x small slice cake, 4 chocolate digestives, 1 chocolate coated biscuit eg. 2 finger kit-kat, 100g egg custard tart 1 milk chocolate bar, 125mls whole milk, 70mls evaporated milk, 1 tblsp skimmed milk powder, 40mls condensed milk

nutritional composition of milk alternatives

25th September 2019 / / 0 Comments

If you have a child who has lactose intolerance or cow’s milk allergy, chances are you need to think about the nutritional composition of milk alternatives. Cow’s milk and its products are good sources of calcium and trace elements like iodine in the UK diet.  As someone who takes nutrition seriously, a Paediatric Dietitian and mother of 3 growing teenagers, I would like to point out that the nutritional composition of milk alternatives available in our shops is shockingly poor.  It does not serve consumers well, has insufficient nutrition for infants, children or teens, and for those who depend on the nutrients milk would normally provide.  The missing nutrients and their physiological roles are as follows:

  • calcium – for growth and maintenance of strong bones, blood clotting
  • iodine – for neurological development during pregnancy, control of metabolism, thyroid function
  • Vitamin B2 – for healthy skin, eyes and nervous system, releasing energy from food
  • protein – for growth and repair of all body tissues, immune function
  • Vitamin B12 – assists in maturing red blood cells, absorption of iron
  • lactose – the milk sugar – food for the beneficial lactobacillus genus of bacteria, maintenance of a healthy intestinal microbiota

Exciting range of nut milks
I was quite excited to see such an explosion of nut milks now routinely available; and on researching this recently, felt somewhat aggrieved to see such poor nutritional composition.  Nuts are one of nature’s most incredibly nutritious foods – high in calories, protein, essential fats, minerals like zinc, calcium, iron and magnesium as well as B vitamins. They are also (currently) fairly conflict-free and sustainable. There are not many foods you can say that about! Unfortunately none – and yes I do actually mean NONE – of that goodness is retained in the resultant, washed out and expensive product marketed as milk.  Some have no calcium, no protein, no minerals no vitamins, and poor calories. Mil for mil they are 7 times the price.

Compare the nutritional composition of milk alternatives in the chart below, and take care to ensure that you choose ones with higher calories and protein for young children, ensuring they are fortified with calcium, and where possible Vitamin D and other vitamins.

Type of Milk Calories Protein Calcium Vitamin D Extras
Whole Cow’s Milk 69 3.3 120 Low Wide range of nutrients
Cow’s Milk formula 66 1.3 65 1.2 Full range of nutrients
Mature Breast Milk 67 1.3 35* Varies Wide range of nutrients
Goats Milk 70 2.8 120 Low Wide range of nutrients
Arla Lactose Free Milk 56 3.3 120 Low Wide range of nutrients
KoKo unsweetened 16 0.2 120 0.75 Nothing
Oatly Original 46 1.0 120 1.5 Vitamins
Innocent Hazelnut Milk 72 1.0 0 0 Nothing
Innocent Almond Milk 37 1.4 0 0 Nothing
Alpro Soya Original 42 3.3 120 0.75 Vitamins
Alpro Cashew Milk 23 0.5 120 0.75 Vitamins
Alpro Soya Growing-Up 1-3 64 2.5 120 1.5 Iodine, Vitamins
Rice Dream plus calcium 50 0.1 120 0.75 Not for <5years
  • absorption of calcium from breast milk is extremely efficient, but infants needs for calcium from 6-12 months through are high.  Check out  good sources of calcium if weaning your cow’s milk allergic infant.
treatment options in cow's milk allergy

treatment options for cow’s milk allergy

6th April 2018 / / 0 Comments

Treatment options for cow’s milk allergy is the 3rd in this 5-part blog series on non-IgE Cow’s Milk Allergy in Infancy and is best read following confirming a diagnosis of cow’s milk allergy.

 

Treatment options for cow’s milk allergy in infancy depend on the severity of symptoms and whether breast, formula or combination feeding is the preferred choice for parents.  An allergy focused clinical history taken by a GP or Paediatric Dietitian, will have the key information on which the best treatment options for cow’s milk allergy can be considered for both mum and baby.

