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Are your children eating the right foods for good nutrition?

Eating problems is a huge issue for almost all parents. Some have kids who don't want to eat; others say their kids only want to eat junk food; and others say the problem is the children are not eating their vegetables.

Then there are the other issues – taking two hours to finish a meal, only eating if there is some form of “entertainment” and even overeating.

Paediatrician Dr Yeoh Seen Hun answers some common questions:

What can parents do if their child is not eating?

It depends on the reason that they are not eating. Most of the time they might just not like the taste of the food the parents prepare. Sometimes it's due to the parents' approach to feeding. For example, most adults know that a high fibre diet of vegetables is good for children. Unfortunately, because of the taste, children don't really like it. Asian parents are more anxious and tend to force their children to eat or make them eat large portions.

That is a common problem that we encounter.

Most of the time children prefer something with a stronger taste like junk food and carbonated drinks. When they get used to this they tend to dislike a good healthy diet.

To prevent this, parents have a very important role in the sense that they should show a good example. They themselves shouldn't buy snacks when watching movies or eat it when watching TV.

With children, it's very simple. If they are active and running around, they sleep well, they don't fall ill very often, that means they are healthy. If you have seen the growth chart, you'll notice the child's growth is not in a linear line. At certain stages their growth slows down.

The growth chart is just a tool to guide us on whether the child is growing accordingly. Doctors would look at the child as a whole – how is the muscle bulk, fat tissue and development. All this will count to assess whether they have adequate nutrition.

At certain ages, sometimes they can be very picky. If you just take it lightly and keep trying, most of the time they will take the food.

Another common misconception is that children must have a certain portion of food. Parents forget that children are small and do not eat as much as adults. Hopefully they take just one quarter of what we usually take. Sometimes we think they need to eat more when they don't really need it.

If you are worried that they will be hungry if they're not eating enough during meals, then give them nutritious snacks in between like cereal crackers or fruits which is a healthy diet for them as well.

Children are usually very simple and follow their instincts, especially babies.

When they are hungry they will cry. When they are satisfied feeding they will stop sucking because they are full.

You don't have to strictly follow a routine of feeding them every three hours. That doesn't work because once they are full they will just stop sucking. It's the same with toddlers and bigger children. Often, when they are full they will stop eating.

Does having a routine help?

Routine and discipline works for older children and adults but for smaller children we have to be opportunistic. We can't say 'okay today we must have three portions of vegies, two portions of cereal, one portion of fat and follow that strictly. That doesn't work.

A schedule is important when it comes to meal times. For example, during dinner time it's very important that the whole family sits down together, switch off the TV and don't have any quarrelling or fighting at the table. Also, don't bring along toys to the table as that will certainly distract them. It's not advisable.

When you take it as a routine, for example, dinner is always at 7pm … sooner or later they will get used to eating at the scheduled times.

Try to feed them at a particular time every day so they get familiar with the timing.

But that doesn't mean that when they don't follow you get stressed up and force them to sit quietly. Just give them a portion of food and let them try it themselves. If they can't finish it just take it away. Don't pressure them. Try again another day.

How do you introduce new food?

If parents want to introduce vegetables, for example, they have to start slowly and in small portions even though we know that having large portions is good. Sometimes we cannot strictly stick to the rules. For example, if you serve them that portion and they can't finish it, then take it away. Don't get angry or force them to eat. That doesn't work. They will feel stressed out and in the end they will just run away whenever they see that vegetable.

The way to introduce new food to your child is to keep trying. Some parents say it takes 10-15 attempts before they succeed.
Dr Yeoh: 'The trick is to start slowly and with small portions and give them a variety.'
The trick is to start slowly and with small portions and give them a variety. You never know; they may not like the taste of some of the ingredients in the food. If you mix all sorts of vegetables together, they may refuse to take it completely just because of one ingredient.

Try a little bit today. If they refuse to eat it today, you can try a day later or a week later.

Sometimes you have to change the way you prepare the food. Parents have to be creative, maybe make a face using the carrot sticks. Don't scold the child for being picky. Parents themselves have to change the way they cook that vegetable or find some new recipes. It can be steamed or fried – there can be many ways of food preparation.