Considerations

  • Breast feeding the cow’s milk allergic infant
  • Supplementary calcium, iodine and Vitamin D for mum
  • Advantages of continuing breast feeding for mum and baby
  • Alternative formulas for the cow’s milk allergic infant
  • First line prescription formulas
  • Symptoms requiring a more specialised formula

Breast feeding the cow’s milk allergic infant
Breast feeding can safely continue in the knowledge that it is protective for the allergic infant, with many advantages.  But it’s not without it’s challenges! Strict avoidance of all cow’s milk and it products, including the small amounts hidden in foods, will resolve the symptoms.  Mum needs to follow a well-balanced but strictly cow’s milk free diet at a time when her needs for nutrition are especially high. The widely available range of milks such as soya, oat, rice and nut milks are low in nutritional value and make a poor contribution to mums’ nutritional needs.  Mum needs to be committed and knowledgeable about her own needs.  For mums whose weight is low or who struggle to eat enough, or for mums who are having difficulty coping should seek further advice if they wish to continue breast feeding.  For babies with severe atopic eczema and poor weight gain, a formula milk should be considered.

Nutrition for mum and baby
Cow’s milk (and it’s products) are the principal source of calcium and iodine in UK diets, with needs increased during pregnancy and lactation by around 50-66%. Calcium is of central importance for women’s bone health and iodine for foetal and infant brain development and function.  Vitamin D is limited in foods but essential to ensure calcium is absorbed into bone and together with calcium and iodine should be taken in supplement form.

Breastfeeding Pros for baby Pros for mum
  • Improved immune development
  • Reduced incidence of ear, gut and respiratory infections
  • Enhanced tolerance to new foods
  • Enhanced taste development, facilitating broader weaning foods
  • Development of varied Microbiome, enhancing immune development
  • Bonding with baby
  • Helpful in return to pre-pregnancy weight
  • Reduction in breast cancer risk
  • Convenience and low cost
  • Bonding with baby

Alternative formulas for the cow’s milk allergic infant
Soya or goats milk formula are not recommended as treatment options for cow’s milk allergy in infants: 50 – 66% of infants will have immune reactions similar to those in cow’s milk allergy. Broadly, two types of formula are available as treatment options for cow’s milk allergy in infancy – peptide (EHF) or amino acid (AA).   The first treatment option is an extensively hydrolysed formula (EHF), in which the proteins are hydrolysed, “digested” or  broken down into short chains called peptides. The immune system does not recognise these peptides as cow’s milk protein in 90-95% of infants with non-IgE CMA, and the EHF is well tolerated.  There are a variety of EHF types and brands available on prescription, subtely suited to different needs, and is one area of a Paediatric Dietitian’s expertise.  Current EHF formulas are available with or without lactose (the milk sugar); casein (curds) or whey based protein; first or second (follow-on) milks with added iron and calcium.  Lactose has the advantage of making the formula taste better, but may not be well tolerated in infants with delayed diagnosis. Whey based formulas tend to empty from a baby’s tummy more quickly and may help improve symptoms of reflux. Second or follow-on milks are only suited for babies over 6 months.

Symptoms requiring a more specialised formula
For infants who develop symptoms of cow’s milk allergy during exclusive breast feeding, have severe symptoms or who are symptomatic following a 2-4 week trial on an EHF, an amino acid formula (AA) is indicated.  Proteins in this type of formula are further broken down from peptide chains into individual units called amino acids and are well tolerated by almost all infants.  As an expensive option (£30 per tin) careful consideration is given to its prescription.

Next Positive Outcomes for Cow’s Milk Allergy

a spoonful of sugar helps the porridge go down

26th September 2017 / / 0 Comments

I am now thinking about sugar in teaspoons; I am thinking 5 a day. Adults should be consuming a maximum of 30g added sugar per day, (and children 19-24g) so it depends on the size of your teaspoon; mine is quite big at 6g. A typical level spoonful is 4g; so is a sachet or a cube. A larger teaspoon or heaped is about 6g. Naturally occurring sugars are found in milk, whole fruits and vegetables and are not counted as added sugars. Added sugars are those added at home or by the manufacturer as well as those present in honey, fruit juices and syrups.

I want to keep added sugar within limits, know how much I have and of course I want to enjoy my food. Strangely, thinking in teaspoons of sugar helps me to think more positively about added sugar.