Sometimes, even children are scared to try something new. At the first attempt they may not like it but if you try again and again, they may finally accept it.

Even if they don't accept it, there are so many other vegetables to try.

Is it okay for children to have cookies and candy?

Cookies and candy tend to have higher sugar content. It's okay to give children this occasionally, once every 1-2 days, not more often than that.

You should always try to cut down on foods that are high in sugar and salt like crisps and some juices.

Some people mistakenly think that the juice we get from the supermarket is good. Unfortunately most of these fruit juices are high in colouring and flavouring.

So, parents should try to make fruit juice freshly themselves rather than buying the versions from the supermarket with the additives and colouring.

Does a child become more active if he or she takes a lot of sugar?

Sugar doesn't really make children more hyper but it makes them predisposed to the future risk of getting diabetes.

While diabetes is observed in adults, the individual's eating habits from childhood does play a role.

It's also genetic so it's not just based on the diet.

How about junk food? Is it okay in moderation?

There have been studies about junk food and colouring and how it affects the child's development. There is a tendency to correlate the two. It's not clearly proven but there is some evidence or observations that they may be related.

So junk food and those with colouring should be avoided.

What should parents do about children who chew a long time and those who chew and spit out their food?

If they are taking a long time to chew, it could be that they are just not paying attention; they are playing with their food. In which case, remove the distractions – TV and toys – from the dinner table.

There are a few possibilities for those who chew and then spit out the food. Sometimes the portion is too large and they just can't swallow it or they are scared of swallowing. Or maybe the texture is a bit coarse.

Or if they spit it out it could be that they don't really like the taste.

Some parents say that usually this problem will go away in a few weeks without you doing much.

Others say it's better to avoid giving the child those foods for a while. When they reintroduce that food again a few weeks later, the problem is no longer there.

It's possibly just a transient behaviour.

There's no clear conclusion but the observation is that it tends to be temporary.

How about babies who regurgitate the milk?

Regurgitation of milk by babies is just the flowing of the milk from the stomach to the mouth without forceful throwing up.

That is a common condition observed in babies two months and younger. It has been found that about 90% of babies regurgitate the milk at least once a day for the first month.

It's just a small amount and it's normal.

It only becomes alarming if it happens at every feed, during the feed, or even in between feeds. Sometimes the baby might even have a choking sensation.

If the baby just cries or coughs all of a sudden without any obvious reason because of the reflux and feeling of heartburn then that is the time we should suspect something is wrong.

If it's a simple mild regurgitation, parents can just change to smaller amounts of milk but have more frequent feeds.

For babies, the stomach muscles are still a bit lax and so they tend to regurgitate. This will improve over time as they get older.

One measure to avoid this is to give them smaller feeds so that the stomach is not so distended but at the same time you can compensate by giving them more frequent feeds.

For example, if you are giving your baby 3oz every three hours, you can actually cut it down to 2oz every two hours. So the total amount of milk they get throughout the day is still the same but this way their stomach won't be so distended and they won't regurgitate so easily.

Other ways to minimise baby's regurgitation is to not let him lie flat after feeding. Hold him for a while, keep him upright for about 5-10 minutes before lying him down.

What is the latest time children should have their dinner?

There is no fixed time for dinner but usually we try to avoid feeding them immediately before sleep.

Whatever they have eaten, they need time to digest it. If they take food just before sleeping it tends to be converted to fat and it contributes to weight gain.

It's also not good to have milk or fruit juice just before sleeping because even fruit juice has sugar content.

For older children you can give them a small snack if they are still hungry after dinner but make sure it's about 2-3 hours before they go to sleep.

Is it true that proper nutrition improves their IQ?

If they don't get proper nutrition it may affect their IQ and their concentration.

If you go through the advertisements for formula milk you will find claims of it improving the child's IQ. Actually that is just a small portion of the IQ improvement or development. It shouldn't be taken too seriously and parents should not spend so much of money on milk.

If you don't give tactile, verbal or play stimulation then it won't matter what formula milk you give your baby - they are not going to be smarter than any other children.

The formula milk contributes just a small portion to the child's IQ development. Don't waste money on that.