This nutritional calculation, comparing a luxury bowl of porridge to a typical sugar-ladden snack shows similar calories but very different amounts of added sugar. Perhaps it’s my Scottish roots, but I eat porridge quite often, especially when I need to be focused and work through the afternoon without feeling hungry.  Sounds dull and uninteresting? Ring the changes with some essential indulgence. This is my creamed porridge with raspberries recipe containing 1 teaspoon of added sugar.

   

Add 100mls water and 240mls whole milk to a small pot over the heat
Add 40g porridge oats and bring to the boil, then simmer for 5 minutes, stir occassionally
Pour into a bowl to cool; add a handful of frozen raspberries – pushing them into the hot porridge
Sprinkle 1 teaspoon Demerara sugar and let it melt
Drizzle 1 spoonful of double cream. YUMMY!


Nutrition Facts per portion
Creamed porridge with raspberries Can classic coke (330mls) and Snickers Bar (48g)
Calories 385kcals 384kcals
Protein 12g 4.5g
Total sugars 21g 33g
of which added 5g (1 teaspoon) 28g (> 5 teaspoons)
Fat 16g 13g
Calcium 300mg 47mg

You can see that all calories are not equal! There is similar calorie content but 5 times the amount of added sugar.  Total sugar in the porridge comes from naturally occurring sugars: lactose in the milk (11g) and fructose in the raspberries (5g).  More than twice the amount of protein, and lots of slow release carbohydrates help feelings of fullness for longer.  No sugar high – and no sugar slump!  With 6 times the amount of calcium at 300mg,  a 30% contribution to a teenagers daily needs for this essential  mineral. Oh yes, and it’s healthy for the skin, the digestive system and the brain; providing soluble fibre, prebiotics and slow-release energy for many hours.

 

calcium and vitamin D in teens

8th June 2016 / / 0 Comments

The calcium and vitamin D combination is one of the most important vitamin and mineral duos for teenage nutrition. All teens need a good supply of calcium as their bones increase in density long after they have stopped growing in length. Vitamin D plays its part by regulating the absorption of calcium from the gut. Functioning similarly to a hormone, vitamin D receives information about how much bone is needed and determines how much calcium to deliver to the skeleton to make bone.  This happens for existing bone, making it stronger and denser with the additional calcium, and also for new bone as existing bones lengthen during pubertal growth spurts.

Dietary sources of vitamin D only contribute about 5% of overall needs; the rest being manufactured on the skin’s surface by the action of UV light from the sun.  Vitamin D is then absorbed through the skin, stored in the liver, and then converted into an active form of Vitamin D by the kidney, ready for action in the gut.  

Boys generally need more calcium than girls and are also more likely to have lower circulating levels of vitamin D. Calcium needs for girls are around 800mg and boys around 1000mg. Habitual lower intakes of calcium cause the intestine to up-regulate its absorption, provided there is enough vitamin D, and so calcium is only half the picture to promote strong bones.  In the UK , where the sunlight is low for at least half the year, the general population is at risk of vitamin D deficiency.  A supplement of 25ug/micrograms (or 1000 international units) of Vitamin D for 6 months of the year – during late autumn/winter/early-spring – helps to ensure bones continue to mineralise during this super-growth period. Teens who eat a poorly planned vegan diet may consider a calcium and vitamin D supplement.

Calcium needs can be met by 4 – 5 servings of dairy products each day.  For kids who don’t eat dairy, fortified soya products, nuts and seeds are good choices.  For well-rounded nutrition, a mix of different types of calcium rich foods is best.  

Good Sources of Calcium

Portion               Food                                            Calcium (mg)
200mls cow’s milk 230
200mls soya milk 240
150g natural yoghurt 300
150g fruit yoghurt 240
30g cheddar cheese 200
30g soya cheese 125
2 tinned pilchards 330
4 tinned sardines 460
120g tinned salmon 105
1 tsp tahini (sesame seeds) 135
30g almonds 65
10 apricots 75
1 dried fig 50
90g spinach 145
3 tbls baked beans 70
portion broccoli 35
portion spring greens 65
1 slice white bread 30
1 slice wholemeal bread 20

Source “The Composition of Foods” 5th Ed; McCance & Widdowson; Royal Society of Chemistry

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