Breast milk is still the best milk.

Is obesity a problem for Malaysian children?

It seems to be a trend that our children are getting more obese. Unfortunately, most of the time parents are busy working and children are put in front of the TV which is the most convenient way of keeping them quiet. That is one way that children become obese. Some children just sit in front of the TV for 2-3 hours every day. Or they are busy playing computer games. So, they don't do much physical activities.

Additionally, during TV time they have snacks or junk food. That will cause obesity.

There is no easy way to solve this problem unless the parents are willing to spend more time taking them out for a walk, or accompanying them to play sports.

It's important that the whole family puts in the effort. If you ask children not to eat junk food but you are not exhibiting a good example, then how can you expect your child to follow what you say?

In such cases, at least try to keep their weight static as they are growing taller so that they will go back to the normal range for their height and age.

Is using food as a reward a contributing factor to obesity?

Try not to make food a reward. For example, telling them that if they do their homework or listen to you, then you will take them for their favourite fast food. Or if they eat their vegetables, you will give them a chocolate bar. It defeats the purpose of giving them vegetables.

If you do this, they will always think that chocolate and fast food are rewards or good things and they will think of vegetables as the bad things in life.

In future, if there is no reward, they won't eat their vegetables.

Some parents think that their child's baby fat will go away when he or she grows up. Is this true?

Baby fat will go away once the child starts walking and running but not for all children. If the child starts out life being overweight, they tend to be overweight later in life, too.

It could be because of genetics. But it could also be the feeding behaviour. Sometimes parents try to lengthen the interval in between feeds by feeding the child a little bit later. But that may not be a good way of feeding because when you starve them they get very hungry so when you do feed them they tend to take more than they need to take.

That is not a good and healthy way of eating. You need to change the diet and the eating habits and not just cut down the volume. Exercising is also very important.

What about children who love to eat everything? Isn't it good that they want to try everything?

You may have a child who likes to eat everything but that doesn't mean you have to feed him everything. If your child is used to a heavy meal and their stomach is distended all the time, then they won't be satisfied so easily and they keep on adding food and they must have that distended stomach feeling to be satisfied.

So they keep eating more and more and they get bigger and bigger.

There is evidence that shows that if people are obese at childhood they tend to be obese when they are adults and they have a higher risk of getting diabetes, hypertension and heart disease. If we want to prevent all these chronic diseases it should start from the time they are small.

Some parents give their children a glass of water before a meal so that they will feel full and won't eat as much. Does this work?

It doesn't really work that well because they will ask for more food very soon; sooner than usual. Instead of doing that, you might as well give them something high in fibre and low in calories like fruits and vegetables. That will certainly help, rather than giving them plain water.

For babies who are being breastfed or drinking formula milk, they are already getting the adequate water requirement just from the breast milk or formula milk. So it's not necessary for them to have water.

It's only when they start to take solids that you should give them water. How much of water they need depends on what their diet consists of. If they are taking diluted porridge, there is a lot of water in there. So they might be getting adequate water from the porridge. Of course, in between just give them some plain water and that should be fine.

When should parents start their child on semi-solids and then solids?

Usually we recommend weaning from six months because that's when the swallowing co-ordination is better so they tend to tolerate solids better. To start with, choose some baby cereal which is easy for them to swallow. Start with more caution. Just put a little bit on the tip of a spoon and let them taste it.

If they keep on thrusting their tongue and they don't seem to know how to swallow, probably they are not ready yet. If they are able to swallow it easily that means that they are quite good at taking the semi-solid and that's the time to start introducing it into their diet.

Start with small portions which are more diluted and then move on to bigger portions which are more concentrated. That's the way of slow progress until after one to two years when they start to take rice just like adults.

Is it okay to give children spicy food?

Some people say that spicy food boosts the body's immunity. Others say it causes gastric. I think a little bit of spice in our diet shouldn't be a problem, but not for small children.

Don't get the wrong idea that just because you like sambal your children should also be eating sambal from small. No. Let them try it when they are a bit bigger but too much spicy food will also cause diarrhoea and stomach upset. So be careful not to give them too much.

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